伽玛刀治疗脑胶质细胞瘤的临床初步观察  

The clinical preliminary report of Gamma knife radiosurgery for gliomas

作　　者：于新[1] 刘宗惠[1] 周东学[1] 郝进敏[1] 亓树彬[1] 杜吉祥[1] 张伟[1] 李冰[1] 

机构地区：[1]海军总医院神经外科,北京100037

出　　处：《中华神经外科杂志》2002年第2期83-86,共4页Chinese Journal of Neurosurgery

摘　　要：目的　评价伽玛刀对脑内胶质细胞瘤的治疗效果。方法　自 1996年 11月至 1999年 12月对 5 7例病理诊断明确的脑胶质瘤患者进行了伽玛刀治疗 ,其中男 35例 ,女 2 2例 ,年龄 7～ 6 8岁 ,平均 30 8岁。病变位于大脑半球 2 7例 ,丘脑及基底节区 2 2例 ,脑干 2例 ,小脑 2例。病理诊断 :星形细胞瘤Ⅰ级 7例 ,Ⅱ级 5例 ,Ⅰ～Ⅱ 18例 ,少枝胶质瘤 4例 ,室管膜瘤 2例 ,星形细胞瘤Ⅲ级 2例 ,Ⅳ级 2例 ,Ⅲ～Ⅳ级 13例 ,胶质母细胞瘤 4例。周边剂量为 12～ 2 2Gy ,平均为 16 5Gy。结果　随访时间为 6至 4 2个月 ,平均为 2 3个月。 36例低恶度胶质瘤的影像学复查结果 :显效 6例 ;有效 14例 ;微效 5例 ;无变化 6例 ;恶化 5例。有效率为 5 5 6 %。 2 1例高恶度胶质瘤中 2～ 3个月及远期影像有效率分别为 6 6 7%和 2 3 8%。 6 ,12 ,2 4 ,36个月的存活率分别为 :95 2 % (2 0 / 2 1) ;81 0 % (17/ 2 1) ;4 7 1% 9(8/ 17)和 33 3% (3/ 9)。 15例病人 (2 6 3% )于治疗后 12个月内出现放射性水肿。结论　伽玛刀对体积较小 ,边界相对较清的低恶度胶质瘤的治疗是有效的 ,对高恶度胶质瘤在短期内可有效地杀死靶区内肿瘤细胞并延缓肿瘤的生长 ,但并不能有效地控制周边肿瘤细胞生长和复发。Objective To investigate the clinical effects of Gamma knife radiosurgery on cerebral gliomas. Methods From November 1996 to December 1999,57 patients with gliomas had been treated with Gamma knife radiosurgery in Navy General Hospital. There were 35 males and 22 females, and their ages ranged from 7 to 68 years, with an average of 30 8 years. The lesions were located in cerebral hemisphere for 27 cases, 22 in basal area, 2 in brainstem and 2 in cerebellum. In all patients, histological diagnoses were astrocytoma grade Ⅰ in 7 cases, grade Ⅱ in 5, grade Ⅰ Ⅱ in 18, oligodendroglioma in 4, ependymoma in 2, astrocytoma grade Ⅲ in 2, grade Ⅳ in 2, grade Ⅲ Ⅳ in 13 and glioblastoma in 4. The marginal dose ranged from 12 to 23Gy, with an average of 16 5Gy. Results All patients had been followed up from 6 to 42 months (averaged 23 months). The imaging examination in 36 low grade gliomas showed disappeared in 6 cases (16 7%), reduced more than 50% in 14 (38 9%), reduced from 25% to 50% in 5(13 9%). The effective rate was 55 6%. In 21 high grade gliomas, the effective rates in imaging examination in 2 to 3 months and long timed follow up (averaged 23 months) were 66 7% and 23 8%, respectively. The survival rates in 6, 12, 24 and 36 months were 95 2% (20/21), 81 0%(17/21), 47 1%(8/17) and 33 3% (3/9). The radioactive brain edema was found in 15 patients(26 3%) within 12 months after treatment. Conclusions Gamma knife radiosurgery is an effective method to a selected group of patients with small to medium sized, well defined, histologically proven low grade cerebral gliomas. Although Gamma knife radiosurgery can effectively kill the tumor cells in the target area and prevent the tumor grouwth, it can not control the growth of the tumor cells outside the target area and prevent the recurrence of the tumor.

关 键 词：伽玛刀 脑胶质细胞瘤 治疗 诊断 临床研究 

分 类 号：R739.4[医药卫生—肿瘤]