伽玛刀治疗手术后的颅底脊索瘤  

Radiosurgery for post-operative chordomas of skull base

作　　者：刘阿力[1] 王忠诚[1] 孙时斌[1] 王美华[1] 罗斌[1] 刘鹏[1] 

机构地区：[1]北京市神经外科研究所 伽玛刀室,100050

出　　处：《中华神经外科杂志》2006年第5期262-266,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨手术后残存脊索瘤的伽玛刀治疗的相关因素。方法回顾性分析本中心自1996年6月至2004年底伽玛刀治疗的31例手术残存脊索瘤病例,其中男性20例,女性11例;年龄8-70岁,平均40．2岁。伽玛刀治疗的肿瘤体积0．47-27．6cm3,平均(11．4±7．4)cm3;射点数3 -12个,平均(6．5±2．4)个;肿瘤边缘剂量10-16Gy,平均(12．7±1．2)Gy;最大剂量20．8-40Gy,平均(29．2±4．0)Gy。结果本组28例得到治疗后6-102个月(平均30．2个月)的临床随访;和6-78 个月,平均28个月的影像随诊。用Kaplan-Meier生存分析,患者3年和5年的总生存率为90．9％和 75．8％。而影像学随诊中3年和5年的肿瘤实际控制率为64．2％和21．4％。伽玛刀治疗后1年左右多数肿瘤体积缩小;临床症状也相应缓解。随着时间延长,肿瘤复发比例增高。本组肿瘤增大的9 例中,7例为伽玛刀靶区外生长;再次伽玛刀治疗4例,再手术4例,继续临床观察1例。本组共2例死亡。尚未发现伽玛刀相关的严重并发症。结论对开颅手术残存的脊索瘤,伽玛刀是一种可选的治疗方法。治疗要及时,并要充分认知肿瘤的习性和对伽玛刀治疗的反应,有益于延长患者生存期, 提高生存质量。Objective To discuss the essentials of gamma knife surgery （GKS） in the treatment of residual chordomas of the skull base after open surgery. Methods Thirty-one patients with a skull base chordoma were analyzed retrospectively who had undergone an open surgery followed by GKS between June 1996 and December 2004. There were twenty male and eleven female. The median patient age was 40.2 years （ range 8-70yr）. The mean tumor volume treated with GKS was 11.4cm3 （ range 0.47-27.6cm^3 ）. The median tumor margin dose was 12.7Gy （range 10-16Gy） and the median maximum radiation dose was 29.2Gy （range 20.8-40Gy）. Twenty-eight patients were followed -up for 6-102 months （mean 30.2 months） clinically and 6 - 78 months （ mean 28 months） in imaging. Results In this series, the 3 - and 5 - year total survival rate were 90.9% and 75.8%, while the 3 - and 5 - year actuarial tumor control rate were 64.2% and 21.4%, respectively. Most tumors shrunk around 1 year after GKS in the MR image, and the clinical symptoms also correspondingly alleviated. However along with the time, we found 9 tumors enlarged, but 7 of the tumors recurred out of previous treated targets. Four of them underwent a repeated radiosurgery, 4 open surgery again, and 1 still clinical observation. There are two patients dead, and no radiation-related serious complications found in this group. Conclusions GKS is one of the effective treatments for residual chordomas of the skull base after surgery. The procedures should be implemented in time. It is beneficial to recognize adequately the tumor＇s radiobiological response to the GKS in prolonging the lifetime and improving the survival quality.

关 键 词：脊索瘤 伽玛刀放射外科 

分 类 号：R739.4[医药卫生—肿瘤]