脑室外神经细胞瘤的辅助放疗效果(附10例报告)  

Outcomes of adjuvant radiotherapy for extraventricular neurocytomas:a report of 10 cases

作　　者：徐建堃[1] 陈怡东 王雷明[2] 赵志莲[3] 徐庚[4] 高莹 赵永瑞[1] 冯瑾 邱晓光[5] Xu Jiankun;Chen Yidong;Wang Leiming;Zhao Zhilian;Xu Geng;Gao Ying;Zhao Yongrui;Feng Jin;Qiu Xiaoguang(Department of Radiation Oncology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Pathology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Nuclear Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Radiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学宣武医院放射治疗科,北京100053 [2]首都医科大学宣武医院病理科,北京100053 [3]首都医科大学宣武医院放射与核医学科,北京100053 [4]首都医科大学宣武医院神经外科,北京100053 [5]首都医科大学附属北京天坛医院放射治疗科,北京100070

出　　处：《中华神经外科杂志》2023年第4期345-350,共6页Chinese Journal of Neurosurgery

摘　　要：目的探讨脑室外神经细胞瘤(EVN)手术切除后行辅助放疗的临床疗效。方法回顾性分析2001年1月至2020年12月行肿瘤切除和(不和)术后放疗的10例EVN患者[占同期收治的脑室内、外神经细胞瘤患者的6.8%(10/147)],其中首都医科大学附属北京天坛医院神经外科和放疗科收治5例,首都医科大学宣武医院神经外科和放疗科收治5例。肿瘤主体位于鞍区2例,额叶2例,丘脑3例,顶叶1例,脊髓2例。10例患者中,6例术后接受三维适形或调强放疗,中位放疗剂量为54 Gy(50.4~58.0 Gy)。术后行门诊和电话随访。采用Kaplan-Meier生存分析评估患者的生存时间,通过影像学随访判断肿瘤有无复发。结果除1例行活组织检查外,余9例均行肿瘤切除术,其中全切除、近全切除、部分切除各3例。所有患者均获随访,中位随访时间为69.5个月(范围为16~142个月)。10例患者中,共3例出现复发,其中2例原位复发于颈髓,包括1例行活组织检查的患者和1例行肿瘤全切除的患者,前者于术后16个月死于肿瘤复发,后者复发后行手术治疗和放疗,至末次随访时仍带瘤生存;1例原位复发于鞍区的患者接受部分切除7个月后再次复发,行手术切除和放疗,至末次随访时仍带瘤生存。接受不全切除(近全切除和部分切除)加辅助放疗的5例患者无一例复发;接受全切除加或不加放疗患者的复发比例为1/3。10例患者的5、10年总生存率均为90%,5、10年无进展生存率分别为80%和60%。结论初步研究表明,EVN患者接受不全切除术后行辅助放疗可能能够获得与全切除相当的无进展生存率。Objective To investigate the clinical efficacy of adjuvant radiotherapy after surgical resection of extraventricular neurocytoma(EVNs).Methods A retrospective study was conducted on the clinical data of 10 EVN patients(accounting for 6.8%of intraventricular and extraventricular neurocytomas treated in the same period)who underwent tumor resection with or without postoperative adjuvant radiotherapy(RT)from January 2001 to December 2020.Among them,5 cases were admitted to the Department of Neurosurgery and Department of Radiology,Beijing Tiantan Hospital,Capital Medical University,and 5 cases were admitted to the Department of Neurosurgery and Department of Radiation Oncology of Xuanwu Hospital,Capital Medical University.The tumor was located in the sellar region in 2 cases,in the frontal lobe in 2 cases,in the thalamus in 3 cases,in the parietal lobe in 1 case and in the spinal cord in 2 cases.Six patients underwent three-dimensional conformal radiotherapy or adjuvant intensity-modulated radiation therapy with a median dose of 54 Gy(range:50.4-58.0 Gy).Follow-up was performed postoperatively by out-patient clinic or telephone.Kaplan-Meier survival analysis was used to evaluate the survival of patients,and tumor recurrence was determined by imaging follow-up.Results Except 1 case undergoing biopsy,the remaining 9 cases underwent tumor resection,including gross total resection in 3 cases,subtotal resection in 3 cases,and partial resection in 3 cases.All patients were followed up for a median of 69.5 months(range:16-142 months).Among the 10 patients,a total of 3 relapsed,2 of which were located in the cervical spinal cord and included 1 patient who underwent biopsy and 1 patient who underwent total resection.The former died of tumor recurrence 16 months after the operation;the latter underwent operation and radiotherapy after recurrence and still survived with tumor at the last follow-up.One patient developed orthotopic recurrence in the sellar region at 7 months post partial resection,underwent surgical resection an

关 键 词：神经细胞瘤 显微外科手术 预后 脑室外 放疗 

分 类 号：R739.41[医药卫生—肿瘤]