CAJ | 학술논문

目的：探索调强适形放疗（IM RT ）后程结合γ刀推量放射治疗术后高级别脑胶质瘤的疗效，并探讨其预后影响因素。方法选择2007年6月至2010年6月间我院放疗科收治的60例术后病理证实为Ⅲ～Ⅳ级脑胶质瘤，且未口服过替莫唑胺化疗的患者，对照组30例采用单纯IM RT 放疗方法；观察组30例采用IM RT结合后程γ刀推量放疗方法，比较两组的近期疗效（3个月后M RI复查结果）及1年、2年、3年生存率，并用COX模型对综合组进行预后多因素分析。结果观察组3个月总有效率为70．0％（21／30）；对照组3个月总有效率为23．3％（7／30），两组之间比较差异具有统计学意义（χ2＝13．125，P＜0．05），观察组与对照组1年、2年、3年生存率分别为76．67％（23／30）、63．33％（19／30）、30．00％（9／30）；70．00％（21／30）、56．67％（17／30）、23．33％（7／30），两组之间比较差异具有无统计学意义（χ2＝0．341，P＞0．05；χ2＝0.278，P＞0．05；χ2＝0．341，P＞0．05），COX模型对综合组进行预后多因素分析显示：年龄、病理类型与预后有关，K PS评分、性别与预后无密切关系。结论 IM RT放疗结合γ刀推量放射治疗未口服过替莫唑胺的术后高级别脑胶质瘤，明显提高了病灶局部控制率（近期疗效），但远期疗效（1年、2年、3年生存率）并未提高，COX模型对综合组进行预后分析显示，年龄、病理类型与预后有关，而K PS评分、性别与预后无关。
목적：탐색조강괄형방료（IM RT ）후정결합γ도추량방사치료술후고급별뇌효질류적료효，병탐토기예후영향인소。방법선택2007년6월지2010년6월간아원방료과수치적60례술후병리증실위Ⅲ～Ⅳ급뇌효질류，차미구복과체막서알화료적환자，대조조30례채용단순IM RT 방료방법；관찰조30례채용IM RT결합후정γ도추량방료방법，비교량조적근기료효（3개월후M RI복사결과）급1년、2년、3년생존솔，병용COX모형대종합조진행예후다인소분석。결과관찰조3개월총유효솔위70．0％（21／30）；대조조3개월총유효솔위23．3％（7／30），량조지간비교차이구유통계학의의（χ2＝13．125，P＜0．05），관찰조여대조조1년、2년、3년생존솔분별위76．67％（23／30）、63．33％（19／30）、30．00％（9／30）；70．00％（21／30）、56．67％（17／30）、23．33％（7／30），량조지간비교차이구유무통계학의의（χ2＝0．341，P＞0．05；χ2＝0.278，P＞0．05；χ2＝0．341，P＞0．05），COX모형대종합조진행예후다인소분석현시：년령、병리류형여예후유관，K PS평분、성별여예후무밀절관계。결론 IM RT방료결합γ도추량방사치료미구복과체막서알적술후고급별뇌효질류，명현제고료병조국부공제솔（근기료효），단원기료효（1년、2년、3년생존솔）병미제고，COX모형대종합조진행예후분석현시，년령、병리류형여예후유관，이K PS평분、성별여예후무관。
Objective To explore clinical efficacy of postoperative high -grade intracranial glioma treated by the intensity modulated conformal radiotherapy (IMRT) combined with γ-knife Integrated boost radiother-apy ,and to explore the prognostic factors .Methods 6 0 cases postoperative patients were selected ,all of those were treated in our hospital radiotherapy department June 2 0 0 7 - June 2 0 1 0 and been pathologically confirmed grade Ⅲ ~ Ⅳ grade intracranial glioma and been not taken the oral temozolomide chemotherapy ,3 0 cases of the control group were treated by IMRT Simply ;30cases of the observation group were treated by IMRT combined with γ-knife Integrated boost radiotherapy ,short -term effect (MRI review results after 3 -months) and 1 -year ,2 -year ,3 -year survival rates were compared ,multivariate prognostic factors were analyzed by using COX model .Results The 3 -months total effective rate was 7 0 .0% (2 1/3 0 ) in the observation group ,2 3 .3%(7/3 0 )in the control group ,the difference between the two groups was statistically significant (χ2 =1 3 .1 2 5 ,P<0 .0 5 ) ,1 -year、2 -year、3 -year survival rates were respectively 7 6 .6 7% (2 3/3 0 )、6 3 .3 3% (1 9/3 0 )、3 0.0 0% (9/3 0 ) in the observation group ;7 0 .0 0% (2 1/3 0 )、5 6 .6 7% (1 7/3 0 )、2 3 .3 3% (7/3 0 ) in the control group ,the difference between the two groups was not statistically significant (χ2 = 0 .3 4 1 ,P= 0 .5 5 9 ;χ2 =0.2 7 8 ,P=0 .5 9 8 ;χ2 =0 .3 4 1 ,P=0 .5 5 9 ) ,multivariate prognostic factors analysis by using COX model on the observation group showed :age、pathological type were related with prognosis ,KPS scores、gender were not .Con-clusion IMRT radiotherapy combined with γ-knife Integrated boost radiotherapy significantly improved local tumor control rate (short -term effect) of postoperative patients who were pathologically confirmed grade Ⅲ ~Ⅳ grade intracranial glioma and were not been taken the oral temozolomide chemotherapy ,but the long -term efficacy (1 -year、2 -year、3 -year survival rates) did not been improved ,multivariate prognostic factors analy-sis by using COX model on the observation group showed :age、pathological type were related with prognosis , while ,KPS scores、gender were not .