脑膜瘤分阶段伽玛刀放射外科治疗的策略及疗效分析  

Innovative strategy of staged Gamma knife radiosurgery for meningiomas and the analysis for the results

作　　者：丁建波 王滨江 许云[4] 潘力 王恩敏 张南 于同刚 陈晶晶 董艳 DING Jian-bo;WANG Bin-jiang;XU Yun(Department of Neurosurgery,Shanghai Gamma Hospital,Shanghai 200235,China)

机构地区：[1]上海伽玛医院神经外科,上海200235 [2]上海伽玛医院放射科,上海200235 [3]上海伽玛医院护理部,上海200235 [4]南京医科大学附属脑科医院伽玛刀治疗中心 [5]复旦大学附属华山医院神经外科

出　　处：《临床神经外科杂志》2020年第4期452-454,458,共4页Journal of Clinical Neurosurgery

基　　金：上海市卫生健康委员会科研课题基金(20194Y0482)。

摘　　要：目的探索存在手术禁忌证的体积较大或靠近重要神经结构的脑膜瘤患者的分阶段伽玛刀放射外科治疗的策略及其疗效。方法80例脑膜瘤患者,其中61例患者接受剂量分割分阶段放射外科治疗,单次周边剂量为7~11 Gy,40%~50%的等剂量线;19例患者接受体积分割分阶段放射外科治疗,单次周边剂量为8~14 Gy,40%~50%的等剂量线。分阶段治疗的时间间隔为3~17个月,平均(9.1±3.1)个月。治疗后随访时间为6~72个月,平均(36.5±7.2)个月。结果所有患者均顺利完成治疗计划,未出现严重不良反应和新发神经功能障碍者。两个阶段治疗后6个月、1年、2年和3年患者的肿瘤体积分别缩小了(25.27±19.13)%、(24.98±19.82)%、(30.49±17.64)%和(32.12±16.55)%。结论对于体积较大或邻近重要结构的脑膜瘤采用分阶段伽玛刀放射外科治疗有显著的效果和安全性;该治疗方案为存在开颅手术禁忌证的脑膜瘤患者提供了一个最佳的治疗选择。Objective To explore the strategy and curative effects of staged Gamma knife radiosurgery for patients with surgical contraindications suffering from large meningiomas or meningiomas close to important nerve structures.Methods 80 patients were included in the study.61 patients were treated with dose-fractionated radiosurgery,with a single peripheral dose of 7-11 Gy,40%-50%isodose line.19 patients were treated with volume-fractionated radiosurgery,with a single peripheral dose of 8-14 Gy,40%-50%isodose line.The treatment interval was 3-17(mean 9.1±3.1)months.The follow-up time was 6-72(mean 36.5±7.2)months.Results All patients successfully completed the treatment plan.No serious adverse reactions and new neurological dysfunction were found.Six months,one year,two years and three years after the two-stage treatment,the volume of tumor decreased by 25.27%±19.13%,24.98%±19.82%,30.49%±17.64%and 32.12%±16.55%respectively.Conclusion Staged Gamma knife radiosurgery provides significant effect and safety for meningiomas with large volume or adjacent to important structures,this treatment scheme provides an optimal treatment option for meningiomas with contraindications of craniotomy.

关 键 词：脑膜瘤 伽玛刀 放射外科 分阶段放射外科 

分 类 号：R739.41[医药卫生—肿瘤]