Packer R J, Boyett J M, Zimmerman R A, Albright A L, Kaplan A M, Rorke L B, Selch M T, Cherlow J M, Finlay J L, Wara W M
Department of Neurology, Children's National Medical Center, Washington, DC 20010.
Cancer. 1994 Sep 15;74(6):1827-34. doi: 10.1002/1097-0142(19940915)74:6<1827::aid-cncr2820740628>3.0.co;2-q.
Brain stem gliomas remain the childhood brain tumors most resistant to treatment. Treatments with hyperfractionated radiotherapy at doses as high as 7560 cGy have been fairly well tolerated. This study was undertaken to determine the toxicity and possible efficacy of hyperfractionated radiotherapy in children with brain stem gliomas using 100 cGy of radiation twice daily, to a total dose of 7800 cGy.
Sixty-six children (mean age at diagnosis, 7.5 years) with diffuse intrinsic brain stem gliomas were treated. Patients were evaluated for potential toxicity of treatment, progression-free survival, survival, and response to treatment.
Objective response to treatment was documented in 20 of 58 (34%) evaluable patients, with 8 (14%) patients having a greater than 50% reduction in tumor size. Overall survival was 35% plus or minus 6% at 1 year and 11% plus or minus 6% at 3 years. Intralesional cystic/necrotic radiographic changes developed in nine patients 6 weeks after radiation, and three of these patients subsequently improved without antitumor intervention. Six of 14 autopsied patients had evidence of probable radiation-induced intralesional necrotic damage, and in 1, necrosis may have played a role in death. Thirty-three of 66 patients were treated with steroids for prolonged periods.
The results of this treatment regimen demonstrate that hyperfractionated radiotherapy, as delivered in this study to a total dose of 7800 cGy, is relatively well tolerated, but may result in prolonged steroid-use dependency and possible radiation-associated damage. Objective responses to treatment were seen in 34% of patients, but these results were not better than those seen at lower doses of hyperfractionated radiotherapy. There is no evidence that radiation to 7800 cGy results in improved survival for patients with diffuse intrinsic brain stem gliomas.
脑干胶质瘤仍然是最难治疗的儿童脑肿瘤。采用高达7560厘戈瑞剂量的超分割放疗，耐受性相当良好。本研究旨在确定对脑干胶质瘤儿童使用每日两次、每次100厘戈瑞放疗，总剂量达7800厘戈瑞的超分割放疗的毒性及可能疗效。
对66例（诊断时平均年龄7.5岁）弥漫性固有脑干胶质瘤患儿进行治疗。对患者进行治疗潜在毒性、无进展生存期、生存期及治疗反应评估。
58例可评估患者中有20例（34%）记录到客观治疗反应，8例（14%）患者肿瘤大小缩小超过50%。1年总生存率为35%±6%，3年为11%±6%。9例患者放疗6周后出现瘤内囊性/坏死性影像学改变，其中3例患者随后未经抗肿瘤干预病情改善。14例尸检患者中有6例有可能的放射性瘤内坏死损伤证据，1例中坏死可能在死亡中起作用。66例患者中有33例长期接受类固醇治疗。
本治疗方案结果表明，本研究中给予总剂量7800厘戈瑞的超分割放疗耐受性相对良好，但可能导致长期类固醇使用依赖及可能的放射性相关损伤。34%的患者出现客观治疗反应，但这些结果并不优于较低剂量超分割放疗所见结果。没有证据表明照射7800厘戈瑞能改善弥漫性固有脑干胶质瘤患者的生存期。
