伽玛刀治疗血管母细胞瘤临床分析  被引量:18

Gamma knife radiosurgery for hemangioblastomas: clinical results and pathological findings

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作  者:王恩敏[1] 张南[1] 王滨江[1] 潘力[1] 周良辅[1] 陈红[1] 戴嘉中[1] 蔡佩武[1] 

机构地区:[1]复旦大学华山医院神经外科,上海200233

出  处:《中华外科杂志》2003年第7期516-519,共4页Chinese Journal of Surgery

摘  要:目的 探讨伽玛刀 (γ刀 )对血管母细胞瘤的治疗作用。 方法 应用γ刀治疗血管母细胞瘤 1 7例。 1 2例为单发肿瘤 ,5例为多发肿瘤 ,肿瘤总数 2 9个 ;肿瘤直径 6~ 55mm ,平均 1 6mm。照射肿瘤的中心剂量为 2 1 0~ 50 0Gy ,周边剂量为 1 2 0~ 2 4 0Gy。 结果  1 7例患者全部获随访 ,随访时间 1 8~ 62个月 ,平均 46个月。 5例患者症状改善肿瘤缩小 ;5例症状无明显变化 ;3例分别于γ刀术后 1 8、2 2、2 5个月死于肿瘤发展、开颅手术和肾癌 ;4例分别于γ刀术后 3、4、2 9和 48个月因症状加重开颅手术切除肿瘤。γ刀对血管母细胞瘤的局部控制率 :1年为 92 % ;2年为 88% ;3年为 80 % ;4年为 75 %。 结论 当肿瘤周边剂量为 1 6 0~ 2 0 0Gy,γ刀能有效控制中小型实质性血管母细胞瘤 。Objective To retrospectively evaluate the effects of Gamma knife in the treatment of cerebral hemangioblastomas. Methods From 1993 to 1996, seventeen patients with 29 hemangioblastomas were treated with Gamma knife. The patients mean age was 35 years (range: 16-61 years). The mean tumor diameter was 16 mm (range: 6-55 mm) Thirteen patients had recurrent or residual hemangioblastomas. Four with primary hemangioblastomas were diagnosed using CT, MRI and DSA The maximum dose to the tumors was 21 0-50 0 Gy, with meam dose of 33 7 Gy The radiation dose to the periphery of tumors was 12 0-24 0 Gy, with mean dose of 17 6 Gy Results All the patients had been followed up for 18 to 62 months, with mean 46 months Five patients experienced clinical improvement and reduction in tumor volume, and 5 remained stable and tumor unchanged in volume during the follow up period Three patients died of tumor progression, surgery and cancer after treatment 18, 22, 25 months respectively. Four patients underwent surgery respectively at 3, 4, 29 and 48 months after gamma knife operation. The local control rate of the tumors at 1 year was 92%, 2 years 88%, 3 years 80% and 4 years 75% Pathological findings in these patients showed varying degrees of small vessel thickening and occlusion together with degeneration, necrosis in the center of tumor and loss of tumor cells at periphery. Conclusions Gamma knife is not adequately reliable for the control of hemangioblastoma cysts, it is an effective treatment of small or medium size solid tumors, but long term follow up is needed. The recommended dose is 16 to 20 Gy.

关 键 词:伽玛刀 放射治疗 血管母细胞瘤 照射剂量 

分 类 号:R730.5[医药卫生—肿瘤]

 

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