389例脑胶质瘤立体定向放射治疗效果评价(英文)

目的探讨脑胶质瘤立体定向放射治疗的疗效及放疗副反应。方法从1995年6月到1998年12月,用立体定向放射治疗的方法共治疗脑胶质瘤病人389例,其中用立体定向放射外科(ster-eotactic radiosurgery,SYS)方法治疗151例,分次立体定向放射治疗(fractionated stereotatic radiotherapy,FSRT)方法治疗238例。SRS组单次周边剂量20～30Gy,靶点1～6个,平均2.48个,照射弧5～21个,平均8.45个;FSRT 组每日或隔日照射,每次周边剂量8～12Gy,共照射2～5次,靶点1～6个,平均2.53个,照射弧6～20个,平均8.25个。结果治疗结束后3个月,SRS 组完全缓解(CR)21例,占13.9%,部分缓解(PR)69例,占45.7%,稳定(SD)26例,占17.2%,进展(PD)35例,占23.2%,总有效率(PR+CR+SD)为76.8%;FSRT 组完全缓解(CR)47例,占19.7%,部分缓解(PR)114例,占47.9%,稳定(SD)49例,占20.6%,进展(PD)28例,占11.8%,总有效率(PR+CR+SD)为88.2%,两组差别有显著性(X~2=9.874,P=0.020)。全部病人的1、3、5年生存率分别为54.3%、29.3%、16.5%;SRS 组和 FSRT 组的1、3、5年生存率分别为52.3%、26.5%、11.9%和55.5%、31.1%、19.3%,两组差别没有显著性意义(X~2=2.16,P=0.1417);放射治疗的主要副反应为脑水肿,SRS组较 FSRT 组为重(X~2=4.916,P=0.027)。结论立体定向放射治疗对脑胶质瘤有较好的疗效,FSRT 与 SRS 相比,具有疗效好副作用小的优点。

Therapeutic Effects of Stereotactic Radiotherapy on 389 Cases of Brain Glioma

Objective:To investigate the treatment effectiveness and side effects of stereotactic radiotherapy for brain glioma.Methods:From Jun.1995 to Dec.1998,389 cases of brain gliomas were treated by stereotactie radiotherapy,among which 151 cases were treated by stereotactic radiosurgery(SRS)and the other 238 cases,by fractionated stereotactic radiotherapy(FSRT).In the SRS group,the marginal tumor dose was 20 to 30 Gy(median,2.6 Gy).One to 6 isocenters(median,2.48)and 5 to 21 irradiation arcs (median.8.45)were applied.In the FSRT group,the per-fraction marginal tumor dose was 8 to 12 Gy with 1 to 6 isocenters(median,2.53),6 to 20 irradiation arcs(median,8.25)and 2-5 fractions delivered everyday or every other day.Results:Three months after treatment,the complete and partial response rates were 13.9% and 45.7% in SRS group respectively.The stable disease rate was 17.2%.The total effective rate was 76.8%.In FSRT group,the complete and partial remission rates were 19.7% and 47.9% respectively. The stable disease rate was 20.6%.The total effective rate was 88.2%.The total effective rate of FSRT group was higher than that in SRS group(X~2=9.874,P=0.020).The 1-year,3-year and 5-year survival rate of all patients was 54.3%,29.3%,16.5% respectively.The 1-year,3-year and 5-year survival rate in SRS group and FSRT group was 52.3% vs 26.5%,11.9% vs 55.5%,and 31.1 vs 19.3% respectively.There was no significant difference between the two groups(X~2=2.16,P=0.1417).The brain edema caused by the main radiation was more severe in the SRS group than in FSRT group(X~2=4.916,P=0.027).Conclusion:It is effective for brain glioma to be treated by stereotactic radiotherapy.Compared with SRS,the FSRT has the advantage of good effect and less side response.