Hall W A, Djalilian H R, Sperduto P W, Cho K H, Gerbi B J, Gibbons J P, Rohr M, Clark H B
Department of Neurosurgery, University of Minnesota Hospital and Clinic, Minneapolis 55455, USA.
J Clin Oncol. 1995 Jul;13(7):1642-8. doi: 10.1200/JCO.1995.13.7.1642.
To evaluate the role of stereotactic radiosurgery in the management of recurrent malignant gliomas.
We treated 35 patients with large (median treatment volume, 28 cm3) recurrent tumors that had failed to respond to conventional treatment. Twenty-six patients (74%) had glioblastomas multiforme (GBM) and nine (26%) had anaplastic astrocytomas (AA).
The mean time from diagnosis to radiosurgery was 10 months (range, 1 to 36), from radiosurgery to death, 8.0 months (range, 1 to 23). Twenty-one GBM (81%) and six AA (67%) patients have died. The actuarial survival time for all patients was 21 months from diagnosis and 8 months from radiosurgery. Twenty-two of 26 patients (85%) died of local or marginal failure, three (12%) of noncontiguous failure, and one (4%) of CSF dissemination. Age (P = .0405) was associated with improved survival on multivariate analysis, and age (P = .0110) and Karnofsky performance status (KPS) (P = .0285) on univariate analysis. Histology, treatment volume, and treatment dose were not significant variables by univariate analysis. Seven patients required surgical resection for increasing mass effect a mean of 4.0 months after radiosurgery, for an actuarial reoperation rate of 31%. Surgery did not significantly influence survival. At surgery, four patients had recurrent tumor, two had radiation necrosis, and one had both tumor and necrosis. The actuarial necrosis rate was 14% and the pathologic findings could have been predicted by the integrated logistic formula for developing symptomatic brain injury.
Stereotactic radiosurgery appears to prolong survival for recurrent malignant gliomas and has a lower reoperative rate for symptomatic necrosis than does brachytherapy. Patterns of failure are similar for both of these techniques.
评估立体定向放射外科在复发性恶性胶质瘤治疗中的作用。
我们治疗了35例患有大型（中位治疗体积，28 cm³）复发性肿瘤且对传统治疗无反应的患者。26例（74%）患有多形性胶质母细胞瘤（GBM），9例（26%）患有间变性星形细胞瘤（AA）。
从诊断到放射外科的平均时间为10个月（范围，1至36个月），从放射外科到死亡的平均时间为8.0个月（范围，1至23个月）。21例GBM（81%）和6例AA（67%）患者已经死亡。所有患者从诊断开始的精算生存时间为21个月，从放射外科开始为8个月。26例患者中有22例（85%）死于局部或边缘性复发，3例（12%）死于非连续性复发，1例（4%）死于脑脊液播散。多因素分析显示年龄（P = 0.0405）与生存改善相关，单因素分析显示年龄（P = 0.0110）和卡氏功能状态（KPS）（P = 0.0285）与生存相关。组织学、治疗体积和治疗剂量在单因素分析中不是显著变量。7例患者因放射外科后平均4.0个月出现的占位效应增加而需要手术切除，精算再手术率为31%。手术对生存没有显著影响。手术时，4例患者有复发性肿瘤，2例有放射性坏死，1例既有肿瘤又有坏死。精算坏死率为14%，症状性脑损伤的病理结果可以通过综合逻辑公式预测。
立体定向放射外科似乎能延长复发性恶性胶质瘤的生存时间，并且与近距离放射治疗相比，症状性坏死的再手术率更低。这两种技术的复发模式相似。
