Rampling R
Beatson Oncology Centre, Western Infirmary, Glasgow, Scotland.
Forum (Genova). 1998 Jul-Sep;8(3):289-301.
Radiation was conclusively proved to be of value in the treatment of malignant gliomas in the late 1970's where it enabled an approximate doubling of the survival time. Further study defined a number of prognostic factors which provide a basis for selecting patients for treatment. The introduction of computer tomography (and later magnetic resonance) scanning allowed a more rational approach to target volume definition and a reduction in radiation-related morbidity. Dose-ranging studies defined a standard approach to treatment (60 Gray in 30 fractions). Since then numerous attempts have been made to improve on these results. Marginal benefits have been claimed for altered fractionation schemes, limited volume dose escalation (implants and stereotaxy), radiation sensitisers and particle therapies. However none has become routine in clinical practice. Advances in planning technology have allowed a further reduction in the volume of normal brain irradiated and the potential for dose escalation. Low grade astrocytoma has not been examined in the same way and great doubt exists with respect to optimal treatment. There is a great opportunity for research to realise the potential in the new techniques for improving the outlook for patients with malignant glioma and in clarifying the role of radiation in low grade tumours.
20世纪70年代末，放射治疗被确凿证明对恶性胶质瘤的治疗具有价值，它能使患者的生存时间大约延长一倍。进一步的研究确定了一些预后因素，为选择治疗患者提供了依据。计算机断层扫描（以及后来的磁共振成像）的引入，使得在确定靶区体积时能采用更合理的方法，并降低了与放疗相关的发病率。剂量范围研究确定了标准的治疗方法（30次分割，总剂量60格雷）。从那时起，人们进行了无数次尝试以改善这些结果。对于改变分割方案、有限体积的剂量递增（植入和立体定向放疗）、放射增敏剂和粒子治疗，都有人声称有边际效益。然而，这些方法都没有成为临床实践中的常规方法。放疗计划技术的进步使得正常脑组织受照射的体积进一步减小，并且有了剂量递增的可能。低级别星形细胞瘤尚未以同样的方式进行研究，对于最佳治疗方案存在很大疑问。在利用新技术改善恶性胶质瘤患者的预后以及明确放疗在低级别肿瘤中的作用方面，有很大的研究机会。
