Hyperfractionated and accelerated-hyperfractionated radiotherapy for glioblastoma multiforme.

C Nieder, U Nestle, R Ketter, H Kolles, S J Gentner, W I Steudel, K Schnabel
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引用次数: 35

Abstract

Because of promising radiobiological advantages allowing dose escalation and/or reduction of treatment time, hyperfractionated and accelerated-hyperfractionated radiotherapy (hf-rt, ahf-rt) were introduced as part of treatment of glioblastoma multiforme (gbm). In December 1988 we started a prospective study of hf-rt (total dose 78 Gy, two daily fractions of 1.3 Gy, interval between daily fractions 6 hr, treatment time 6 weeks, n = 34 patients). The results were compared with our previous regimen of conventionally fractionated radiotherapy (cf-rt: total dose 60 Gy, single dose 2 Gy, treatment time 6 weeks, n = 32 patients). In June 1990, the protocol was modified in order to reduce treatment time (ahf-rt: total dose 60 Gy, two daily fractions of 1.5 Gy, interval 6 hr, treatment time 4 weeks, n = 92 patients until December 1996). No chemotherapy was given. Entry criteria were: age > or = 17 years, pathological diagnosis of supratentorial gbm, and no previous treatment other than surgery. The ahf-rt group included significantly more patients with previous surgical resection instead of biopsy only. Compared with the cf-rt group, both the hf-rt and the ahf-rt group included significantly more patients with frontal tumor location. We found no significant survival difference between the groups (median survival 7-10 months, 1-year survival rate 19%-29%). Progression-free survival, clinical course, and toxicity were also not significantly different. Karnofsky performance status, age, and corticosteroid dose during radiotherapy were the most important prognostic factors. The results of this trial are in large agreement with most previous publications. It demonstrated no improved survival. However, it showed that treatment time can be reduced by ahf-rt without loss of survival benefit or intolerable toxicity. A short radiotherapy course might be appropriate for many patients with gbm who are not suitable for rather aggressive investigational therapies.

多形性胶质母细胞瘤的超分割和加速超分割放疗。
由于有希望的放射生物学优势,可以增加剂量和/或减少治疗时间,超分割和加速超分割放疗(hf-rt, ahf-rt)被引入作为多形胶质母细胞瘤(gbm)治疗的一部分。1988年12月,我们开始了一项hf-rt的前瞻性研究(总剂量为78 Gy,每日两次1.3 Gy,每日两次间隔6小时,治疗时间6周,n = 34例患者)。结果与我们以往的常规分次放疗方案(cf-rt:总剂量60 Gy,单次剂量2 Gy,治疗时间6周,n = 32例)进行比较。1990年6月,为了缩短治疗时间,对方案进行了修改(ahf-rt:总剂量60戈瑞,每日两次1.5戈瑞,间隔6小时,治疗时间4周,截至1996年12月,n = 92例患者)。没有化疗。入组标准:年龄>或= 17岁,病理诊断为幕上gbm,除手术外无其他治疗史。ahf-rt组包括更多既往手术切除而非活检的患者。与cf-rt组相比,hf-rt组和ahf-rt组均有更多的患者出现额部肿瘤。我们发现两组间生存率无显著差异(中位生存期7-10个月,1年生存率19%-29%)。无进展生存期、临床病程和毒性也无显著差异。Karnofsky性能状态、年龄和放射治疗期间皮质类固醇剂量是最重要的预后因素。这项试验的结果与大多数先前的出版物在很大程度上一致。结果显示生存率没有提高。然而,它表明ahf-rt可以缩短治疗时间,而不会失去生存益处或无法忍受的毒性。对于许多不适合进行积极的研究性治疗的gbm患者,短期放疗可能是合适的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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