A Retrospective Comparison of Treatment Results among GBM Patients Treated with Different Radiotherapy Protocols

比較多型性膠狀母細胞瘤經術後不同放射治療療程之治療結果：回溯性研究

周上愉(Shang-Yu Chou) ； 黃俊杰(Chun-Chieh Huang) ； 黃郁傑(Yu-Jie Huang) ； 方富民(Fu-Min Fang) ； 黃英彥(Eng-Yen Huang) ； 王重榮(Chong-Jong Wang) ； 陳惠君(Hui-Chun Chen) ； 王友明(Yu-Ming Wang) ； 許軒之(Hsuan-Chih Hsu)

《放射治療與腫瘤學》 21卷2期 (2014/06) Pp. 89-100

https://doi.org/10.6316/TRO/201421(2)89

摘要

目的：比較多型性膠狀母細胞瘤術後經不同放射治療療程之治療結果。材料與方法：從1995年2月至2012年9月，共分析65位多型性膠狀母細胞瘤病患經手術切除後接受不同之輔助性局部放射治療。第一組病患（27位）接受局部放射治療6000 cGy/30次照射合併帝盟多及輔助性帝盟多療程（合併使用劑量為每日75 mg/m^2 BSA,服用期間為放射治療第一天至最後一天;輔助劑量為每日150至200 mg/m^2 BSA，連續服用5天休息23天為一個循環，服用至病患發生死亡或惡化）；第二組病患（24位）僅接受6660-7000 cGy/33-35次照射之術後局部放射治療，無化學治療介入；第三組病患（14位）接受照野內再照射之術後局部放射治療（每日於大照野照射180 cGy，再減小照野照射70 cGy，共照射25-26日，達總劑量6250-6500 cGy，無化學治療介入。研究終點為整體存活期（overall survival）。結果：追蹤期的中位數為13.6個月。65位病患之整體存活期中位數及復發時間中位數為13.3及8.2個月。第一組、第二組及第三組病患之整體存活期中位數分別為19.9、12.6與10.4個月。其中第一組病患的整體存活期較長，與第二、三組結果相較有統計學上的顯著差異。疾病無惡化存活期（progression-free survival）的中位數於三組病患間並無顯著差異。病患體能狀態、手術是否完全切除腫瘤及術後輔助性治療方法是整體存活期的重要預後因子。結論：本回溯性研究發現病患體能狀態、手術是否完全切除腫瘤及術後輔助性治療方法是影響多型性膠狀母細胞瘤存活期的重要因子。病患體能狀態佳、手術切除乾淨及接受術後局部放射治療6000 cGy/30次照射合併帝盟多及輔助性帝盟多療程，可達到良好的整體存活期。

關鍵字

放射治療 ； 多型性膠狀母細胞瘤 ； 帝盟多

並列摘要

Purpose: To compare the treatment results of different radiotherapy protocols for glioblastoma multiforme (GBM). Materials and Methods: Between February 1995 and September 2012, 65 patients with GBM who treated with maximal surgical resection, followed by different external radiotherapy (RT) protocols were evaluated retrospectively. 27 patients (group 1) had received CCRT (concurrent chemoradiotherapy) with temozolomide (TMZ) administered orally at 75 mg/m^2 body surface area (BSA) daily from the first to the last day with local RT (6000 cGy/30 fractions), followed by adjuvant TMZ (150 to 200 mg/m^2 BSA, 5-day dosing and 23 days non-treatment) till the patient's death or progressive disease occurred. 24 patients (group 2) had received adjuvant RT alone with 6660-7000 cGy/33-35 fractions. 14 patients (group 3) had received field-in-field (FIF) boost protocol with RT consisted of daily fractions of 180 cGy to brain tumor site, followed by subsequently 70 cGy (total 250 cGy daily) to reduced field of tumor bed with a total dose of 6250-6500 cGy without other chemotherapy permission. The primary endpoint was overall survival (OS). Results: Median follow-up was 13.6 months (range, 3.6-67.1 months). Median OS and time to progression for 65 patients were 13.3 and 8.2 months, respectively. Median OS of group 1, 2 and 3 were 19.9, 12.6 and 10.4 months, respectively. The group 1 had significantly better OS than both group 2 (p = 0.03) and group 3 (p = 0.04). No significant difference in OS of group 2 and 3 (p = 0.06). Median progression free survival (PFS) did not differ significantly among group 1, 2 and 3 (median PFS: 9.8, 7.2 and 9.7 months, respectively; group 1 vs 2, group 2 vs 3, and group 3 vs 1, p = 0.09, 0.90 and 0.80, respectively). Patient ECOG PS (Eastern Cooperative Oncology Group performance status), GTR (gross tumor resection) or not and RT protocol were significantly correlated with overall survival on both univariate and multivariate analysis. Conclusions: Three independent predictors of survival were identified in our studies: ECOG PS, GTR or not and RT protocol. When independent prognostic factors were examined, advantageous median OS was found out for the patients whose ECOG PS were ≤ 2 and who had GTR, followed by TMZ during and after conventional RT (6000 cGy/30 fractions).

並列關鍵字

Radiotherapy ； Glioblastoma multiforme (GBM) ； Temozolomide