伽玛刀治疗颅内血管母细胞瘤的疗效及肿瘤复发因素分析  

Analysis of the results of gamma knife radiosurgery for hemangioblastomas of the brain and the factors related to the tumor recurrence

作　　者：王恩敏[1] 王滨江[1] 张南[1] 潘力[1] 董亚非[1] 周良辅[2] 戴嘉中[3] 蔡佩武[3] 陈宏[4] 

机构地区：[1]复旦大学附属华山医院伽玛刀医院神经外科,上海200040 [2]复旦大学附属华山医院神经外科 [3]复旦大学附属华山医院伽玛刀医院放射科,上海200040 [4]复旦大学附属华山医院神经病理科

出　　处：《中华医学杂志》2004年第10期813-817,共5页National Medical Journal of China

摘　　要：目的　分析伽玛 (γ)刀治疗颅内血管母细胞瘤 (HB)的中长期疗效及肿瘤复发原因。方法　应用γ刀治疗 35例HB ,其中 18例为多发肿瘤 ,17例为单发。向肿瘤实施的平均中心剂量为35 6Gy ,平均周边剂量为 17 2Gy。对单发肿瘤和多发肿瘤的复发时间、γ刀对单发肿瘤与多发肿瘤的疗效以及疗效与肿瘤周边剂量之间的关系进行了统计学分析。结果　平均随访时间 6 6个月 ,最后一次随访时 ,死亡 6例 ,存活 2 9例 ,其中 2 1例患者肿瘤控制良好 ,8例再次手术。γ刀对单发肿瘤和多发肿瘤疗效之间的差异无显著意义 (P >0 0 5 ) ,而肿瘤控制良好者的治疗剂量与疗效不佳者的治疗剂量之间的差异有显著意义 (P <0 0 1)。肿瘤控制率 :1年为 94 % ;2年 85 % ;3年 82 % ;4年 79% ;5年 71%。单发肿瘤术后复发的平均时间为 6 3个月 ,多发肿瘤为 2 5个月 ,两组的时间差异有显著意义 (P <0 0 0 1)。结论　当肿瘤周边剂量为 16 0～ 2 0 0Gy时 ,γ刀对中小型实质性HB有良好的中长期控制作用 ,但是与Hippel Lindau病相关的多发HB ,γ刀治疗仍面临肿瘤复发。Objective To assess the 5-year-result of leksell gamma knife (LGK) in controlling hemangioblastomas of the brain (HB) and to analyze the factors related to tumor recurrence or development of new tumors. Methods From November 1993 to September 2001,35 patients,28 males and 7 females,aged 36 (16～61),18 with multiple tumors and 17 with solitary tumor,the number of tumors being 93 in total,were treated by LGK. Twenty-one patients with HBs were associated with von Hippel-Lindau disease (VHLD). The tumor size ranged 5～55 mm with a mean size of 13 mm. The mean maximum irradiation dose was 35.6 Gy (20.0～50.0 Gy) at tumor center and the mean minimum dose was 17.2 Gy (12.0～24.0 Gy) at tumor periphery. Fisher exact test,independent T test and Wilcoxon rank sum W test were used to analyze the results of LGK on solitary and multiple HBs,the recurrent time of the HBs,and the relation between minimum irradiation dose and tumor control. Results 35 patients had been followed for 24-114 months with a mean value of 66 months. 29 patients were alive and 6 died. Of the 29 patients 21 achieved satisfying tumor control,and 8 patients underwent open surgery because of tumor-associated cysts enlarging or development of new tumors after LGK. 21 patients had improvement or remained stable in neurological status. Of the 8 reopened patients,2 had deteriorated symptoms and the other 6 remained neurologically stable. Of the 35 patients,7 developed new tumor during the follow-up period,and 5 had second LGK. Tumor control: Of the 29 cases,solitary or multiple tumors in 23 patients decreased in volume or remained the same,although two developed new tumors. The result of LGK in controlling HBs showed no significant difference between the solitary and multiple HBs ( P >0.05),but the dose of long-term tumor control was significantly higher than that of uncontrolled tumors ( W =98,P <0.01). The tumor control rate was 94% 1 year after; 85% 2 years after; 82% 3 years after; 79% 4 years after; and 71% 5 years after. For the patients with solitar

关 键 词：伽玛刀 颅内血管母细胞瘤 肿瘤复发 放射疗法 Hippel-Lindau病 

分 类 号：R739.4[医药卫生—肿瘤]