37例脑神经胶质瘤术后调强放疗的近期疗效及生存质量观察  

Therapeutic effects and quality of life in 37 glioma patients with postoperative intensity-modulated radiotherapy

作　　者：严丹方[1] 严森祥[1] 杨劲松[1] 孙晓丽[1] 陆中杰[1] 

机构地区：[1]浙江大学医学院附属第一医院放疗科,杭州310003

出　　处：《中华放射医学与防护杂志》2010年第6期721-724,共4页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的 评价调强放疗（IMRT）对术后脑神经胶质瘤患者的初步疗效及生存质量影响.方法 回顾分析2007-2009年本院初治、病理确诊的神经胶质瘤患者37例,全部行显微镜下肿瘤切除术.术后2～4周行IMRT,2.0 Gy/次,5次/周,至40～50 Gy后适当缩野并加量至50～60 Gy.参考欧洲肿瘤研究与治疗组织建议勾画靶区：大体肿瘤靶区（GTV）：低级别神经胶质瘤为术前T2加权（T2WI）磁共振成像（MRI）上高信号区范围及术后瘤腔,高级别神经胶质瘤为术前T1加权（T1WI）增强MRI上异常强化区及术后瘤腔;临床靶区（CTV）：低级别神经胶质瘤为GTV＋1.5 cm,高级别为GTV＋2.5 cm;计划靶区（PTV）：CTV＋0.4 cm.观察半年生存率、1年生存率及无进展生存时间.比较所有患者治疗前后的卡氏评分与量化后的乏力症状以及头痛、嗜睡、认知障碍、记忆力下降、个性行为、言语障碍、癫痫发作、感觉神经异常、运动神经异常等脑功能改变情况,探讨影响生存质量的相关因素.结果 中位随访时间13个月,半年生存率100%,1年生存率79.2%,中位无进展生存时间10个月,半年无进展生存率87.5%,1年无进展生存率82.4%.生存质量改变以疲乏感、轻度记忆下降及认知功能障碍为主,影响记忆改变的主要因素是放射剂量,而疲乏感只与年龄有关.结论 IMRT对脑神经胶质瘤有较好的局控率,同时有利于改善患者的生存质量.Objective To evaluate treatment outcomes and quality of life （QOL） in glioma patients treated with postoperative intensity-modulated radiotherapy （IMRT）, and to explore the possible clinical factors of affecting QOL. Methods From 2007 to 2009, 37 patients with low or high grade glioma were analyzed retrospectively. All patients were operated by tumor resection below microscopy. IMRT began at 2-4 week postoperstion with 2.0 Gy/fractior, 5 fractions/week and to shrink portal and to add dose to 50-60 Gy/25-30 fractions after 40-50 Gy. The gross tumor volume （GTV） was defined as preoperation T2WI MRI high sign area and postoperation tumor cavity for low grade glioma, and with preoperation T1WI MRI enhanced abnormity area and postoperation tumor cavity for high grade glioma. The clinical target volume （ CTV ） was defined as GTV with a margin of 1.5 cm for low grade glioma and a margin of 2.5 cm for high grade ghoma, the planning target volume （PTV） with CTV plus 0.4 cm margin for setup errors according to the European Organization for Research and Treatment of Cancer （ EORTC ）.The treatment outcomes and QOL were assessed. Results The half-year and one-year survival rates for all the patients were 100% and 79.2%, respectively. The median progression-free survival time was 10 months. The main side-responses after postoperative IMRT were fatigue and mild memory decline or cognitive disabilities, which were radiation dose-dependent. Conclusions Postoperative IMRT is an effective and safe modality of therapy for glioma patients.

关 键 词：神经胶质瘤 调强放射疗法 生存质量 认知功能 记忆下降 

分 类 号：R739.4[医药卫生—肿瘤]