颅内巨大转移瘤分次立体定向放射治疗的研究  

Study on fractionated stereotactic radiosurgery for large intracranial metastases

作　　者：梁恩顺[1] 佘永传[1] LIANG En- shun;SHE Yong-chuan(Gamma Knife Treatment Center,Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China)

机构地区：[1]南京医科大学附属脑科医院伽玛刀治疗中心,南京210029

出　　处：《临床神经外科杂志》2018年第3期190-192,共3页Journal of Clinical Neurosurgery

摘　　要：目的评价立体定向放射外科治疗对巨大单发转移瘤使用分次治疗取代单次治疗的安全性及有效性。方法选取2014年7月至2015年6月69例颅内>3 cm的转移瘤患者,以中位周边剂量16 Gy分两次治疗,中位肿瘤体积28.6 cm^3。结果随访3～12个月,2例患者因颅外疾病进展失访,其余67例患者最后1次MRI检查显示,肿瘤缩小41例(61.1%),肿瘤体积不变23例(34.3%),肿瘤增大3例(4.5%);肿瘤控制率为95.5%。颅内水肿缩小37例(55.2%),体积不变24例(35.8%),体积增大6例(8.9%);水肿控制率为91%。结论立体定向放射分次治疗对颅内巨大转移瘤的局部控制率及安全性较高。Objective Stereotactic radiosurgery（ SRS） delivered in 2 fractions had been employed in patients with large brain metastases（ 3 cm） as an alternative to single-fraction SRS with the aim to reduce late radiation-induced toxicity while maintaining high local control rate. This study assessed the efficacy and safety of fractionated SRS for the treatment of large brain metastases.Methods In present study,the efficacy and toxicity of multi-fraction SRS in patients with single brain metastases were evaluated. Between July 2014 and June 2015,69 patients（ 26 men and 43 women） with brain metastases had been treated with multi-fraction SRS. The median SRS dose was16 Gy（ range 12 to 20 Gy） in 2 fractions and the median treatment volume was 28. 6 cm^3（ range,18-98 cm^3）. Results With available radiographic,at a follow-up of 3-12 months,2 died of progressive extracranial disease. Tumor response was evaluated on contrast-enhanced T1-weighted images,and edema volume was defined as the peritumoral increased signal detected on T2-weighted images. The local tumor control rate was 95. 5%,the volume was decreased in 41 patients（ 61. 1%）. The volume was stable in 23 patients（ 34. 3%）. The volume was increased in 3 patients（ 4. 5%） and intracranial edema was decreased in 37 patients（ 55. 2%）. Volume was unchanged in24 cases（ 35. 8%）. Volume increased in 6 cases（ 8. 9%） and edema control rate was 91%.Conclusion Fractionated SRS is feasible and safe in patients with large brain metastases.

关 键 词：伽玛刀 转移瘤 立体定向放射分次治疗 

分 类 号：R730.55[医药卫生—肿瘤]