Fractionated Gamma Knife and Synchronous Chemotherapy in the Treatment of Adult Supratent-orial High-grade Glioma
|School||Luzhou Medical College|
|Keywords||Gamma Knife TMZ High-grade gliomas Stereotacticradiosurgery|
Background and Purpose: Glioma, the majority of which ishigh-grade gliomas, glioblastoma (GBM) mainly, represent the mostcommon form of intracranial primary tumor. Since the aggressive growthcharacter of high-grade gliomas, it is hard to be complete resected andeasy to relapse. Surgical resection followed by radiotherapy andchemotherapy in the treatment of glioma is vrey important. However, thetolerance dose of normal brain as well as the functional areas of brain toradiotherapy limits the increase of radiation therapy dose, and the overallefficacy of radiotherapy is unsatisfactory, and expand the range ofirradiation or change the dose fractionation can not significantly improvethe quality of life andsurvival rate. This, stereotactic radiosurgery (SRS)is a safe and effective treatment of postoperative residual tumor orunresectable tumor lesions, such as Gamma Knife, CyberKnife, protonknife, which has accumulated a wealth of clinical experience in thetreatment of benign intracranial tumor. The treatment effect and lowadverse reaction of SRS has been fully affirmed, at the same time,because of it’s non-invasive, non-pain characteristics, the range of applicationsSRS as postoperative adjuvant or alternative treatment of brain tumors iswider and wider. For example, the Gamma Knife can effectively inhibitthe multiplication of the glioma cells, so, after resection, using GammaKnife, SRS or fractionated radiotherapy combined with chemotherapy inthe treatment of glioma has positive significance. Current treatment ofhigh-grade gliomas has involved maximal surgical resection,chemoradiontherapy, immunotherapy, genetherapy, targetedtherapy.Wherein, for the residual after resection, small tumor or the recurrentglioma, gamma knife play an increasingly important role. In this trial, wecompare the therapeutic efficacy of SRS combined with temozolomidewith that of Gamma Knife fractionated radiotherapy combined withtemozolomide for high-grade gliomas, provide the data and the basis forthe treatment of high grade gliomas. Methods: From January2009toDecember2011,52complete follow-up patients with high-grade gliomasof Gamma Knife treatment room of363Hospital,30cases (57.69%) ofmale,22cases (42.31%) of female, Age from21-82years old, with anaverage age of44.48years were analyzed. These patients were dividedinto two groups as SRS combined with temozolomide(24cases,14casesof male,10cases of female) and fractionated SRS combined withtemozolomide (28cases,16males and12females). The retrospectiveanalysis to evaluate its therapeutic effect, The chi-square test and (or) the Fisher exact test method were used to analyzed statistically significant ofthe response rate of two groups. Survival analysis were studied byKaplan–Meier curves,the Cox proportional hazards method was used toanalyz the relevant factors of the survival of all patients, those factorsincluded gender, age, tumor location, tumor type, size of thepostoperative residual tumor. fractionated SRS dose was from23to34Gy in2-3fractions,once per2or7days, and the SRS dose was escalatedfrom10to22Gy, mean dose16Gy,treatment of peripheral dose,follow-up time, and other related factors. P＜0.05was considered asstatistically significant results.Results: The response and side effect rateof fractionated SRS combined with temozolomide group weresignificantly better than that of SRS combined with temozolomide group(X2=5.223, P=0.022). Tumor control rate is significantly influenced byprescription dose (X2=5.822, P=0.016). gender, age, tumor location,tumor type, size of the postoperative residual tumor and symptoms aftersurgery did not influence patient’s survival. Locally controll and overallsurvival was significantly influenced by radiation dose(P=0.03).Conclusion: The local contral and overall survival rates ofpostoperative fractionated SRS combined with temozolomide were betterthan that of SRS combined with temozolomide, and fractionated SRScombined temozolomide can improve patient outcomes and quality oflife, reduce side effect and complication. fractionated SRS combined with temozolomide is a safe, feasible and effective postoperative methodfor high-grade gliomas patients. The cases of this study sample is still few,conclusion needed continuously long-term clinical test.