389例脑胶质瘤立体定向放射治疗效果评价  

The Therapeutic Effects of Stereotactic Radiotherapy on 389 Cases of Brain Glioma

作　　者：牛道立[1] 何中[2] 胡慧玲[3] 

机构地区：[1]广州医学院第一附属医院放疗科,广东广州510120 [2]河南科技大学第一附属医院神经外科,河南洛阳471000 [3]河南科技大学第一附属医院X刀中心,河南洛阳471000

出　　处：《中国神经肿瘤杂志》2004年第2期82-85,共4页Chinese Journal of Neuro-Oncology

摘　　要：背景与目的:脑胶质瘤一般难以通过手术完全切除,随着立体定向放射治疗技术的发展,胶质瘤的治疗趋向于手术联合放疗的综合治疗。本文探讨脑胶质瘤立体定向放射治疗的疗效及不良反应。方法:从1995年6月到1998年12月,用立体定向放射治疗的方法共治疗脑胶质瘤患者389例,其中用立体定向放射外科(stereotactic radiosurgery,SRS)方法治疗151例,分次立体定向放射治疗(fractionated stereotatic radiotherapy,FSRT)方法治疗238例。SRS组单次周边剂量20～30Gy,靶点1～6个,平均2.48个,照射弧5～21个,平均8.45个;FSRT组每日或隔日照射,每次周边剂量8～12Gy,共照射2～5次,靶点1～6个,平均2.53个,照射弧6—20个.平均8.25个。结果:治疗结束后3个月,SRS组完全缓解21例(13.9%),部分缓解69例(45.7%),稳定26例(17.2%),进展35例(23.2%).总有效率为76.8%;FSRT组完全缓解47例(19.7%),部分缓解114例(47.9%),稳定49例(20.6%),进展28例(11.8%),总有效率为88.2%,两组差别有显著性(P=0.020)。全部患者的1、3、5年生存率分别为54.3%、29.3%、16.5%;SRS组和FSRT组的1、3、5年生存率分别为52.3%、26.5%、11.9%和55.5%、31.1%、19.3%。两组差别没有显著性意义(P=0.1417);放射治疗的主要不良反应为脑水肿,SRS组较FSRT组为重(P=0.027)。结论:立体定向放射治疗对脑胶质瘤有较好的疗效,FSRT与SRS相比,具有疗效好、副作用小的优点。BACKGROVND & OBJECTIVE: To investigate the treatment effectiveness and side effects of stereotactic radiotherapy for brain glioma. METHODS: From Jun 1995 to Dec 1998, 389 cases of brain gliomas were treated by stereotactic radiotherapy, among which 151 cases were treated by stereotactic radiosurgery(SRS) and the other 238 cases, by fractionated stereotactic radiotherapy(FSRT). In the SRS group, the marginal tumor dose was 20 to 30Gy(median, 26Gy). One to 6 isocenters(median, 2.48) and 5 to 21 irradiation arcs(median, 8.45) were applied. In the FSRT group, the per-fraction marginal tumor dose was 8 to 12Gy with 1 to 6 isocenters(median, 2.53), 6 to 20 irradiation arcs(median, 8.25)and 2-5 fractions delivered everyday or every other day. RESULTS: Three months after treatment, the complete and partial response rate were 13.9% and 45.7% in SRS group respectively. The stable disease rate was 17.2%. The total effective rate was 76.8%. In FSRT group, the complete and partial response rate were 19.7% and 47.9% respectively.The stable disease rate was 20.6%.The total effective rale was 88.2%.The total effective rate of FSRT group was higher than that in SRS group(X^2=9.874, P=0.020).The 1-, 3-and 5- year survival rate of all patients were 54.3%,29.3%, 16.5% respectively.The 1-, 3-and 5-year survival rate of SRS group and FSRT group were 52.3%, 26.5%, 11.9% and 55.5%, 31.1%, 19.3% respectively.There was no significant diffenence between the two groups(X^2=2.16, P=0.1417).The main radiation caused side effect was brain edema.The SRS group was more severe than FSRT group(X^2=4.916, P=0.027).CONCLUSIONS: It is effective for brain glioma to be treated by stereotactic radiotherapy.Compared with SRS, the FSRT has the advantages of good effect and less side response.

关 键 词：脑胶质瘤 立体定向 放射治疗 不良反应 

分 类 号：R739.41[医药卫生—肿瘤] R730.55[医药卫生—临床医学]