摘要
目的：回顾性分析恶性胶质瘤术后行同期推量调强放疗（simultaneous integrated boost intensitymodulated radiotherapy,SIB-IMRT）的疗效及其预后影响因素。方法：2009年4月至2012年4月共94例恶性胶质瘤患者术后接受SIB-IMRT,行CT扫描定位,确定靶体积（GTV、CTV）和重要器官,GTV定义为部分切除或者次全切除后的残留病灶,而CTV则定义为包括术前肿瘤病灶在内的并往外扩2.0 cm边缘的范围。采用同期推量技术,设置处方剂量GTV为60 Gy,每次分割2.4 Gy,CTV为50 Gy,每次分割2 Gy,使用MIMIC系统实施调强放疗。记录放疗期间不良反应,并计算总体生存率。应用COX回归模型进行预后相关因素的多因素分析。结果：本组患者无4级以上急性不良反应,多为1-2级,有2例发生后期放射性脑坏死。患者的1、2和3年总生存率分别为81.1%、57.1%和30.7%,1、2和3年无局部进展生存率分别为65.3%、40.0%、11.8%。多因素分析显示影响总体生存率的独立预后因素包括肿瘤是否位于功能区（P=0.033、0.021）、病理分级（P=0.019、0.016）、肿瘤手术切除程度（P〈0.001）。结论：采用术后同期推量调强放疗方法治疗恶性胶质瘤能够获得较为理想的近期临床疗效,而且患者对放疗相关的不良反应尚可耐受。肿瘤是否位于功能区、病理分级、肿瘤手术切除程度是重要的预后因素。
Objective： To evaluate the outcome and prognostic factors of simultaneous integrated boost intensitymodulated radiotherapy（ SIB-IMRT） in the treatment of malignant gliomas. Methods： From Apr. 2009 to Apr.2012,94 cases of malignant glioma were treated with SIB-IMRT. All patients fixed with mask and had a CT scan.The target volumes（ CTV,CTV） and organs at risk（ OAR） were contoured. GTV was identified as residual focus after partial or near total resection,CTV as the preoperation focus with 2. 0 cm margin. The doses of prescription were GTV 60 Gy,2. 4 Gy·f^-1,CTV 50 Gy,2. 0 Gy·f^-1using SIB technique and IMRT was implemented with MIMIC system. The treatment reaction was recorded. The overall survival rate was calculated. The prognostic factors were analyzed by using multivariate COX regression model. Results： The acute treatment toxicity occurred mostly in grade 1 to grade 2 and no adverse reaction was observed in grade 4. Two cases had late radiation induced brain necrosis. The overall 1-,2-,and 3-year survival rates were 81. 1%,57. 1% and 30. 7%,and the 1-year,2-yera,and 3-year local progression free survival rate were 65. 3%,40. 0% and 11. 8%. Multivariate analysis revealed that tumor location,pathological grading and extent of resection were independent prognostic factors.Conclusion： Postoperative SIB-IMRT has a better short-term efficacy in the treatment of malignant glioma and the adverse reaction is tolerable. Tumor location,pathological grading and extent of resection are important prognostic factors.
出处
《东南大学学报（医学版）》
CAS
北大核心
2016年第5期746-751,共6页
Journal of Southeast University(Medical Science Edition)
关键词
胶质瘤
调强放疗
同期推量
预后
glioma
intensity-modulated radiotherapy
simultaneous integrated boost
prognosis
