摘要
背景与目的:恶性胶质瘤传统放疗失败的主要原因是局部复发。如何提高局部放疗剂量同时降低不良反应是提高疗效的潜在解决方案。本文介绍了同期推量(SIB)调强放疗(IMRT)在高级别胶质瘤术后应用中的初步临床结果及剂量学分析。方法:2005年12月至2008年2月,26例高级别胶质瘤术后患者接受了同期推量调强放射治疗。所有患者行面罩固定CT扫描定位,确定靶体积(GTV,CTV)和紧要器官(OAR)。GTV确定为部分切除或次全切除的局部残留病灶。CTV定义为包括术前肿瘤病灶外加20mm边缘。采用同期推量技术,设置处方剂量GTV 60Gy,2.4Gy/f;CTV 50Gy,2.0Gy/f,使用MIMiC系统实施调强放疗。评价各靶区和OAR的剂量分布,观察急性不良反应,随访统计患者生存率。结果:全部患者均在5周之内顺利完成全程调强放疗。共计25次分割,每周5次。各靶区平均剂量GTV 60.8Gy,CTV 51.0Gy,PTV 45.5Gy。各紧要器官的平均剂量,在脑干、视交叉、视神经(病灶同侧)分别是20.5Gy、18.3Gy、10.2Gy。无患者因严重不良反应而中断治疗或延长放疗时间。1年、2年总生存率是61.5%、15.4%;无疾病进展生存率是15.3%、8.1%。结论:同期推量IMRT技术应用于高级别胶质瘤患者可提高局部放疗剂量并获得较理想的靶区剂量分布,OAR可得到良好的保护,其不良反应可以耐受。需进一步随机对照研究确认临床疗效。
BACKGROUND OBJECTIVE：The main reason of failure in malignant glioma therapy is the local recurrence.It＇s a potential solution by increasing irradiation dose and decreasing toxicity.We described the initial clinical effects and dosimetry analyses using intensity-modulated radiation therapy（IMRT）with simultaneous integrated boost（SIB） technique in high-grade gliomas.METHODS：From December 2005 to Februry 2008,26 patients with high-grade glioma after operation received IMRT with SIB technique.All patients fixed with mask and had a CT scan.The target volumes（GTV,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 20mm margin.The doses of prescription are GTV 60Gy,2.4Gy/f;CTV 50Gy,2.0Gy/f using SIB technique and IMRT was implemented with MIMiC System.The dose distribution of target volumes and OAR were evaluated.Toxicity was evaluated and survival rates were calculated.RESULTS：All the patients finished IMRT in 5 weeks with 25 fractions,5f/w.The average dose at GTV,CTV and PTV is respectively 60.8Gy,51.0Gy and 45.5Gy,at brainstem,optic chiasm and optic nerve（the same as ill side）,20.5Gy,18.3Gy and 10.2Gy.The treatment wasn＇t interrupted or delayed due to severe toxicity.The 6-monthe overall survival（OS） and progression-free survival（PFS） respectively were 61.5% and 15.4%,15.3% and 8.1%,respectively.CONCLUSIONS：There are local irradiation dose increases and good dose distribution of target volumes,well protected OAR and acceptable toxicity,by using IMRT with SIB technique in high-grade gliomas.It＇s necessary that more random control clinical trial is taken to verify the clinical effects.
出处
《中国神经肿瘤杂志》
2010年第2期113-116,共4页
Chinese Journal of Neuro-Oncology
关键词
胶质瘤
调强放射治疗
紧要器官
同期推量
Gliomas
Intensity-modulated radiotherapy
Organs at risk
Simultaneous integrated boost
