Dutta Debnarayan, Jose Meenu, Kalavagunta Sruthi, Sasidharan Ajay, Nair Haridas, Edappattu Annex H
Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Department of Medical Physics, Amrita Institute of Medical Science, Kochi, Kerala, India.
Radiat Oncol J. 2024 Mar;42(1):32-42. doi: 10.3857/roj.2023.00542. Epub 2024 Jan 23.
Retrospective audit of recurrent glioma patients treated by different fractionation schedules and to validate the modified Combs prognostic score in Indian patient cohort.
Between Jan 2009 and June 2022, 66 recurrent gliomas patients treated with standard adjuvant treatment-radiation (RT) ± temozolomide (chemotherapy)-and re-treated with RT (±chemotherapy) were categorized as per modified Combs prognostic criteria and outcomes were compared.
Sixty-six patients with recurrent gliomas who received reirradiation (re-RT) were audited-53% males; 61% Karnofsky performance status (KPS) ≥80 at time of re-RT; median age 41.5 years (range, 6 to 70 years); 67% <50 years; primary histology low-grade glioma in 33% ; grade III 27%, grade IV 40%; initial median dose of 60 Gy equivalent dose in 2 Gy fractions EQD2; maximum safe resection at recurrence 41%; mean and median follow-up 78 ± 51 months and 66 months. Mean time interval between RT was 46.4 ± 39 months. Mean planning target volume (PTV) volume in conventional RT (Conv-RT), hypofractionated RT (Hypo-RT), and ultra-hypofractionated RT (UF-RT) was 226.1 ± 140.7 mL, 162.8 ± 123.3 mL, and 143.3 ± 145.8 mL. Mean dose for Conv-RT, Hypo-RT, and UF-RT was 50 Gy (range, 40 to 60), 31 Gy (range, 20 to 40), and 20 Gy (range, 10 to 30). Mean overall survival (OS) in Conv-RT, Hypo-RT, and UF-RT cohort was 18.8 months (range, 2.4 to 76.8); 6.6 months (range, 2 to 17.4), and 13.9 months (range, 3 to 131.9). Median OS as per Combs criteria were 16.6 months (Group a), 24.6 months (Group b), 4.6 months (Group c), and 3 months (Group d). Significant survival benefit was with good KPS score (KPS >80 vs. <80; 20.46 vs. 5.25 months; p < 0.001), patients receiving salvage chemotherapy (20.46 vs. 6.96 months; p = 0.001), and patients received re-RT biological equivalent dose BED3 >80 Gy (16.62 vs. 5.48 months; p = 0.03). Median OS in our patient cohort and Combs cohort in Group a was 16.6 and 19.5 months; Group b was 24.6 and 11.3 months; Group c was 4.7 and 8.1 months, and Group d was 2 and 5.5 months, respectively. Six months survival in our patient cohort and Combs cohort in Groups a, b, c, d were 100%, 92%, 34%, 17% and 94%, 79%, 70%, 41%, respectively. Twelve months survival in our patient cohort and Combs cohort in Groups a, b, c, d were 88%, 74%, 22%, 0% and 88%, 47%, 22%, 7%, respectively.
Modified Combs prognostic factors predicts OS and is applicable in Indian subcontinent patient population.
对采用不同分割方案治疗的复发性胶质瘤患者进行回顾性审计，并在印度患者队列中验证改良的Combs预后评分。
2009年1月至2022年6月期间，66例接受标准辅助治疗（放疗±替莫唑胺化疗）且复发后再次接受放疗（±化疗）的复发性胶质瘤患者，根据改良的Combs预后标准进行分类，并比较其预后。
对66例接受再程放疗（re-RT）的复发性胶质瘤患者进行了审计，其中男性占53%；再程放疗时61%的患者卡氏功能状态（KPS）≥80；中位年龄41.5岁（范围6至70岁）；67%的患者年龄<50岁；33%的患者原发性组织学类型为低级别胶质瘤，27%为III级，40%为IV级；初始中位剂量为60 Gy等效剂量（2 Gy分割）；复发时最大安全切除率为41%；平均和中位随访时间分别为78±51个月和66个月。放疗之间的平均时间间隔为46.4±39个月。常规放疗（Conv-RT）、大分割放疗（Hypo-RT）和超分割放疗（UF-RT）中的平均计划靶体积（PTV）分别为226.1±140.7 mL、162.8±123.3 mL和143.3±145.8 mL。Conv-RT、Hypo-RT和UF-RT的平均剂量分别为50 Gy（范围40至60）、31 Gy（范围20至40）和20 Gy（范围10至30）。Conv-RT、Hypo-RT和UF-RT队列中的平均总生存期（OS）分别为18.8个月（范围2.4至76.8）、6.6个月（范围2至17.4）和13.9个月（范围3至131.9）。根据Combs标准，中位总生存期在a组为16.6个月，b组为24.6个月，c组为4.6个月，d组为3个月。良好的KPS评分（KPS>80 vs.<80；20.46 vs.5.25个月；p<0.001）、接受挽救性化疗的患者（20.46 vs.6.96个月；p = 0.001）以及接受再程放疗生物等效剂量BED3>80 Gy的患者（16.62 vs.5.48个月；p = 0.03）具有显著的生存获益。我们患者队列和Combs队列中a组的中位总生存期分别为16.6个月和19.5个月；b组分别为24.6个月和11.3个月；c组分别为4.7个月和8.1个月；d组分别为2个月和5.5个月。我们患者队列和Combs队列中a、b、c、d组的6个月生存率分别为100%、92%、34%、17%和94%、79%、70%、41%。我们患者队列和Combs队列中a、b、c、d组的12个月生存率分别为88%、74%、22%、0%和88%、47%、22%、7%。
改良的Combs预后因素可预测总生存期，适用于印度次大陆的患者群体。
