立体定向放射外科治疗世界卫生组织2级和3级少突胶质细胞瘤：一项国际多中心研究
Stereotactic Radiosurgery for World Health Organization Grade 2 and 3 Oligodendroglioma: An International Multicenter Study.
作者信息
Langlois Anne-Marie, Iorio-Morin Christian, Kallos Justiss, Niranjan Ajay, Lunsford L Dade, Peker Selcuk, Samanci Yavuz, Park David J, Barnett Gene H, Liscak Roman, Simonova Gabriela, Pikis Stylianos, Mantziaris Georgios, Sheehan Jason, Lee Cheng-Chia, Yang Huai-Che, Bowden Greg N, Mathieu David
机构信息
Department of Surgery, Division of Neurosurgery, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke , Québec , Canada.
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA.
出版信息
Neurosurgery. 2025 Apr 1;96(4):870-880. doi: 10.1227/neu.0000000000003177. Epub 2024 Sep 20.
BACKGROUND AND OBJECTIVES
Oligodendrogliomas are primary brain tumors classified as isocitrate deshydrogenase-mutant and 1p19q codeleted in the 2021 World Health Organization Classification of central nervous system tumors. Surgical resection, radiotherapy, and chemotherapy are well-established management options for these tumors. Few studies have evaluated the efficacy of stereotactic radiosurgery (SRS) for oligodendroglioma. As these tumors are less infiltrative than astrocytomas and typically recur locally, focal therapy such as SRS is an appealing option.
METHODS
This study was performed through the International Radiosurgery Research Foundation. The objective was to collect retrospective multicenter data on tumor control, clinical response, and morbidity after SRS for oligodendroglioma. Inclusion criteria were age of 18 years or more, single-fraction SRS, and histological confirmation of grade 2 or 3 oligodendroglioma. The primary end points were progression-free survival (PFS) and overall survival from SRS. Secondary end points included clinical evolution and occurrence of adverse radiation events or other complications. Descriptive statistics, Kaplan-Meier analyses, and univariate and multivariate analyses were performed.
RESULTS
Eight institutions submitted data for a total of 55 patients. The median follow-up time was 24 months. The median age at SRS was 46 years, and the median Karnofsky Performance Status was 90%. The median marginal dose used was 15 Gy. The median PFS was 17 months, with actuarial rates of 60% at 1 year, 31% at 2 years, and 24% at 5 years after SRS. Factors significantly associated with worsened PFS were World Health Organization grade 3, previous radiotherapy and chemotherapy, and higher marginal dose. The median overall survival post-SRS was 58 months, with actuarial rates of 92% at 1 year, 83% at 2 years, and 49% at 5 years. Karnofsky Performance Status remained stable post-SRS in 51% and worsened in 47% of patients, most often because of tumor progression (73%). Radiation-induced changes occurred in 30% of patients, of which only 4 were symptomatic.
CONCLUSION
SRS is a reasonable management option for patients with oligodendroglioma.
背景与目的
少突胶质细胞瘤是原发性脑肿瘤，在2021年世界卫生组织中枢神经系统肿瘤分类中被归类为异柠檬酸脱氢酶突变型且1p19q共缺失型。手术切除、放疗和化疗是这些肿瘤公认的治疗选择。很少有研究评估立体定向放射外科（SRS）治疗少突胶质细胞瘤的疗效。由于这些肿瘤的浸润性低于星形细胞瘤，且通常局部复发，像SRS这样的局部治疗是一个有吸引力的选择。
方法
本研究通过国际放射外科研究基金会进行。目的是收集关于SRS治疗少突胶质细胞瘤后肿瘤控制、临床反应和发病率的回顾性多中心数据。纳入标准为年龄18岁及以上、单次分割SRS以及组织学确诊为2级或3级少突胶质细胞瘤。主要终点是SRS后的无进展生存期（PFS）和总生存期。次要终点包括临床进展以及放射性不良事件或其他并发症的发生情况。进行了描述性统计、Kaplan-Meier分析以及单因素和多因素分析。
结果
8家机构提交了总共55例患者的数据。中位随访时间为24个月。SRS时的中位年龄为46岁，中位卡诺夫斯基功能状态评分（KPS）为90%。使用的中位边缘剂量为15 Gy。中位PFS为17个月，SRS后1年、2年和5年的精算生存率分别为60%、31%和24%。与PFS恶化显著相关的因素有世界卫生组织3级、既往放疗和化疗以及较高的边缘剂量。SRS后的中位总生存期为58个月，1年、2年和5年的精算生存率分别为92%、83%和49%。51%的患者SRS后KPS保持稳定，47%的患者KPS恶化，最常见的原因是肿瘤进展（73%）。3折患者出现了放射性改变，其中只有4例有症状。
结论
SRS是少突胶质细胞瘤患者合理的治疗选择。
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