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目的评价高分级脑胶质瘤应用同步加量调强放疗(SIB-IMRT)的临床疗效、毒性和剂量的可行性。方法 2009年11月至2012年12月入选16例高分级(Ⅲ～Ⅳ级)脑胶质瘤患者。调强放疗定义两个计划靶区(PTV):大体肿瘤靶区(GTV)包及T1加权增强期外放0.5 cm定义为计划肿瘤靶区(PGTV),放射剂量70 Gy/28次,2.5 Gy/次;亚临床区(CTV)为GTV外扩2 cm(包及T2水肿区)外放0.5 cm为计划亚临床靶区(PCTV),放射剂量56 Gy/28次,2.0 Gy/次。用剂量体积直方图分析靶区和危险器官剂量分布,并评价疗效、毒性、分割及总剂量的可行性。结果中位随访时间17个月,截止随访日期所有患者肿瘤均出现复发,15例(93.8%)出现靶区内复发,其中12例患者出现PGTV复发和3例在PCTV的复发;1例在靶区外复发。4例患者随访截止日仍存活,其余12例患者因肿瘤进展死亡。总的1年无进展生存(PFS)为20%,2年PFS为10%;1年和2年总生存(OS)率分别为77%和31%。治疗过程中6例患者发生Ⅰ～Ⅱ级急性放射毒性反应,无相关的放射晚期毒性反应。结论 SIB-IMRT未能改善高分级脑胶质瘤的局部控制率和生存率,但可以给肿瘤区和周围水肿区不同剂量照射,在肿瘤区及周边组织形成剂量梯度,降低正常脑组织受量。
Objective To evaluate the clinical efficacy, toxicity and dose of SIB-IMRT in high-grade gliomas. Methods From November 2009 to December 2012, 16 patients with high grade (grade Ⅲ ~ Ⅳ) gliomas were enrolled. IMRT Defining Two Planned Targets (PTVs): Gross tumor target (GTV) package and T1-weighted enhancement Ejection 0.5 cm defined as planned tumor target (PGTV), radiation dose of 70 Gy / 28 times, 2.5 Gy / Sub-clinical area (CTV) for the GTV out 2 cm (package and T2 edema area) 0.5 cm outside the planned sub-clinical target area (PCTV), the dose of 56 Gy / 28 times, 2.0 Gy / time. Dose-volume histograms were used to analyze the dose distribution of target areas and dangerous organs and to evaluate the efficacy, toxicity, fragmentation, and overall dose feasibility. Results The median follow-up time was 17 months. All patients had recurrence of tumor in the follow-up date. Fifteen patients (93.8%) had recurrence within the target area, including 12 patients with recurrence of PGTV and 3 patients with recurrence of PCTV. Recurrence outside the area. Four patients survived the follow-up deadline, and the remaining 12 patients died of tumor progression. The overall 1-year progression-free survival (PFS) was 20% and the 2-year PFS was 10%; the 1-year and 2-year overall OS rates were 77% and 31%, respectively. During the course of treatment, acute radiotoxic reactions of grade Ⅰ ~ Ⅱ occurred in 6 patients with no relevant late radiation toxicity. Conclusion SIB-IMRT failed to improve the local control rate and survival rate of high-grade glioma, but it could irradiate the tumor area and the surrounding edema area with different doses and form a dose gradient in the tumor area and surrounding tissues, reducing the amount of normal brain tissue .