低分割立体定向放射治疗原发性视神经鞘脑膜瘤的疗效分析  

Analysis of therapeutic effect of fractionated stereotactic radiotherapy for primary optic nerve sheath meningioma

作　　者：穆晓峰[1] 宁健[1] 杨书明[1] 赵水喜[1] 杨远游[1] 赵卫东[1] 程海民[1] 肖利华[2] 

机构地区：[1]武警总医院放疗中心,北京100039 [2]武警总医院眼眶病研究所,北京100039

出　　处：《武警医学》2011年第7期610-612,共3页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的评价在4 Gy×10次的剂量分割模式下,采用低分割立体定向放射治疗原发性视神经鞘脑膜瘤的近期疗效。方法 2004-8至2010-3本院收治的15例原发性视神经鞘脑膜瘤患者采用SGS-Ⅰ型超级伽玛刀进行低分割立体定向放射治疗,靶区处方剂量为40 Gy/4 Gy×10次,放疗结束后6个月进行随访,观察患者肿瘤控制率,临床症状改善情况及视力保存率。结果经过中位时间23个月的随访,肿瘤控制率100%(15例),肿瘤最大径缩小超过50%的患者有4例。突眼症状改善率100%,治疗前后突眼度分别为(17.3±0.8)mm及(14.5±0.3)mm,P<0.01。全组视力保存率为73.3%(11/15),其中改善2例,稳定9例,下降2例,失明2例。有10例出现轻度的治疗相关反应,对症治疗后缓解。结论原发性视神经鞘脑膜瘤接受处方剂量为40 Gy/4 Gy×10次低分割立体定向治疗,疗效确切,但视力改善率较低,甚至出现失明患者,对于剂量分割模式尚需进一步研究。Objective To assess the efficacy of fractionated stereotactic conformal radiotherapy （SCRT） with target dose of 40Gy using 4Gy/fractionation in patients with primary optic nerve sheath meningioma （ONSM）. Methods Between 2004 and 2010, 15 patients （ 15 eyes） with ONSM were treated by Hyper - SGSI gamma knife treatment system;All patients received SCRT with a median dose of 40 Gy in 10 fractionations. Clinical and radiographic follow - up were performed every 6 months after SCRT therapy, Efficacy of SCRT and improvement of symptoms were evaluated by clinic manifestation and change of tumor maximum diameter in different follow - up time. Results After a median follow - up of 23 months, tumor control rate was 100% （ 15 cases） , the maximum diameter of the tumor was reduced more than 50% in 4patients （26.7%） ; 25% - 50% in 6patients （40%） ; 10% - 25% in 6 patients （33.46%）. Proptosis was improved in all cases （ 11 cases）. The degree of proptosis at pro and post treatment were （ 17.3 ± 0. 8 ） mm, 14.5 ± 0.3cm respectively,P 〈 0.05. The visual control rate in all patients was 73.3% （11/15 ） ;Visual acuity was improved in 2 patients,remained stable in 9 patients,and deteriorated in 2patients, blindness in 2 patients. Reversible conjunctival edema was seen in 10 patients. Conclusions Fractionated stereotactic radiotherapy can improves tumor control and proptosis for ONSM;Control rate for the visual observation is still needed for a long time, The best dose fractionation with SCRT for ONSM was required for further study.

关 键 词：低分割立体定向放射治疗 原发性视神经鞘脑膜瘤:治疗效果 伽玛刀 

分 类 号：R739.41[医药卫生—肿瘤]