Postoperative Radiotherapy of Adult Supratentorial High-grade Astrocytoma

成人惡性星狀細胞腦瘤之術後放射治療

陳尚文(Shang-Wen Chen) ； 容世明(Shih-Ming Jung) ； 林芳仁(Fan-Jen Lin) ； 曾振淦(Chen Kan Tseng) ； 陳文政(Wen Cheng Chen) ； 張東杰(Joseph Tung-Chieh Chang) ； 洪志宏(Ji-Hong Hong)

《中華放射線醫學雜誌》 24卷1期 (1999/02) Pp. 15-20

摘要

了解高惡性度星狀細胞腦瘤病人接受術後放射治療之預後因子。自1979年至1988年，有79位病人，經組織切片證實之高惡性星狀細胞腦瘤，在林口長庚醫院完成術後放射治療。27位病人接受完全腫瘤切除，32位接受部份切除，20位只接受定位切片。31位患者之病理報告為Kernohan第三級，48位患者為第四級。56位為男性，23位為女性。患者年紀、性別，Kernohan病理分期，手術範圍；治療之方式，及輻射劑量，進入單變數及多變數分析。二年的存活率為15%中間值存活為46週。年紀病理分期及手術範圍會影響到預後。病人接受一日多次放射治療並沒有此傳統放射治療好。針對49位接受傳統放射治療之患者做單變數及多變數分析發現Kernohan病理分期，手術範圍及腫瘤輻射劑量都是獨立的預後因子。對於高惡性度的腦瘤，完全的腫瘤切除及提高腫瘤輻射劑量都可提高患者的存活。

關鍵字

惡性腦瘤 ； 放射治療 ； 預後因子

並列摘要

To find the prognostic factors of high grade glioma patients treated by postoperative radiotherapy. From 1979 through 1988, 79 patients with proven supratentorial high-grade astrocytoma completed external beam irradiation at Chang Chung Memorial Hospital following surgery, including by total removal (27 patients); subtotal removal (32 patients) or biopsy only (20 patients). Thirty-one patients and 48 (60.8%) patients had Kernohan grade Ⅲ tumors and Glioblastoma multiform, respectively. There were 56 male (70.9%) and 23 female patients. Median age at time of diagnosis was 40 years (range, 15 to 69 years). The patients were subject to univariate and multivariate analyses according to age, sex, Kernohan grading, extent of surgery, treatment modality, and irradiation dose. Overall 2-year survival was 15% and median survival was 46 weeks. Improved survival were much more likely in patients younger than 40 years (p=0.016), with Kernohan grade Ⅲ tumors (p=0.002), and those who underwent surgical excision (p=0.001). Multiple daily fractionation (30 patients) did not lengthen patient survival when compared with conventional radiotherapy (49 patients). For the 49 patients treated with conventional radiotherapy, the dose appeared to be associated with lengthened survival (p=0.037). Multivariate analysis using Cox's proportional hazard model for the 49 patients treated using conventional therapy showed Kernohan grade, extent of surgery, and irradiation dose were independent prognostic factors. Tumor pathological grade, extent of surgery and radiation dose were important prognostic factors in patients with high-grade astrocytoma. More extensive surgery and higher postoperative radiation dose lengthened the survival in patients with high-grade astrocytoma.

並列關鍵字

Brain neoplasm ； high-grade astrocytoma ； radiotherapy ； prognostic factors