Background

Despite multimodality treatment, the prognosis of glioblastoma (GBM) has remained poor. Intraoperative radiation therapy (IORT) offers additional local control by directly applying a radiation source to the resection margin, where most recurrences occur.

Methods

We performed a systematic review on the oncologic outcomes and toxicities of IORT for GBM in the era of modern external beam radiation therapy (EBRT) and chemotherapy with temozolamide.

Results

Four studies representing 123 patients were included. Majority (81%) were newly diagnosed, and gross total resection was reported in 13–80% of cases. IORT modalities included electrons from a linear accelerator (LINAC) and photons from a 50-kV x-ray device. Median doses were from 12.5 to 20 Gy for electron-based studies and 10–25 Gy for photon-based studies. Adjuvant treatment consisted of 46–60 Gy post-operative EBRT in electron-based studies and the Stupp protocol in photon-based studies. Complications included radiation necrosis (2.8–33%), infection, hematoma, perilesional edema, and wound dehiscence. Median time to local recurrence was 9.9–16 months and the reported overall progression-free survival was 11.2–12.2 months. Median overall survival was 13–14.2 months for the electron-based studies and 13.8–18 months for the photon-based studies.

Conclusion

IORT resulted in improved local control and comparable overall survival rates with the Stupp protocol. Although photon-based IORT had better results than electron IORT, this may be due to improvements in other forms of adjuvant treatment rather than the IORT modality itself. The overall effect of IORT on GBM treatment is still inconclusive due to the small number of patients and heterogeneous reporting of data.

中文翻译：

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胶质母细胞瘤术中放疗：技术和结果的系统评价

背景

尽管进行了多模式治疗，但胶质母细胞瘤 (GBM) 的预后仍然很差。术中放射治疗 (IORT) 通过将放射源直接应用于切除边缘，提供额外的局部控制，其中大部分复发发生。

方法

我们对现代外照射放疗 (EBRT) 和替莫唑胺化疗时代 IORT 治疗 GBM 的肿瘤学结果和毒性进行了系统评价。

结果

包括代表 123 名患者的四项研究。大多数 (81%) 是新诊断的，13-80% 的病例报告了全切除。IORT 模式包括来自直线加速器 (LINAC) 的电子和来自 50 kV X 射线设备的光子。基于电子的研究的中位剂量为 12.5 至 20 Gy，基于光子的研究为 10-25 Gy。辅助治疗包括基于电子的研究中的 46-60 Gy 术后 EBRT 和基于光子的研究中的 Stupp 方案。并发症包括放射性坏死（2.8-33%）、感染、血肿、病灶周围水肿和伤口裂开。局部复发的中位时间为 9.9-16 个月，报告的总无进展生存期为 11.2-12.2 个月。基于电子的研究的中位总生存期为 13-14.2 个月，基于光子的研究为 13.8-18 个月。

结论

IORT 改善了局部控制并与 Stupp 方案相比具有可比的总体存活率。虽然基于光子的 IORT 比电子 IORT 有更好的结果，但这可能是由于其他形式的辅助治疗的改进，而不是 IORT 方式本身。由于患者数量少和数据报告异质性，IORT 对 GBM 治疗的整体效果仍无定论。