目的:探讨多发高级别胶质瘤(multiple high-grade gliomas,M-HGGs)的病理特征及复发模式.方法:回顾性分析2020年08月至2022年04月于我院放射治疗科诊疗的26例M-HGGs患者,分析其病理特征、影像特征、治疗方式及复发模式.结果:本组26例患者均行手术治疗,术后病理示IDH野生型24例,IDH突变型2例,8例(30.8％)患者伴有MGMT启动子甲基化,免疫组化显示25例p53过表达,1例阴性;Ki-67均值为(40.19±6.99)％.24例患者术后行辅助治疗,2例行保守治疗.随访时间3～20个月,19例患者复发,14例(73.7％)局部复发,5例脑部远地部位复发;复发时间1～14个月,中位无进展生存期(progression-free survival,PFS)6个月.Kaplan-Meier生存分析显示手术切除程度及术后辅助治疗与较好的PFS相关(P=0.001,P=0.000);多变量分析同样提示手术切除程度及术后辅助治疗是改善PFS的预后因素(P=0.006,P=0.031).结论:M-HGGs多为IDH野生型,且伴有p53过表达和高Ki-67增殖指数等不良预后指标;局部复发仍是M-HGGs最常见的复发模式,手术切除程度和术后辅助治疗可能影响M-HGGs患者的预后.

Objective:To investigate the efficacy and safety of fractionated stereotactic radiotherapy (FSRT) based on linear accelerator for small volume brain metastases.Methods:A total of 21 patients with small volume brain metastases who received FSRT from August 2020 to June 2022 were enrolled as subjects, including 45 lesions. Small-volume brain metastases were defined as ≤3 cm in diameter and ≤6 cm 3 in volume, and the dose/fractionation scheme was 27-30 Gy/3 F or 30-40 Gy/5 F. Three months after radiotherpy, the efficacy of FSRT in small brain metastases and the incidence of radiation brain injury were evaluated, and the incidence of radiation brain injury in subgroup analysis was performed according to the diameter, volume, dose/fractionation scheme, biological effective dose (BED) 10, and location of lesions. Results:Twenty-four lesions (53.33%, 24/45) were evaluated as complete response, another 13 lesions (28.89%, 13/45) were evaluated as partial response, and in the remaining 8 lesions (17.78%, 8/45) were evaluated as stable disease. The local control rate was 100% (45/45), the objective remission rate was 82.22% (37/45), and the intracranial distant progression rate was 23.81% (5/21). During the treatment and follow-up, there were 7 lesions (15.56%, 7/45) of radiation-induced brain injury, and the incidence of symptomatic radiation-induced brain injury was 11.11% (5/45). Subgroup analysis showed that the incidence of radiation brain injury in the group with a lesion diameter of 2-3 cm was higher than that with a lesion diameter of <2 cm group, with a statistically significant difference [80.00% (4/5) vs. 7.50% (3/40), χ2=12.69, P<0.001]; the incidence rate of radiation brain injury in the group with lesion volume of 4-6 cm 3 was higher than that with lesion volume of <4 cm 3 group, with a statistically significant difference [57.14% (4/7) vs. 7.89% (3/38), χ2=7.49, P=0.006]. There was no significant difference in the incidence of radiation brain injury between the dose/fractionation scheme of lesions 27-30 Gy/3 F and 30-40 Gy/5 F [9.52% (2/21) vs. 20.83% (5/24), χ2=0.40, P=0.527]. There was no significant difference in the incidence of radiation brain injury between the BED 10<60 Gy and ≥60 Gy [28.57% (2/7) vs. 13.16% (5/38), χ2=0.22, P=0.641]. There was no significant difference in the incidence of radiation brain injury between the lesions in the same lobe and the single or multiple lesions in different lobes [28.57% (4/14) vs. 9.68% (3/31), χ2=1.38, P=0.240) . Conclusion:FSRT based on linear accelerator is effective for small volume brain metastases. Brain metastases with the diameter <2 cm or volume <4 cm 3 are associated with a lower incidence of radiation brain injury than that of lesions with the diameter of 2-3 cm or volume of 4-6 cm 3.

Objectives: To explore the clinicopathological features and prognosis of multifocal high-grade gliomas (M-HGGs) with H3F3A mutation in adults. Methods: Four adult patients with H3F3A-mutant M-HGGs who were treated at our institution from August 2020 to December 2021 were reviewed, including clinical, pathological and radiologic data. A series of 16 adult patients with M-HGGs without H3F3A mutation was used as a comparative group. Progression-free survival (PFS) and overall survival (OS) were compared between the groups using the Kaplan–Meier method. Results: All patients were IDH wild-type and TERT wild-type, and P53 was overexpressed. A patient with the H3 G34R mutation and 1 of 3 patients with the H3 K27 M mutation had MGMT promoter methylation. The lesions with the H3 G34R mutation were located in the cerebral hemisphere; the lesions with H3 K27 alterations were mainly in the midline structure, and the cerebral hemisphere could also be involved. One patient underwent subtotal resection (STR), and 3 patients underwent biopsy. All patients received radiotherapy, and the median PFS and OS were 9.5 months and 14.5 months, respectively. The clinical outcomes were similar to those of non-H3F3A-mutated M-HGGs patients (median PFS and OS were 7.0 months and 18.0 months, respectively). Conclusion: We describe the clinicopathological features and outcomes of 4 adult M-HGGs patients with H3F3A mutation, and found this mutation doesn’t appear to have a negative outcome with the administration of current therapies.

Objective:To investigate the clinical efficacy of adjuvant radiotherapy after surgical resection of extraventricular neurocytoma (EVNs).Methods:A retrospective study was conducted on the clinical data of 10 EVN patients (accounting for 6.8% of intraventricular and extraventricular neurocytomas treated in the same period) who underwent tumor resection with or without postoperative adjuvant radiotherapy (RT) from January 2001 to December 2020. Among them, 5 cases were admitted to the Department of Neurosurgery and Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, and 5 cases were admitted to the Department of Neurosurgery and Department of Radiation Oncology of Xuanwu Hospital, Capital Medical University. The tumor was located in the sellar region in 2 cases, in the frontal lobe in 2 cases, in the thalamus in 3 cases, in the parietal lobe in 1 case and in the spinal cord in 2 cases. Six patients underwent three-dimensional conformal radiotherapy or adjuvant intensity-modulated radiation therapy with a median dose of 54 Gy (range: 50.4-58.0 Gy). Follow-up was performed postoperatively by out-patient clinic or telephone. Kaplan-Meier survival analysis was used to evaluate the survival of patients, and tumor recurrence was determined by imaging follow-up.Results:Except 1 case undergoing biopsy, the remaining 9 cases underwent tumor resection, including gross total resection in 3 cases, subtotal resection in 3 cases, and partial resection in 3 cases. All patients were followed up for a median of 69.5 months (range: 16-142 months). Among the 10 patients, a total of 3 relapsed, 2 of which were located in the cervical spinal cord and included 1 patient who underwent biopsy and 1 patient who underwent total resection. The former died of tumor recurrence 16 months after the operation; the latter underwent operation and radiotherapy after recurrence and still survived with tumor at the last follow-up. One patient developed orthotopic recurrence in the sellar region at 7 months post partial resection, underwent surgical resection and radiotherapy, and remained alive with residual tumor at the last follow-up. None of the 5 patients who received incomplete resection (subtotal resection or partial resection) plus adjuvant radiotherapy had a recurrence. Among the 3 patients who received total resection, 1 of the 2 patients who received no adjuvant radiotherapy had a recurrence, while the patient who received adjuvant radiotherapy had no recurrence. The 5-year and 10-year overall survival rates of the 10 patients were both 90%, and the 5-year and 10-year progression-free survival rates were 80% and 60%, respectively.Conclusion:Preliminary studies suggest that adjuvant radiotherapy after incomplete resection in patients with EVN may achieve progression-free survival comparable to total resection.

Purpose: Patients with grade II/III diffuse glioma (lower grade glioma, LGG) with isocitrate dehydrogenase wild-type (IDH-wt) and telomerase reverse-transcriptase promoter mutation (TERTp-mut) experience shorter overall survival (OS) time than IDH mutant patients. The optimal treatment strategy for these patients is unclear. We compared the effects of radiotherapy (RT) alone vs. RT concurrent with temozolomide (TMZ) followed by adjuvant TMZ in these LGG patients. Patients and methods: Thirty-seven LGG patients with IDH-wt and TERTp-mut were randomly allocated to either RT alone treatment (RT group, n = 18; 60 Gy in 30 daily fractions) or RT concurrent with TMZ (75 mg/m(2)/d, 7 d/week) followed by adjuvant TMZ (CRT group, n = 19). The median follow-up duration was 17 months. Log-rank test was used for OS and PFS comparisons. Results: The 1-year OS rate was 94.1% [95% confidence interval (CI) 82.9-100] in the CRT group and 74.6% (95% CI, 52.9-96.4) in the RT group. The median OS values in the CRT and RT groups were statistically different [25 vs. 17 months, respectively; hazard ratio (HR) 0.271; 95% CI, 0.092-0.793; P = 0.017], while PFS values were not (16 vs. 7 months, respectively; HR, 0.917; 95% CI, 0.397-2.120; P = 0.840). Multivariate analysis indicated that CRT treatment and female sex were associated with significantly longer OS (P = 0.001, P = 0.016, respectively). Conclusion: CRT treatment for IDH-wt/TERTp-mut grade II/III gliomas resulted in significantly longer OS than RT alone. Female sex was a significant favorable prognostic factor. (C) 2021 The Authors. Published by Elsevier B.V.

BackgroundHow germline single nucleotide polymorphisms are involved in the etiology of medulloblastoma remans poorly understood. We hypothesized that CCDKN2A/B rs1063192 and rs4977756 and also the long noncoding RNA (lncRNA) CDKN2BAS rs2157719 glioma susceptibility polymorphisms identified by genome-wide association studies may contribute to medulloblastoma predisposition. MethodsTo test this hypothesis, we genotyped these genetic variants among 160 medulloblastoma patients and 443 health controls in a Chinese population. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression. ResultsWe found that only the lncRNA CDKN2BAS rs2157719 T>C genetic polymorphism was significantly associated with an increased medulloblastoma risk (C allele: OR = 1.85, 95% CI = 1.32-2.58; p = 2.7 x 10(-4)). The stratified analyses showed an elevated risk of pediatric medulloblastoma associated with CDKN2BAS rs2157719 CC or TC genotype (both p < 0.05). Moreover, the association between the CDKN2BAS rs2157719 polymorphism and medulloblastoma risk is more pronounced in males (OR = 2.22, 95% CI = 1.36-3.62; p = 0.001). ConclusionsThe findings of the present study provide important insights into the genetic complexities and predisposition of medulloblastoma in Chinese, especially at the lncRNA germline variation level.

As a crucial oncogene, B cell lymphoma-2 (BCL-2) could promote cancer cell survival by inhibiting apoptosis via suppressing activation of proapoptotic proteins, such as BAX and BAK. There is a functional rs2279115 genetic polymorphism locating in BCL-2 promoter and deregulating BCL-2 expression. However, it is still largely undefined how BCL-2 rs2279115 promoter noncoding genetic variant is involved in glioma development. We examined the association between BCL-2 rs2279115 and glioma risk using a case-control approach. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression adjusted by age and sex. Our results demonstrated that BCL-2 rs2279115 was significantly associated with glioma risk. The odd of individuals harboring A allele (CA + AA genotype) was 0.50 (95% CI = 0.39-0.64, p = 1.0 x 10(-7)) compared with CC genotype carriers. Stratification analyses by sex elucidated that BCL-2 rs2279115 was significantly associated with glioma risk in males (OR = 0.41, 95% CI = 0.30-0.58, p = 1.0 x 10(-7)), but not in females (p > 0.05). In summary, our results indicate that the functional BCL-2 rs2279115 genetic variant contributes to glioma predisposition and suggest prevalent involvement of regulatory genetic variations in glioma development.

Long noncoding RNA (lncRNA) growth arrest-specific 5 (GAS5) accumulates in growth-arrested cells and plays a crucial role in progression of multiple cancers, including glioma. There is a functional GAS5 rs145204276 indel genetic polymorphism in the promoter region. However, it is still largely unknown how the GAS5 indel genetic polymorphism is involved in etiology of glioma. We evaluated the association between the GAS5 indel genetic polymorphism and glioma development in a Chinese population. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression adjusted by age and sex. We found that carriers of the GAS5 del allele was significantly associated with elevated risk of glioma (OR = 1.71, 95% CI = 1.34-2.18, p = 1.7 × 10-5). Compared with the GAS5 ins/ins genotype, the ins/del genotype or the del/del genotype was significantly associated with 1.57-fold or 2.61-fold increased glioma susceptibility (p = 0.001 or p = 9.0 × 10-6). When patients were stratified by disease subtypes, The GAS5 indel polymorphism was not significantly associated with risk of oligodendroglial tumor (p = 0.353). Integrated analyses indicated that the GAS5 indel polymorphism might alert the binding of transcriptional factor TFAP2A and activation of its expression based on ENCODE and REMBRANDT databases. Our results highlight the importance and potential of the biological relevance of the GAS5 indel genetic variant in glioma predisposition.

Background: For patients with a brain metastasis (BM), systemic therapy is usually administered after the completion of radiotherapy, especially in cases of multiple BMs. However, the role of systemic therapy in patients with a limited number of BMs is not clear. Therefore, we conducted a retrospective study to explore this question. Methods: Consecutive patients with a pathologically confirmed malignancy and 1–3 intracranial lesions that had been documented within the last decade were selected from the databases of three hospitals in China. Results: A total of 250 patients were enrolled; of them, 135 received radiotherapy alone and 115 received radiotherapy plus systemic therapy. In patients receiving whole-brain radiation therapy (WBRT) as radiotherapy, 28 received WBRT alone and 35 patients received WBRT plus systemic therapy. Of the patients treated with stereotactic radiosurgery (SRS), 107 received SRS alone and 80 received SRS plus systemic therapy. Multivariate analysis revealed that systemic therapy significantly reduced the risk of mortality compared with radiotherapy alone (hazard ratio [HR] = 0.294, 95% confidence interval [CI] = 0.158–0.548). Further, when the analysis was conducted in subgroups of WBRT (HR = 0.230, 95% CI = 0.081–0.653) or SRS (HR = 0.305, 95% CI = 0.127–0.731), systemic therapy still showed the ability to reduce the risk of mortality in patients with BMs. Conclusion: Systemic therapy after either SRS or WBRT radiotherapy may significantly reduce the risk of mortality of patients with 1–3 BMs.

BackgroundRecurrence of thymomas even after complete resection is common, but the relapse patterns remain controversial. This study aimed to define the patterns and predictors of relapse after complete resection of thymoma.MethodsA single-institution retrospective study was performed with 331 patients who underwent radical resection of thymoma between 1991 and 2012.ResultsAfter a median follow-up of 59months, the recurrence rate was 6.9% (23/331). Relapse occurred in 23 patients with the pleura (14) and tumor bed (6) as the most common sites of recurrence. According to the definitions of the International Thymic Malignancy Interest Group, 10 (43.5%) patients had local relapse, 15 (65.2%) had regional relapse, 10 (43.5%) had distant relapse. The difference in survival following relapse between lung and regional relapse was statistically significant (P=0.027) but that between lung and distant relapse was not (P=0.808). The recurrence rates correlated with the initial Masaoka stage. Further, recurrence also correlated with World Health Organization (WHO) tumor type. The recurrence-free survival rates in patients with tumor size ⩾8cm were worse than those of patients with tumor size <8cm (P=0.007). Tumor size was also correlated with stage (r=0.110). As tumor becomes larger, the stage is more advanced (P=0.023). Multivariate analysis showed that Masaoka stage (P=0.005), tumor size (P=0.033), and WHO histological type (P=0.046) were predictive factors of relapse.ConclusionRegional recurrence is the most common relapse pattern but local and distant relapse are also common. Advanced Masaoka stage, larger tumor size, and type B3 are risk factors of recurrence. Lung relapse should be considered distant relapse. Further, tumor size was correlated with Masaoka stage and therefore should be considered in the staging system.

目的 探讨儿童颅内室管膜瘤的临床特点和治疗转归.方法 回顾性分析2010年8月至2012年8月收治的经病理证实的18例儿童颅内室管膜瘤术后放射治疗患者的临床资料,观察疗效并结合文献进行分析.结果 男15例,女3例,年龄3～13岁(中位年龄5岁).中位随访27个月,KPS评分≥80分者14例,KPS评分60～ 80分者4例.术后复发4例,其中3例死亡.未观察到严重的放射治疗副作用.结论 手术是室管膜瘤的首选治疗方法,部分切除和间变性室管膜瘤患者,术后放射治疗是最重要的辅助手段;室管膜瘤常规行局部放射治疗,治疗失败的主要原因为原位复发.

Background and purpose: The role of adjuvant radiotherapy for central neurocytomas (CNs) is not clear. Therefore, we aimed to examine the clinical outcomes of treating histologically confirmed CNs with adjuvant RT after surgical resection.Material and methods: Sixty-three CN patients were retrospectively evaluated: 24 patients underwent gross total resection (GTR); 28, subtotal resection (STR); 9, partial resection (PR), and 2, biopsy (Bx). They underwent adjuvant RT after surgery (median dose, 54 Gy).Results: The median follow-up was 69 months (15-129 months). The 5-year overall survival (OS) and 5-year progression-free survival (PFS) were 94.4% and 95% after GTR + RT, 96.4% and 100% after STR + RT, and 100% and 90.9% after PR + RT. Only three patients had tumor recurrence: at the primary site at 30 and 24 months in two GTR + PR patients, and dissemination to the spinal cord at 75 months in one STR + RT patient. Thirty-eight (63.3%) patients experienced late neurotoxicity (28, grade 1; 7, grade 2; 3, grade 3). Short-term memory impairment was the most common toxicity.Conclusions: RT after incomplete resection (IR) led to OS and PFS comparable to those for GTR. Considering the excellent outcomes and limited late toxicity, adjuvant RT maybe a good option for CN patients who undergo IR.

As a crucial homologous recombination repair gene, RAD52 participates in maintenance of genomic stability and prevention of tumorigenesis. Although several cancer susceptibility RAD52 single nucleotide polymorphisms (SNPs) have been identified previously, little was known on how the RAD52 SNPs are involved in glioma development in Han Chinese. Therefore, we examined the association between five RAD52 SNPs (rs1051669, rs10774474, rs11571378, rs7963551 and rs6489769) and glioma risk using a case–control design. Odds ratios (ORs) and 95 % confidence intervals (CIs) were estimated by logistic regression. We found that only the RAD52 rs7963551 SNP was significantly associated with glioma risk, with the odds of having the rs7963551 AC or CC genotype in patients was 0.49 (95 % CI 0.37–0.65, P = 9.2 × 10−6) or 0.39 (95 % CI 0.18–0.81, P = 0.012) compared with the AA genotype. These data are consistent with functional relevance of allelic regulation of RAD52 expression by the rs7963551 SNP and miRNA let-7 in cancer cells. Stratified analyses elucidated that statistically significant association between glioma and rs7963551 SNP only existed in either astrocytic tumors (P = 6.3 × 10−6) or oligoastrocytic tumors (P = 0.002). In conclusion, our results support the hypothesis that genetic variants influencing miRNA-mediated regulation of tumor suppressor genes or oncogenes may contribute glioma susceptibility.

OBJECTIVE:To assess the efficacy and prognostic factors of preoperative radiation therapy in patients of elbow arthrolysis.METHODS:From October 2008 to September 2010, 43 patients with heterotopic ossification (HO) history at elbow were studied retrospectively. Radiation therapy was given in single fraction of 8 Gy within 1-4 h pre-operation. The elbow HO classifications at preoperation and the last follow-up were analyzed and their efficacy and related prognostic factors evaluated.RESULTS:The median follow-up period was 34 (23.24-46.26) months. The elbow function of 19 (44.2%) cases returned to normal. One case was ineffective. Only one case had vulnus swelling. Graham and Hastings HO classification scores were significantly different between pre-operation and the last follow-up (Z = -5.899, P = 0.000). Logistic analysis showed that age and time between diagnoses and treatment had a significant influence of elbow HO.CONCLUSION:Preoperative radiation therapy of 8 Gy within 1-4 h of elbow arthrolysis is both safe and effective. And greater age, milder wound and longer time between diagnoses and treatment have better outcomes.

Recent genome-wide association studies have identified several leukocyte telomere length (LTL)-related single nucleotide polymorphisms (SNPs). Our previous data demonstrated that two SNPs (rs398652 on 14q21 and rs621559 on 1p34.2) were associated with LTL and risk of esophageal squamous cell carcinoma in Chinese. However, the role of these genetic variants on glioma risk is still unknown. Therefore, we examined if these genetic variants have impact on the genetic susceptibility of glioma in Chinese. On the basis of analyzing 404 glioma patients and frequency-matched 820 controls, we found that subjects having the 1p34.2 rs621559 AG or GG genotype had an OR of 1.82 (95 % CI = 1.07-3.09, P = 0.026) or 2.12 (95 % CI = 1.26-3.56, P = 0.005) for developing glioma, respectively, compared with subjects having the rs621559 AA genotype. Similarly, the 14q21 rs398652 AG or GG genotype was associated with increased glioma risk (OR = 1.39, 95 % CI = 1.07-1.80, P = 0.012; OR = 1.52, 95 % CI = 1.04-2.20, P = 0.029) compared to AA genotype. In all, our results highlight the possible role of telomere in carcinogenesis.

Objeetive A retrospective analysis was carried out to evaluate the prognosis and Influence factors of brain stem gliomas (BSG).Methods From Jul.2009 to Dec.2011,54 patients with pathological diagnosis of WHOⅠ ～ Ⅳ BSG received definitive radiotherapy and eligible for the analysis.In all patients,21 cases accepted subtotal resection,27 cases accepted partial resection and 6 accepted biopsy; 16 cases accepted intensity-modulated radiation therapy (IMRT) and 38 cases accepted three dimensional radiotherapy(3DCRT),1.8～2.0 Gy/f,total dose(DT) was 45 ～60 Gy,the median DT was 50.4 Gy; 24 cases accepted concurrent chemoradiotherapy of temozolomide and 30 cases accepted radiation alone.The significance of related prognostic factors were evaluated by univariate and multivariate analysis.The value of each prognostic factor in the survival was added up to calculate the prognostic index(PI).Results In all patients,the median survival time was 17.5 months.The overall survival rate of 1 year and 3 year was 83％ and 61％,respectively.Univariate and multivariate analysis showed that with a low WHO grade and lesion confined to a single anatomic site gave a better survival.Conclusion Low WHO grade and lesion confined to a single anatomic site are likely to be independent prognostic factors.Prognostic index model can predict the prognosis of BSG more effectively than single variable.

As a tumor suppressor, FEN1 plays an essential role in keeping genomic instability and preventing tumorigenesis. There are two functional genetic variants (-69G>A and 4150G>T) in the FEN1 gene, which have been associated with DNA damage levels in coke-oven workers as well as risks of lung cancer, hepatocellular carcinoma, esophageal cancer, gastric cancer and colorectal cancer in general populations. However, it is still unknown how these polymorphisms and their haplotypes are associated with glioma risk. Therefore, we investigated the role of these polymorphisms in glioma development using a case-control design in a Chinese population. The impact of the haplotypes constructed by these two polymorphisms on glioma risk was also examined. It was observed that the FEN1-69GG or 4150GG genotype were significantly associated to increased glioma risk compared with the -69AA or 4150TT genotype [Odds ratios (OR) = 1.87, 95 % confidence interval (CI) = 1.23-2.85, P = 0.003; or OR = 1.87, 95 % CI = 1.23-2.84, P = 0.003). The associations were more pronounced among female subjects (For -69AG or GG genotype: OR = 2.35, 95 % CI = 1.22-4.52; for 4150TG or GG genotype: OR = 2.33, 95 % CI = 1.21-4.48) and patients with grade 1 or 2 disease (For -69AG or GG genotype: OR = 2.21, 95 % CI = 1.20-4.05; for 4150TG or GG genotype: OR = 2.45, 95 % CI = 1.31-4.58). Additionally, the G(-69)G(4150) haplotype was also significantly associated with increased glioma risk compared with the A(-69)T(4150) haplotype. Our results suggest that FEN1 polymorphisms and haplotypes are associated with glioma risk.

The role of adjuvant radiotherapy (RT) for patients with stage III thymoma after complete resection is not definite. Some authors have advocated postoperative RT after complete tumor resection, but some others suggested observation. In this study, we retrospectively evaluated the effect of postoperative RT on survival as well as tumor control in patients with Masaoka stage III thymoma.

Background Few studies were reported on the comparison of clinical outcomes between intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) in the treatment of glioblastoma multiforme (GBM). This study aimed to determine whether IMRT improves clinical outcomes compared with 3D-CRT in patients with GBM.Methods The records of 54 patients with newly-diagnosed GBM from July 2009 to December 2010 were reviewed. The patients underwent postoperative IMRT or 3D-CRT with concurrent and adjuvant temozolomide. Kaplan-Meier method and log rank test were used to estimate differences of patients' survival.Results The median follow-up was 13 months. Of the 54 patients, fifty (92.6%) completed the combined modality treatment. The 1-year overall survival rate (OS) was 79.6%. The pattern of failure was predominantly local. A comparative analysis revealed that no statistical difference was observed between the IMRT group (n=21) and the 3D-CRT group (n=33) for 1-year OS (89.6% vs. 75.8%, P=0.795), or 1-year progression-free survival (PFS) (61.0% vs. 45.5%, P=0.867). In dosimetric comparison, IMRT seemed to allow better sparing of organs at risk than 3D-CRT did (P=0.050, P=0.055). However, there was no significant difference for toxicities of irradiation between the IMRT group and the 3D-CRT group.Conclusions Our preliminary results suggested that delivering standard radiation doses by IMRT is unlikely to improve local control or overall survival for GBM compared with 3D-CRT. Given this lack of survival benefit and increased costs of IMRT, the utilization of IMRT treatment for GBM needs to be carefully rationalized.