低能X射线术中放疗在胶质母细胞瘤治疗中的应用  

Intraoperative radiotherapy using low energy X-rays for newly diagnosed glioblastoma

作　　者：吴明星 张洪俊 傅兵 马国佛 闵思明 秦舒森 孙时斌[2] 隋大立[3] 韩小弟 Wu Mingxing Zhang Hongjun Fu Bing Ma Guofo Min Siming Qin Shuzen Sun Shibin Sui Dali Han Xiaodi(Department of Neurosurgery , Beijing Tiantan Puhua Hospital, Beijing 100050, China)

机构地区：[1]北京天坛普华医院神经外科,100050 [2]首都医科大学,北京市神经外科研究所 [3]首都医科大学附属北京天坛医院神经外科

出　　处：《中华神经外科杂志》2017年第3期239-243,共5页Chinese Journal of Neurosurgery

摘　　要：目的评估使用低能x射线术中放疗（IORT）治疗胶质母细胞瘤的安全性及有效性。方法回顾性分析2013年2月至2015年9月在北京天坛普华医院神经外科行手术治疗的10例胶质母细胞瘤患者的临床资料。低能x射线术中放疗设备为INTRABEAM（PRS500），采用的剂量为10Gy／2mm（距离球形施用器表面2mm组织接受的剂量为10Gy）。评估手术＋IORT的安全性，包括伤口愈合情况、感染情况、术后严重脑水肿需要行减压术治疗的情况及放射性坏死的发生情况。术后治疗方案为Stupp方案。计算无进展生存期及总生存期。统计方法为Kaplan-Meier生存分析。结果10例患者的肿瘤均位于幕上，手术全切除8例，近全切除2例。手术＋IORT后早期无伤口愈合不良发生，无需手术治疗的严重脑水肿发生。其中1例发生术后感染。中位无进展生存期及中位总生存期分别为9．8个月（95％CI：2．5～17．1个月）和18．9个月（95％CI：10．4～27．4个月）。术后随访磁共振成像发现1例患者发生放射性坏死。结论胶质母细胞瘤应用低能x射线IORT（放疗剂量为10Gy／2mm）耐受性良好，长期疗效值得期待。Objective To assess the safety and efficacy of intraoperative radiotherapy （IORT） using low energy X-rays in patients with newly diagnosed glioblastoma. Methods This retrospective study involved 10 patients of newly diagnosed glioblastoma who underwent surgical resection and IORT at Department of Neurosurgery, Beijing Tiantan Puhua Hospital from February 2013 to September 2015. The low energy X-rays equipment we used was INTRABEAM （ PRS500, Carl Zeiss） and IORT was administered with the dose of 10 Gy to the applicator surface of applicator（ 10 Gy/2mm）. All patients received the Stupp protocol following operation. We assessed the patients＇safety in this group including wound healing deficits, infection, IORT-related cerebral edema requiring surgical intervention and radiation necrosis. The progression-free survival （PFS） and overall survival （IOS） were documented. The Kaplan-Meier survival analysis was conducted. Results All tumors in this study were supratentorial, among which gross total resection and near total resection were achieved in 8 and 2 cases, respectively. No wound healing deficits or IORT-related cerebral edema requiring surgical intervention occurred in this resection plus IORT group in the early period post operation. One patient suffered from postoperative infection. One patient developed radiation necrosis on follow-up MRI scans. Median PFS and median OS were 9.8 months （95% CI 2.5 - 17.1 months） and 18.9 months（95% CI 10.4 -27.4 months）, respectively. Conclusions IORT using low energy X-rays with the dose of 10 Gy/2mm seems tolerable for patients of glioblastoma with expectable long-term effects.

关 键 词：胶质母细胞瘤 放射疗法 计算机辅助 术中放疗 治疗结果 

分 类 号：R739.41[医药卫生—肿瘤]