Laperriere N J, Leung P M, McKenzie S, Milosevic M, Wong S, Glen J, Pintilie M, Bernstein M
Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
Int J Radiat Oncol Biol Phys. 1998 Jul 15;41(5):1005-11. doi: 10.1016/s0360-3016(98)00159-x.
A randomized study was undertaken to assess the role of brachytherapy as a boost to external beam radiation therapy in the initial management of patients with malignant astrocytomas.
Inclusion criteria included the following: biopsy-proven supratentorial malignant astrocytoma of brain < or =6 cm in size, not crossing midline or involving corpus callosum, age 18-70, Karnofsky Performance Status (KPS) > or =70. Patients were randomized to external radiation therapy only delivering 50 Gray (Gy) in 25 fractions over 5 weeks or external radiation therapy plus a temporary stereotactic iodine-125 implants delivering a minimum peripheral tumor dose of 60 Gy. Patients were stratified to age < or =50 or >50, and KPS > or =90 or < or =80.
There were 140 patients randomized between 1986 and 1996, 71 to the implant arm and 69 to external irradiation only. Pathologically 125 patients had necrosis noted in their tumor specimen. Factors associated with improved survival in univariate analysis were age < or =50, KPS > or =90, chemotherapy at recurrence, and reoperation at the original tumor site. The Cox proportional hazards model revealed the following significant factors: treatment at recurrence (chemotherapy or reoperation) with a relative risk (RR) of 0.6 (p = 0.004) and KPS > or =90 with a RR 0.6 (p = 0.007). Randomization to the implant arm was associated with a RR of 0.7 (p = 0.07). Median survival for patients randomized to brachytherapy or not were 13.8 vs. 13.2 months, respectively, p = 0.49.
We conclude that stereotactic radiation implants have not demonstrated a statistically significant improvement in survival in the initial management of patients with malignant astrocytoma.
开展一项随机研究，以评估近距离放射治疗作为外照射放疗的补充在恶性星形细胞瘤患者初始治疗中的作用。
纳入标准如下：经活检证实的幕上脑恶性星形细胞瘤，大小≤6 cm，未跨越中线或累及胼胝体，年龄18 - 70岁，卡氏功能状态评分（KPS）≥70。患者被随机分为仅接受外照射放疗组（在5周内分25次给予50格雷（Gy））或外照射放疗加临时立体定向碘 - 125植入组（给予外周肿瘤最小剂量60 Gy）。患者按年龄≤50岁或＞50岁以及KPS≥90或≤80进行分层。
1986年至1996年间有140例患者被随机分组，71例进入植入组，69例仅接受外照射。病理检查发现125例患者的肿瘤标本中有坏死。单因素分析中与生存改善相关的因素为年龄≤50岁、KPS≥90、复发时化疗以及在原肿瘤部位再次手术。Cox比例风险模型显示以下显著因素：复发时治疗（化疗或再次手术），相对风险（RR）为0.6（p = 0.004）；KPS≥90，RR为0.6（p = 0.007）。随机分配到植入组的RR为0.7（p = 0.07）。随机接受或未接受近距离放射治疗的患者中位生存期分别为13.8个月和13.2个月，p = 0.49。
我们得出结论，在恶性星形细胞瘤患者的初始治疗中，立体定向放射植入并未显示出生存率有统计学意义的改善。
