Analysis Of Recurrence Patterns Of Glioma And Study On The Effect Of Re-radiotherapy

Background and purpose:Glioma,or so called neurogliocytoma,is the most common malignant tumor of the central nervous system in adults,with rapid progression,high recurrence rate and low cure rate,which makes it a major problem in medical field.This article retrospectively analyzed the clinical data of 22 patients with recurrent glioma treated by the department of oncological radiotherapy in Bengbu Medical College First Affiliated Hospital from 2013 to 2016,aiming to study the recurrent patterns of glioma and to explore the effect of recourse radiotherapy,and to analyze the factors that affect the survival and prognosis of recurrent patients after recourse radiotherapy.Methods:To retrospectively analyze the clinical data of 22 patients with recurrent gliomas treated by the department of oncological radiotherapy in Bengbu Medical College First Affiliated Hospital from January 2013 to December 2016,All patients who received surgical treatment at first onset,followed by chemoradiotherapy after operation,were diagnosed as tumor recurrence by pathological or MRI examination.Including 14 males and 8 females;the recurrence age ranged from 6 to 58 years and the median age was 46 years.Cardiothoracic scores were all higher than 60 before reradiation.Pathological grade: 4 cases in class II,10 cases in class III and 8 cases in class IV.22 patients with recurrent glioma received IMRT,including 6 cases of radiotherapy alone and 16 cases of concurrent chemoradiotherapy.Refer to view the MRI images,analyze the relationship between the tumor edema and tumor recurrence site.Data were analyzed using SPSS 19.0 statistical software,Kaplan-Meier method was used for survival analysis,and Log-rank method was used for testing.Univariate analysis was used to predict prognostic factors and Cox proportional hazards model was used to perform multivariate analysis.Results:The type of recurrence and growth tendency was the most common in situ type(54.55%),followed by peripheral type(9.9%),and the tendency of mild peritumoral edema was more in situ type(7/8);heavy degree of edema,growth tendency type mostly peripheral(8/14).Radiotherapy was performed after the head MRI review,the treatment area of the recent evaluation of efficacy: CR:3 cases(13.64%),PR: 8 cases(36.36%),SD: 7 cases(31.82%),The total effective rate(CR + PR): 50%(11/22),the stability rate(CR+PR+SD): 81.82%(18/22).The 3-year cumulative survival rate was 38.1%.The median progression-free survival(PFS)was 18 months.The 6-month and 12-month PFS were 61.90%(13/21)and 52.38%,The mean OS was 22 months,and the 6-month and 1-year survival rates were 85.71%(18/21)and 61.90%(13/21),respectively.The incidence of acute radiation-induced brain edema was 27.27%.The adverse reactions caused by treatments were mild and reversible.No severe ?-? myelosuppression was observed,no thrombocytopenia and significant liver and kidney dysfunction were found,and no treatment-related Deaths.The results of univariate analysis showed that KPS?70 points(?2 = 9.53,P = 0.002),age?50(?2=5.408,P=0.02),pathological grade(?2 =6.57,p=0.01),recurrence time?6 months(?2=11.068,P=0.001)were associated with prognosis,sex(?2 =0.112,p=0.727),whether or not combined with famotidine chemotherapy(?2 =0.224,p=0.636)had no significant correlation with the prognosis of recurrent patients..Cox proportional hazards model multivariate analysis showed that KPS score and pathological grade were prognostic factors.Conclusion:The type of recurrence and growth trend to the most common in situ type,glioma newly diagnosed degree of peritumoral edema have a significant impact on the trend of tumor recurrence.IMRT is a safe and effective treatment of recurrent glioma,Age,KPS score,pathological grade,recurrence time and prognosis are related to the prognosis,KPS score and pathological grade are independent prognostic factors.