[Choice of fractionation regimen for Grade IV gliomas depending on rapid early progression].

Q4 Medicine Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko Pub Date : 2024-01-01 DOI:10.17116/neiro20248805123

A S Chuguev, T M Kobyletskaya, V A Gerasimov, A A Belikova, A D Kaprin, P V Datsenko

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Abstract

Objective: To investigate the effect of two fractionation regimens on survival in patients with Grade IV gliomas depending on rapid early progression (REP).

Material and methods: Fractionation with prescribed doses of 2 and 3 Gy was alternately used in 140 patients with morphologically confirmed Grade IV glioma using a pairwise modeling strategy.

Results: REP was diagnosed in 60 (42.9%) out of 140 patients with Grade IV gliomas and 55 (45.5%) out of 121 patients with glioblastomas. Fatal outcome was observed in 111 (79.3%) patients, 99 (70.7%) ones died from progression of glioma. In case of no REP, the median overall survival as of December 2023 was 32.20 (95% CI 25.7-38.7) months, with REP - only 16.03 (95% CI 13.5-18.6) months (p<0.0001). Median survival was slightly lower in patients with glioblastoma - 28.2 and 16.5 months, respectively (p<0.0001).

In patients with Grade IV gliomas and no REP, 3 Gy (n=40) fractionation regimen was followed by median overall survival 44.98 (95% Cl 15.3-74.6) months, 2 Gy (n=40) - 20.99 (95% CI 9.2-32.7) months (p=0.027). In case of glioblastoma, differences between fractionation regimes lose significance - medians 33.7 and 19.7 months, respectively (p=0.081). According to multivariate analysis, 3 Gy fractionation regimen is more effective than standard radiotherapy (p=0.009) in patients without REP, while significance of isoeffective doses <59.5Gy≥ is slightly lower (p=0.020). Radiotherapy on the background of temozolomide is equally important (p=0.007).

In patients with grade 4 gliomas and REP, 3 Gy (n=30) fractionation regimen was followed by median overall survival 17.18 (95% CI 14.2-20.2) months, 2 Gy (n=30) - 12.88 (95% CI 5.4-20.3) months (p=0.849). In case of glioblastoma, Cox model classification matrix looks as follows: fractionation variant (p=0.423), isoeffective dose <59.5Gy≥ (p<0.0001), temozolomide during radiotherapy (p=0.701), functional status (p=0.485).

Conclusion: In patients with Grade IV gliomas and no REP, 3 Gy fractionation regimen has significant advantages over standard radiotherapy regarding overall survival. In case of more aggressive course of tumor (REP), higher single dose does not improve treatment outcomes. Isoeffective dose ≥59.5Gy is of great importance.

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[IV级胶质瘤分化方案的选择取决于早期病情的快速进展]。

目的根据快速早期进展（REP）情况，研究两种分次治疗方案对IV级胶质瘤患者生存期的影响：采用配对建模策略，对140例形态学确诊的IV级胶质瘤患者交替使用规定剂量为2 Gy和3 Gy的分次治疗方案：140例IV级胶质瘤患者中有60例（42.9%）确诊为REP，121例胶质母细胞瘤患者中有55例（45.5%）确诊为REP。111例（79.3%）患者出现死亡，其中99例（70.7%）死于胶质瘤进展。在无 REP 的情况下，截至 2023 年 12 月的中位总生存期为 32.20（95% CI 25.7-38.7）个月，而有 REP 的情况下--仅为 16.03（95% CI 13.5-18.6）个月（pp.6）个月（pp在IV级胶质瘤且无REP的患者中，采用3 Gy（n=40）分期治疗方案后，中位总生存期为44.98（95% Cl 15.3-74.6）个月，2 Gy（n=40）-20.99（95% CI 9.2-32.7）个月（p=0.027）。就胶质母细胞瘤而言，不同分化方案之间的差异失去了意义--中位数分别为33.7个月和19.7个月（P=0.081）。根据多变量分析，在无 REP 的患者中，3 Gy 分次疗法比标准放疗更有效（p=0.009），而等效剂量的显著性 p=0.020）。在4级胶质瘤和REP患者中，3 Gy（n=30）分次方案的中位总生存期为17.18（95% CI 14.2-20.2）个月，2 Gy（n=30）-12.88（95% CI 5.4-20.3）个月（p=0.849）。对于胶质母细胞瘤，Cox模型分类矩阵如下：分型变异（P=0.423）、等效剂量（P=0.701）、功能状态（P=0.485）：结论：对于 IV 级胶质瘤且无 REP 的患者，3 Gy 分次方案在总生存期方面比标准放疗有明显优势。结论：对于 IV 级胶质瘤且无 REP 的患者，3 Gy 分次方案在总生存期方面比标准放疗方案有明显优势。等效剂量≥59.5Gy非常重要。

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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来源期刊

Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko Medicine-Neurology (clinical)

CiteScore

0.70

自引率

0.00%

发文量

期刊介绍： Scientific and practical peer-reviewed journal. This publication covers the theoretical, practical and organizational problems of modern neurosurgery, the latest advances in the treatment of various diseases of the central and peripheral nervous system. Founded in 1937. English version of the journal translates from Russian version since #1/2013.