Localized Three Dimensional Conformal Hyperfractionated Radiotherapy in Glioblastoma Multiforme Patients-CGH Experience

多形神經膠母細胞瘤以高分次放射治療－國泰綜合醫院的治療經驗

吳錦榕(Ching-Jung Wu) ； 黃金山(Jing-Shan Huang) ； 游佩潔(Pei-Chieh Yu) ； 蕭世禎(Su-Zun Shaw)

《放射治療與腫瘤學》 12卷2期 (2005/06) Pp. 125-135

https://doi.org/10.6316/TRO/200512(2)125

摘要

目的：國泰綜合醫院針對近六年內為術後多形神經膠母細胞瘤的病患進行高分次放射治療作回顧性的分析，評估此類改變分次的放射治療對預後的成效，並綜合其他文章作討論。
材料與方法：自1999至2004年，共有27位術後多形神經膠母細胞瘤的病患在本科接受後續的高分次放射治療。除了一位小孩以外，每位病患給了每天兩次，每次1.2Gy，總劑量給到72Gy。唯一的一位小孩，每次以1.08Gy治療，總劑量給到64.8 Gy。而每位皆以三度空間順形治療法來定位作治療計畫。所有的病患並沒有接受化學治療。其中又有四位病患因腫瘤復發接受了第二次全程的放射治療，是以高分次放射治療或一天一次的傳統放射治療。病患的存活率以Kaplan-Meier方法計算，並評估年齡、性別、Karnofsky Peformance Score、腫瘤最大的直徑及手術方式對存活率的影響。
結果：中位存活率為12個月，一年及兩年的存活率分別是44%與19%。那四位接受了第二次全程的放射治療的病患，他們的存活率相當長，從12個月至個41個月。Karnofsky Performance Score為70至100的病患存活時間較70以下者長；分別為12個月及10個月(p=0.0443)，統計學上是具有意義的。而55歲以下較年輕的病患，雖看起來活得較55歲包含及以上的病患久（13個月比上11個月），但統計學上是不具有意義的。其他的變數並沒有統計學上的差異。
結論：高分次放射治療的好處是在可以提高對腫瘤的放射劑量情況下，對正常組織的傷害並不會相對的增加太多，而且多形神經膠母細胞瘤的病患普遍能耐受此種治療方式，治療期間及之後並未發生嚴重的併發症。本科的病患，中位存活率與其他報告相近。在此研究中，Karnofsky Performance Score是唯一在統計上具有影響存活率的因素。

關鍵字

多形神經膠母細胞瘤 ； 高分次放射治療 ； 改變分次放射治療

並列摘要

Purpose: To evaluate the outcome of post-operative hyperfractionated radiation therapy in patients with glioblastoma multiforme in terms of overall survival and prognostic factors.
Material and Methods: From September 1999 to April 2004, 27 post-operative glioblastoma multiforme patients received hyperfractionated radiation therapy with twice daily fractions of 1.2 Gy at a dose of 72 Gy, except one child who received twice daily 1.08 Gy fraction at a dose of 64.8 Gy. No adjuvant chemotherapy was applied. All patients were irradiated locally after 3-dimensional conformal treatment planning. There were 4 patients who received 2 courses of radiation therapy to the same region of the brain for tumor recurrence, in which the first course was hyperfractionated treatment and the second course were either hyperfractionation or conventional fractionation. Patient and tumor factors were investigated for survival differences using Kaplan-Meier method and Log-Rank test. These include age, sex, Karnofsky Performance Score, tumor maximum diameter, and types of surgery.
Results: Median survival of our 27 patients was 12 months, with 1 year and 2-year survival probabilities of 44% and 19%, respectively. The group of patients who received two full courses of radiation treatment did fairly well in survival ranged 12 to 41 months. Patients with Karnofsky Performance Score equal or greater than 70 had longer median survival than patients less than 70 (12 months and 10 months, respectively). This difference is statistically significant (p=0.0443). Although patients younger than 55 years seemed to do better than those older or equal to 55 years (median survival of 13 months versus 11 months), no significant survival difference was noted. Patients who received total resection had better median survival (12 months) than patients who received inadequate resection (7 months), but this difference did not reach statistical significance either. Other tumor or patient factors showed no survival difference.
Conclusion: The advantage of hyperfractionation radiation treatment is to escalate total tumor dose without increasing toxicity in normal tissues. Total dose of 72 Gy is well tolerated by glioblastoma multiform patients given in hyperfractionated fashion. Overall survival rate and median survival of our patients are comparable to other studies of altered fractionation treatment regime. Karnofsky Performance Score is the most important prognostic factors in our study.

並列關鍵字

Glioblastoma multiforme ； Hyperfractionation ； Altered fractionation