Sivas Cumhuriyet University Faculty of Medicine, Department of Radiation Oncology, Sivas, Türkiye.
Turk Neurosurg. 2024;34(5):809-818. doi: 10.5137/1019-5149.JTN.44460-23.2.
To evaluate survival and prognostic factors associated with survival among patients who underwent reirradiation for recurrent/ progressive primary brain tumors.
A multicenter, retrospective study (7 centers, N=236) was conducted by the Neuro-oncology Group of the Turkish Radiation Oncology Association.
Median overall survival (OS) was 11 months and 1- and 2-year survival rates were 48% and 22%, respectively. Survival was negatively correlated with cumulative biologically effective dose (BED10) (r=-0.158, p=0.016) and cumulative equivalent dose in 2-Gy fractions (EQD2) (r=-0.158, p=0.016). In univariate analysis, survival was associated with performance status (p < 0.001), histopathology at diagnosis and recurrence (p < 0.001), radiotherapy (RT) method used for recurrence (p=0.025), tumor volume at recurrence (p=0.014), cumulative EQD2 ( < 110 vs. ≥110 Gy, p=0.038), and cumulative BED10 ( < 130 vs. ≥130 Gy, p=0.022). In multivariate analysis, tumor volume at recurrence (HR=1.68, 95% CI=1.06-2.64, p=0.025), Karnofsky Performance Status score (HR=5.7, 95% CI=3.26-9.98, p < 0.001), and histopathology at recurrence (glioblastoma vs. high-grade glioma: HR=0.48, 95% CI=0.26-0.88, p=0.019; glioblastoma vs. low-grade glial tumor: HR=0.16, 95% CI=0.08-0.34, p < 0.001) were found to be independent prognostic factors. Radionecrosis was detected in 25% (n=58) of the patients. Re-resection was associated with a higher rate of radionecrosis (37.7% vs. 18%, p=0.002).
The prognostic factors most strongly associated with survival in glioma patients undergoing reirradiation were Karnofsky Performance Status score below 70, glioblastoma histopathology, and tumor volume greater than 4.5 cm3. In addition, survival time was negatively correlated with cumulative EQD2 and BED10. The rate of radionecrosis was higher in patients who underwent re-resection compared those who did not.
评估接受复发性/进展性原发性脑肿瘤再放疗患者的生存情况和相关预后因素。
由土耳其放射肿瘤学会神经肿瘤学组进行了一项多中心回顾性研究（7 个中心，N=236）。
中位总生存期（OS）为 11 个月，1 年和 2 年生存率分别为 48%和 22%。生存与累积生物有效剂量（BED10）（r=-0.158，p=0.016）和 2-Gy 分数等效剂量（EQD2）（r=-0.158，p=0.016）呈负相关。单因素分析显示，生存与表现状态（p<0.001）、诊断和复发时的组织病理学（p<0.001）、用于复发的放射治疗（RT）方法（p=0.025）、复发时的肿瘤体积（p=0.014）、累积 EQD2（<110 与≥110 Gy，p=0.038）和累积 BED10（<130 与≥130 Gy，p=0.022）有关。多因素分析显示，复发时的肿瘤体积（HR=1.68，95%CI=1.06-2.64，p=0.025）、卡氏功能状态评分（HR=5.7，95%CI=3.26-9.98，p<0.001）和复发时的组织病理学（胶质母细胞瘤与高级别胶质瘤：HR=0.48，95%CI=0.26-0.88，p=0.019；胶质母细胞瘤与低级别神经胶质瘤：HR=0.16，95%CI=0.08-0.34，p<0.001）是独立的预后因素。25%（n=58）的患者检测到放射性坏死。再次切除与放射性坏死发生率较高相关（37.7%与 18%，p=0.002）。
在接受再放疗的胶质瘤患者中，与生存最密切相关的预后因素是卡氏功能状态评分低于 70、胶质母细胞瘤组织病理学和肿瘤体积大于 4.5 cm3。此外，生存时间与累积 EQD2 和 BED10 呈负相关。与未行再次切除的患者相比，再次切除的患者放射性坏死发生率更高。
