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3차원 입체조형치료에 의한 아교모세포종의 방사선 선량증가 연구

Other Titles
 Radiation Dose-escalation Trial for Glioblastomaswith 3D-conformal Radiotherapy 
 조재호  ;  이창걸  ;  서창옥  ;  김동석  ;  김태곤  ;  장종희  ;  윤덕현  ;  심수정  ;  조삼주  ;  이세병  ;  박진호  ;  김경주 
 Journal of the Korean Society for Therapeutic Radiology and Oncology, Vol.22(4) : 237-246, 2004 
Journal Title
Journal of the Korean Society for Therapeutic Radiology and Oncology(대한방사선종양학회지)
Issue Date
Glioblastoma ; 3D-CRT ; Dose escalation ; Target volume
Purpose: To investigate the effects of radiation dose-escalation on the treatment outcome, complications and the other prognostic variables for glioblastoma patients treated with 3D-conformal radiotherapy (3D-CRT).

Materials and Methods: Between Jan 1997 and July 2002, a total of 75 patients with histologically proven diagnosis of glioblastoma were analyzed. The patients who had a Karnofsky Performance Score (KPS) of 60 or higher, and received at least 50 Gy of radiation to the tumor bed were eligible. All the patients were divided into two arms; Arm 1, the high-dose group was enrolled prospectively, and Arm 2, the low-dose group served as a retrospective control. Arm 1 patients received 63~70 Gy (Median 66 Gy, fraction size 1.8~2 Gy) with 3D-conformal radiotherapy, and Arm 2 received 59.4 Gy or less (Median 59.4 Gy, fraction size 1.8 Gy) with 2D-conventional radiotherapy. The Gross Tumor Volume (GTV) was defined by the surgical margin and the residual gross tumor on a contrast enhanced MRI. Surrounding edema was not included in the Clinical Target Volume (CTV) in Arm 1, so as to reduce the risk of late radiation associated complications; whereas as in Arm 2 it was included. The overall survival and progression free survival times were calculated from the date of surgery using the Kaplan-Meier method. The time to progression was measured with serial neurologic examinations and MRI or CT scans after RT completion. Acute and late toxicities were evaluated using the Radiation Therapy Oncology Group neurotoxicity scores.

Results: During the relatively short follow up period of 14 months, the median overall survival and progression free survival times were 15±1.65 and 11±0.95 months, respectively. There was a significantly longer survival time for the Arm 1 patients compared to those in Arm 2 (p=0.028). For Arm 1 patients, the median survival and progression free survival times were 21±5.03 and 12±1.59 months, respectively, while for Arm 2 patients they were 14±0.94 and 10±1.63 months, respectively. Especially in terms of the 2-year survival rate, the high-dose group showed a much better survival time than the low-dose group; 44.7% versus 19.2%. Upon univariate analyses, age, performance status, location of tumor, extent of surgery, tumor volume and radiation dose group were significant factors for survival. Multivariate analyses confirmed that the impact of radiation dose on survival was independent of age, performance status, extent of surgery and target volume. During the follow-up period, complications related directly with radiation, such as radionecrosis, has not been identified.

Conclusion: Using 3D-conformal radiotherapy, which is able to reduce the radiation dose to normal tissues compared to 2D-conventional treatment, up to 70 Gy of radiation could be delivered to the GTV without significant toxicity. As an approach to intensify local treatment, the radiation dose escalation through 3D-CRT can be expected to increase the overall and progression free survival times for patients with glioblastomas.
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Appears in Collections:
1. College of Medicine (의과대학) > Research Institute (부설연구소) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kyoung Ju(김경주)
Kim, Dong Seok(김동석)
Kim, Tae Gon(김태곤)
Bak, Jino(박진호)
Suh, Chang Ok(서창옥)
Shim, Su Jung(심수정)
Lee, Se Byeoung(이세병)
Lee, Chang Geol(이창걸) ORCID logo https://orcid.org/0000-0002-8702-881X
Chang, Jong Hee(장종희) ORCID logo https://orcid.org/0000-0003-1509-9800
Cho, Jae Ho(조재호) ORCID logo https://orcid.org/0000-0001-9966-5157
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