Prognostic Factors and Results of Radiotherapy for Brain Stem Gliomas

腦幹神經膠質瘤接受放射治療之預後因子及結果

汪昶佑(Chang-Yu Wang) ； 王重榮(Chong-Jong Wang) ； 許軒之(Hsuan-Chih Hsu) ； 黃英彥(Eng-Yen Huang) ； 梁雲(Stephen Wan Leung) ； 陳惠君(Hui-Chun Chen) ； 孫立民(Li-Min Sun) ； 葉世安(Shyh-An Yeh) ； 方富民(Fu-Min Fang) ； 熊敬業(Ching-Yeh Hsiung)

《放射治療與腫瘤學》 8卷1期 (2001/03) Pp. 15-24

https://doi.org/10.6316/TRO/200108(1)15

摘要

目的：分析接受放射治療的腦幹神經膠質瘤的病患其預後因子及治療結果。
材料與方法：自1986年至2000年間，共有44位腦幹神經膠質瘤的病患為研究對象。包括27位男性和17位女性，年齡自3歲至74歲，中間值為26.5歲。其中19位經組織切片證實為神經膠質瘤，接受腦腫瘤部分切除手術有13位。所有病患均接受放射治療或合併外科手術。放射治療給予總劑量的中間值在55.9 Gy，每次1.8 - 2.0 Gy。存活病患中位追?期為3年。
結果：有16／44個病患達到明顯地神經學症狀的改善。在4／44個病患影像檢查中顯示腫瘤體積減少，在28個病患中腫瘤體積維持不變，而有12個病患其腫瘤體積繼續變大。自治療結束到腫瘤惡化期間的中位值為13.2個月，中位存活期為17.9個月，1年存活率為53%，2年存活率為37%，5年存活率為27%。 Karnofsky performance score大於70%的病患其中位存活期為31.6個月，相較於Karnofsky performance score小於70%的病患其中位存活期為7.9個月（p=0.037）。以多變數分析評估其他一些可能的預後因子（包括病患年齡、性別、腫瘤的分化程度、腫瘤位置、是否接受手術切除、有無腦神經麻痺、放射治療總劑量、三度空間順形放射治療、症狀的持續時間、或影像學上腫瘤是否變大）均不影響病患存活率。
結論：在本研究中Karnofsky performance score是影響存活率的最重要因子。腦幹神經膠質瘤的放射治療結果仍不盡理想，需繼續尋找更有效的治療模式。

關鍵字

腦幹神經膠質瘤 ； 放射治療 ； 預後因子

並列摘要

Purpose:To analyze the prognostic factors and treatment results in patients with brainstem gliomas following radiotherapy.
Materials and Methods:Between 1986 and 2000, 44 patients with brain stem gliomas were evaluated retrospectively. Included were 27 males and 17 females ranging in age from 3 to 74 years (median, 26.5 years). Out of 19 patients with histologically proven glioma, 13 had a partial tumor resection. These patients were treated with various combinations of surgery and radiotherapy. A median total tumor dose of 55.9 Gy was given in daily fractions of 1.8-2.0 Gy. The median follow up time of survivors was 3years.
Results: Neurological improvement was achieved in 16/44 patients. Reduction of tumor size was reported in 4/44, in 28 patients the lesion was unchanged, and 12 patients progressed radiologically. Median time to progression was 13.2 months, and median overall survival time was 17.9 months with an actuarial survival of 53% at 1 year, 37% at 2 years and 27% at 5 years. For patients who had Karnofsky performance score≧70%, their median overall survival was 31.6 months compared to 7.9 months for those who had Karnofsky performance score ＜ 70% (p = 0.037). None of the other potential prognostic factors evaluated (including patient age, gender, tumor grade, tumor location, subtotal resection, presence or absence of cranial nerve palsies, total dose, 3D conformal radiotherapy, duration of symptoms, or radiological response) were associated with patient overall survival in multivariate analysis.
Conclusions:Karnofsky performance score is the most important prognostic factor in this study. The result of radiotherapy for brain stem glioma is still disappointed. It is necessary to continue to search for more effective treatment methods.

並列關鍵字

Brain stem glioma ； Radiotherapy ； Prognostic factors