2012年10月28-31日，第54届美国放射肿瘤学会（ASTRO）年会在美国波士顿举行。来自世界各地的放射肿瘤学领域的医生及相关人士共计11000多人参会。本届年会的主题是“通过创新改善患者治疗（Advancing Patient Care through Innovation）”。 对本届年会进行了专题报道（http://zt.cmt.com.cn/zt/astro2012/index.html），敬请关注！

　　会上，美国学者报告了一项研究：Five Decades of Adult Low-grade Gliomas: Patterns of Care Over Time ，其摘要如下：

Purpose/Objective(s)
To identify changes in patient presentations, treatments and outcomes of low-grade gliomas (LGGs) over the past 50 years.

Materials/Methods
Records of 852 adults diagnosed between 1960 and 2010 with WHO grade II LGGs were reviewed. Patients were grouped by those diagnosed before (group I: 1960-1989) and after (group II: 1990-2010) the widespread use of modern imaging. Survival curves were plotted using the Kaplan-Meier method and compared with the log-rank test. Statistical analysis of prognostic factors employed the Chi-squared test and Fisher's exact test.

Results
Median follow-up was 19.9 and 6.9 years for group I and group II, respectively. Overall, 296 (34.7%) patients received a surgical gross total resection (GTR) or radical subtotal resection (rSTR) and 556 (65.3%) received subtotal resection (STR) or biopsy alone (Bx). Post-operatively, 541 patients received radiation therapy (PORT), 118 received chemotherapy and 295 were observed. Patient gender and age at diagnosis were similar between the two groups (p > 0.05). Those diagnosed before 1990 more often presented with seizures (78% vs. 69%, p = 0.01), headaches (46% vs. 23%, p < 0.0001) and sensory/motor impairment (40% vs. 28%, p = 0.0002). In group II, significantly more oligodendrogliomas (44% vs. 10%, p < 0.0001) and fewer astrocytomas were identified histologically (22% vs. 59%, p < 0.0001). Over time, GTR was achieved more often (31% vs. 13%, p < 0.0001), fewer patients received PORT (58% vs. 74%, p < 0.0001) and more received chemotherapy (18% vs. 6%, p < 0.0001) in group II compared with group I. In both groups, PORT was preferentially delivered to patients with astrocytomas (p < 0.01) and those receiving STR/Bx (p < 0.0001). In group II, additional factors associated with the use of PORT included tumors ≥5 cm (p = 0.002), those in deep locations (p < 0.0001), and patients over 40 years of age (p < 0.0001). Overall, 498 patients (59%) experienced progression, including 159 in group I and 339 in group II. Additionally, 419 (49%) deaths were recorded, which includes 233 from group I and 186 from group II. Median progression free survival (PFS) and overall survival (OS) were 4.4 and 8.9 years, respectively. While PFS was similar between the groups (p > 0.05), OS was better in group II (10-year OS, 54%) compared with group I (34%; p < 0.0001).

Conclusions
OS for LGG appears to be improving over the last 50 years, despite similar rates of progression. In the modern cohort, more patients are being diagnosed with oligodendrogliomas and are undergoing extensive resections (GTR/rSTR), both of which are associated with improvements in OS. Due to risk factor stratification by clinicians, the use of PORT has declined and is primarily being used to treat high-risk tumors in modern patients.