Grosu A L, Feldmann H J, Albrecht C, Kneschaurek P, Wehrmann R, Gross M W, Zimmermann F B, Molls M
Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Technische Universität, Klinikum rechts der Isar, München.
Strahlenther Onkol. 1998 Jan;174(1):7-13. doi: 10.1007/BF03038221.
Radiotherapy became an important component in the treatment of brain gliomas. The aim of this study is to analyse several advantages of the three-dimensional conformal radiation therapy in comparison with a two-dimensional conventional technique and to present the clinical results of 43 patients with brain gliomas treated according to a three-dimensional planning.
Between January 1994 and December 1995, 43 patients with malignant brain gliomas (WHO III and IV) were treated in our department according to a three-dimensional treatment planning. The patients received a total irradiation dose of 60 Gy, 2 Gy/day, 5 days/week. The rate of survival was analysed in relation with the known prognostical factors: histology, Karnofsky index, age, resection status. In 10 patients a three-dimensional treatment planning was compared with a conventional two-dimensional planning: the volume of the normal brain tissue irradiated to high dose levels (95% isodose) and the normal tissue complication probability (NTCP) for the brain by Kutcher and Lyman were comparatively analysed.
The survival rate for the whole group was 14 months. The histology of the tumor, age, Karnofsky index and resection status were important prognostical factors. The three-dimensional planning allows a 15 to 20% reduction in the volume of normal brain tissue irradiated to high dose levels (95% isodose). The NTCP is significantly lower using the three-dimensional technique (range 0.03% to 13%), in comparison with the two-dimensional conventional technique (range 0.1% to 26%). The value of NTCP increases with tumor volume.
Concerning the tumor control and survival rate, the three-dimensional treatment planning shows no advantages compared to the standard conventional methods. The main advantage of the three-dimensional treatment planning is the possibility to spare normal brain tissue. The possibility to integrate mathematical models in the evaluation of the therapy could give this technique new dimensions.
放射治疗已成为脑胶质瘤治疗的重要组成部分。本研究旨在分析三维适形放射治疗相较于二维传统技术的若干优势，并展示根据三维计划治疗的43例脑胶质瘤患者的临床结果。
1994年1月至1995年12月期间，我科对43例恶性脑胶质瘤（世界卫生组织III级和IV级）患者按照三维治疗计划进行治疗。患者接受的总照射剂量为60 Gy，每天2 Gy，每周5天。根据已知的预后因素分析生存率：组织学、卡氏评分、年龄、切除状态。对10例患者的三维治疗计划与传统二维计划进行比较：对比分析高剂量水平（95%等剂量线）照射的正常脑组织体积以及Kutcher和Lyman提出的脑正常组织并发症概率（NTCP）。
全组患者的生存率为14个月。肿瘤组织学、年龄、卡氏评分和切除状态是重要的预后因素。三维计划可使高剂量水平（95%等剂量线）照射的正常脑组织体积减少15%至20%。与二维传统技术（范围为0.1%至26%）相比，三维技术的NTCP显著更低（范围为0.03%至13%）。NTCP值随肿瘤体积增大而增加。
在肿瘤控制和生存率方面，三维治疗计划与标准传统方法相比并无优势。三维治疗计划的主要优势在于能够 sparing正常脑组织。在治疗评估中整合数学模型的可能性可为该技术带来新的发展维度。 （注：原文中“sparing”疑似拼写错误，可能是“spare”，这里暂按“sparing”翻译）
