中枢神经细胞瘤术后放疗的价值研究  

The role of postoperative radiotherapy for central neurocytoma

作　　者：徐建堃[1] 陈怡东 王雷明[2] 高莹 赵永瑞[1] 冯瑾[1] 邱晓光[3] Xu Jiankun;Chen Yidong;Wang Leiming;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)

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]首都医科大学附属北京天坛医院放射治疗科,北京100070

出　　处：《中华放射肿瘤学杂志》2024年第4期314-318,共5页Chinese Journal of Radiation Oncology

摘　　要：目的探讨中枢神经细胞瘤(CN)手术切除后接受辅助放疗的临床疗效。方法回顾性分析2001年1月至2020年12月在北京天坛医院和宣武医院收治的136例CN病例。患者初始治疗包括开颅肿瘤切除术(完全切除、近全切除、部分切除,后两者属于未完全切除)和术后放疗。放疗采用三维适形或调强放疗,中位放疗剂量为54 Gy。复发后治疗包括挽救性手术和挽救性放疗。用Kaplan-Meier法计算总生存(OS)、无进展生存(PFS),用log-rank检验进行单因素分析,以评价各个预后因素对OS及PFS的影响,Cox回归模型分析多个预后因素对PFS和OS的影响。结果患者中位年龄28岁(6~66岁),中位随访时间为94.5(12~237)个月。全组中有79例接受了完全切除,其中术后有68例接受了辅助放疗;38例近全切除,术后有37例接受辅助放疗;16例接受部分切除,术后均行辅助放疗;3例接受了活检,术后均行放疗。全组共3例死亡,2例死于肿瘤复发,1例死于术后并发症。8例出现复发,其中原位复发7例,脊髓播散1例。全组5、10年OS率分别为98.5%和96.8%,5、10年PFS率分别为95.3%和91.6%。完全切除且未放疗组5、10年PFS率分别为90.9%、90.9%,完全切除+放疗组为96.6%、96.6%(P=0.338)。完全切除且未放疗组5、10年OS率分别为100%、100%,完全切除+放疗组为98.5%、98.5%(P=0.693)。完全切除±放疗组与未完全切除+放疗组的10年PFS率为95.8%∶90.3%(P=0.368),10年OS率为98.6%∶94.7%(P=0.436)。多因素分析显示,肿瘤位置、手术切除程度、是否辅助放疗和年龄对PFS和OS均无显著影响。共有81例出现晚期神经不良反应,其中1级69例、2级9例、3级3例;64.2%(52/81例)的患者出现短期记忆损害。结论CN接受单纯完全切除可获得很好的疗效,无需再行术后放疗。接受未完全切除的病例行术后辅助放疗可获得与完全切除相当的临床疗效。Objective To evaluate clinical efficacy of adjuvant radiotherapy(RT)for central neurocytoma(CN)after surgical resection.Methods Clinical data of 136 CN patients admitted to Beijing Tiantan Hospital and Xuanwu Hospital from January 2001 to December 2020 were retrospectively analyzed.Preliminary interventions consisted of craniotomy(gross total resection,subtotal resection and partial resection,the latter two belonging to incomplete resection)and postoperative radiotherapy.Three-dimensional conformal or intensity-modulated radiotherapy was adopted,with a median radiotherapy dose of 54 Gy.Post-recurrence treatment included salvage surgery and radiotherapy.The overall survival(OS)and progression-free survival(PFS)were analyzed using the Kaplan-Meier method.Univariate analysis was performed by log-rank test to evaluate the effect of each prognostic factor on OS and PFS.The effects of multiple prognostic factors on PFS and OS were assessed by Cox regression model.Results The median age was 28 years(range:6-66 years).The median follow-up was 94.5 months(12-237 months).Among all patients,79 cases underwent total resection,and 68 of them received adjuvant radiotherapy.Thirty-eight patients underwent subtotal resection,and 37 of them were treated with adjuvant radiotherapy.Sixteen patients received partial resection and adjuvant radiotherapy.Three cases received biopsy and postoperative radiotherapy.Among all patients,3 cases died,including 2 from tumor recurrence and 1 from postoperative complication.Eight patients had recurrences during follow-up.Among them,7 patients had recurrences at the primary site,1 had tumor dissemination to the spinal cord.The 5-and 10-year OS rates were 98.5%and 96.8%,and the 5-and 10-year PFS rates were 95.3%and 91.6%for the in the entire cohort.In the gross total resection without radiotherapy group,the 5-and 10-year PFS rates were 90.9%and 90.9%,and 96.6%and 96.6%in the gross total resection+radiotherapy group(P=0.338).The 5-and 10-year OS rates were 100%and 100%in the gross total resection w

关 键 词：神经细胞瘤 完全切除 未完全切除 放射疗法 术后 

分 类 号：R739.4[医药卫生—肿瘤]