Mun So Hwa, Jang Hong Seok, Choi Byung Ok, Kim Shin Woo, Song Jin-Ho
Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Radiat Oncol J. 2024 Sep;42(3):218-227. doi: 10.3857/roj.2024.00381. Epub 2024 Sep 26.
To evaluate recurrence patterns of and survival outcomes in glioblastoma treated with intensity-modulated radiation therapy (IMRT) versus three-dimensional conformal radiation therapy (3D-CRT).
We retrospectively examined 91 patients with glioblastoma treated with either IMRT (n = 60) or 3D-CRT (n = 31) between January 2013 and December 2019. Magnetic resonance imaging showing tumor recurrence and planning computed tomography scans were fused for analyzing recurrence patterns categorized as in-field, marginal, and out-of-field based on their relation to the initial radiation field.
The median overall survival (OS) was 18.9 months, with no significant difference between the groups. The median progression-free survival (PFS) was 9.4 months, with no significant difference between the groups. Patients who underwent gross total resection (GTR) had higher OS and PFS than those who underwent less extensive surgery. Among 78 relapse cases, 67 were of in-field; 5, marginal; and 19, out-of-field recurrence. Among 3D-CRT-treated cases, 24 were of in-field; 1, marginal; and 9, out-of-field recurrence. Among IMRT-treated cases, 43 were of in-field; 4, marginal; and 10, out-of-field recurrence. In partial tumor removal or biopsy cases, out-of-field recurrence was less frequent in the IMRT (16.2%) than in the 3D-CRT (36.3%) group, with marginal significance (p = 0.079).
IMRT and 3D-CRT effectively managed glioblastoma with no significant differences in OS and PFS. The survival benefit with GTR underscored the importance of maximal surgical resection. The reduced rate of out-of-field recurrence in IMRT-treated patients with partial resection highlights its potential utility in cases with unfeasible complete tumor removal.
评估调强放射治疗（IMRT）与三维适形放射治疗（3D-CRT）治疗胶质母细胞瘤的复发模式和生存结果。
我们回顾性研究了2013年1月至2019年12月期间接受IMRT（n = 60）或3D-CRT（n = 31）治疗的91例胶质母细胞瘤患者。将显示肿瘤复发的磁共振成像与计划计算机断层扫描融合，以分析根据其与初始放射野的关系分为野内、边缘和野外的复发模式。
中位总生存期（OS）为18.9个月，两组之间无显著差异。中位无进展生存期（PFS）为9.4个月，两组之间无显著差异。接受全切除（GTR）的患者的OS和PFS高于接受手术范围较小的患者。在78例复发病例中，67例为野内复发；5例为边缘复发；19例为野外复发。在接受3D-CRT治疗的病例中，24例为野内复发；1例为边缘复发；9例为野外复发。在接受IMRT治疗的病例中，43例为野内复发；4例为边缘复发；10例为野外复发。在部分肿瘤切除或活检病例中，IMRT组（16.2%）的野外复发频率低于3D-CRT组（36.3%），具有边缘显著性（p = 0.079）。
IMRT和3D-CRT有效治疗了胶质母细胞瘤，OS和PFS无显著差异。GTR带来的生存益处强调了最大程度手术切除的重要性。IMRT治疗的部分切除患者野外复发率降低，突出了其在无法进行完整肿瘤切除的病例中的潜在效用。
