Kim Nalee, Shin Hyunju, Lim Do Hoon, Nam Do-Hyun, Lee Jung-Il, Seol Ho Jun, Kong Doo-Sik, Choi Jung Won, Chong Kyuha, Lee Won Jae
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
Department of Neurosurgery, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
Cancers (Basel). 2023 Dec 21;16(1):64. doi: 10.3390/cancers16010064.
For high-grade glioma (HGG) patients with old age or poor performance status, hypofractionated radiotherapy (hypoRT) in 10-15 fractions is recommended. Also, limited data exist on the impact of salvage treatment after progression in frail patients. We retrospectively analyzed the outcomes of dose-escalated hypoRT in 40 frail HGG patients who were treated with hypoRT between 2013 and 2021. With a median biologically effective dose of 71.7 Gy, a total dose of 56 Gy in 20 fractions was the most frequently used regimen (53.7%). The median age and Karnofsky Performance Status of patients were 74 years and 70, respectively. Most patients ( = 31, 77.5%) were diagnosed with glioblastoma, IDH-wildtype, CNS WHO grade 4. Only 10 (25.0%) patients underwent surgical resection, and 28 (70.0%) patients received concurrent temozolomide during hypoRT. With a median follow-up of 9.7 months, the median overall survival (OS) was 12.2 months. Of the 30 (75.0%) patients with disease progression, only 12 patients received salvage treatment. The OS after progression differed significantly depending on salvage treatment (median OS, 9.6 vs. 4.6 months, = 0.032). Dose-escalated hypoRT in 20 fractions produced survival outcomes outperforming historical data for frail patients.
对于老年或身体状况较差的高级别胶质瘤（HGG）患者，推荐采用10 - 15次分割的低分割放疗（hypoRT）。此外，关于体弱患者病情进展后挽救治疗的影响，现有数据有限。我们回顾性分析了2013年至2021年间接受低分割放疗的40例体弱HGG患者剂量递增低分割放疗的结果。生物等效剂量中位数为71.7 Gy，最常用的方案是20次分割总剂量56 Gy（53.7%）。患者的年龄中位数和卡氏评分分别为74岁和70分。大多数患者（n = 31，77.5%）被诊断为胶质母细胞瘤，异柠檬酸脱氢酶（IDH）野生型，世界卫生组织（CNS WHO）4级。只有10例（25.0%）患者接受了手术切除，28例（70.0%）患者在低分割放疗期间接受了同步替莫唑胺治疗。中位随访时间为9.7个月，中位总生存期（OS）为12.2个月。在30例（75.0%）病情进展的患者中，只有12例患者接受了挽救治疗。进展后的总生存期因挽救治疗而有显著差异（中位总生存期，9.6个月对4.6个月，P = 0.032）。20次分割的剂量递增低分割放疗产生的生存结果优于体弱患者的历史数据。
