PDF(Pubmed)
Abstract：
BACKGROUND: The prognosis of recurrent glioblastoma (GBM) is poor, with limited options of palliative localized or systemic treatments. Survival can be improved by a second localized treatment; however, it is not currently possible to identify which patients would benefit from this approach. This study aims to evaluate which factors lead to a lower Karnofsky performance status (KPS) score after fractionated stereotactic RT (fSRT).
METHODS: We retrospectively collected data from patients treated with fSRT for recurrent GBM at the Institut de Cancérologie de Lorraine between October 2010 and November 2017 and analyzed which factors were associated with a lower KPS score.
RESULTS: 59 patients received a dose of 25 Gy in 5 sessions spread over 5-7 days (80% isodose). The median time from the end of primary radiotherapy to the initiation of fSRT was 10.7 months. The median follow-up after fSRT initiation was 8.8 months. The incidence of KPS and ADL impairment in all patients were 51.9% and 37.8% respectively with an adverse impact of PTV size on KPS (HR = 1.57 [95% CI 1.19-2.08], p = 0.028). Only two patients showed early grade 3 toxicity and none showed grade 4 or late toxicity. The median overall survival time, median overall survival time after fSRT, median progression-free survival and institutionalization-free survival times were 25.8, 8.8, 3.9 and 7.7 months, respectively. Initial surgery was associated with better progression-free survival (Hazard ratio (HR) = 0.48 [95% CI 0.27-0.86], p = 0.013).
CONCLUSIONS: A larger PTV should predicts lower KPS in the treatment of recurrent GBM using fSRT.
METHODS: We retrospectively collected data from patients treated with fSRT for recurrent GBM at the Institut de Cancérologie de Lorraine between October 2010 and November 2017 and analyzed which factors were associated with a lower KPS score.
RESULTS: 59 patients received a dose of 25 Gy in 5 sessions spread over 5-7 days (80% isodose). The median time from the end of primary radiotherapy to the initiation of fSRT was 10.7 months. The median follow-up after fSRT initiation was 8.8 months. The incidence of KPS and ADL impairment in all patients were 51.9% and 37.8% respectively with an adverse impact of PTV size on KPS (HR = 1.57 [95% CI 1.19-2.08], p = 0.028). Only two patients showed early grade 3 toxicity and none showed grade 4 or late toxicity. The median overall survival time, median overall survival time after fSRT, median progression-free survival and institutionalization-free survival times were 25.8, 8.8, 3.9 and 7.7 months, respectively. Initial surgery was associated with better progression-free survival (Hazard ratio (HR) = 0.48 [95% CI 0.27-0.86], p = 0.013).
CONCLUSIONS: A larger PTV should predicts lower KPS in the treatment of recurrent GBM using fSRT.
摘要：
背景：复发性胶质母细胞瘤（GBM）的预后较差，姑息性局部或全身治疗的选择有限。生存率可以通过第二次局部治疗来提高；然而，目前尚无法确定哪些患者将从这种方法中受益.这项研究旨在评估在分割立体定向RT（fSRT）后，哪些因素导致较低的Karnofsky表现状态（KPS）评分。
方法：我们回顾性收集了2010年10月至2017年11月在洛林癌症研究所接受fSRT治疗的复发性GBM患者的数据，并分析了哪些因素与较低的KPS评分相关。
结果：59例患者在5-7天的5个疗程中接受了25Gy的剂量（80％等剂量）。从初次放疗结束到fSRT开始的中位时间为10.7个月。fSRT开始后的中位随访时间为8.8个月。所有患者的KPS和ADL损害发生率分别为51.9%和37.8%，PTV大小对KPS有不利影响（HR=1.57[95%CI1.19-2.08]，p=0.028)。只有两名患者表现出早期3级毒性，没有一名患者表现出4级或晚期毒性。中位总生存时间，fSRT后中位总生存时间，中位无进展生存期和无住院时间分别为25.8、8.8、3.9和7.7个月,分别。初次手术与更好的无进展生存期相关（危险比（HR）=0.48[95％CI0.27-0.86]，p=0.013)。
结论：在使用fSRT治疗复发性GBM时，较大的PTV应预测较低的KPS。
方法：我们回顾性收集了2010年10月至2017年11月在洛林癌症研究所接受fSRT治疗的复发性GBM患者的数据，并分析了哪些因素与较低的KPS评分相关。
结果：59例患者在5-7天的5个疗程中接受了25Gy的剂量（80％等剂量）。从初次放疗结束到fSRT开始的中位时间为10.7个月。fSRT开始后的中位随访时间为8.8个月。所有患者的KPS和ADL损害发生率分别为51.9%和37.8%，PTV大小对KPS有不利影响（HR=1.57[95%CI1.19-2.08]，p=0.028)。只有两名患者表现出早期3级毒性，没有一名患者表现出4级或晚期毒性。中位总生存时间，fSRT后中位总生存时间，中位无进展生存期和无住院时间分别为25.8、8.8、3.9和7.7个月,分别。初次手术与更好的无进展生存期相关（危险比（HR）=0.48[95％CI0.27-0.86]，p=0.013)。
结论：在使用fSRT治疗复发性GBM时，较大的PTV应预测较低的KPS。
