摘要
目的分析髓母细胞瘤临床治疗效果及预后影响因素。方法回顾性分析接受手术、放疗及化疗的髓母细胞瘤36例。按照Chang'sM分期,M0期23例,≥M1期13例。所有病例均接受了原发肿瘤的全切或次全切除手术。其中M0期6例全切术切除范围为肉眼肿瘤外延1.5cm者(根治术),接受全脑全脊髓放疗(craniospinalirradiation,CSI)24Gy,再局限于小脑加量24Gy。其余病例放疗先给予CSI30Gy,然后缩野至后颅窝局部加量20～25Gy,中位分次剂量为1.8Gy。所有≥M1期患者放疗后接受化疗。结果所有病例均完成了放疗及化疗,全组3、5年总生存率分别为69.4(%25/36)和61.1(%22/36)。其中6例根治手术加全脑全脊髓低剂量预防照射患者3、5年生存率均为83.3(%5/6);M0期全切或次全切手术加全脑全脊髓足量放射治疗患者3、5年生存率为70.6(%12/17)、58.8(%10/17);≥M1期患者61.5(%8/13)、53.8(%7/13)。17例全切或次全切手术加CSI足量放疗患者中,手术与放疗间隔时间≤21d、>21d的3年生存率分别为81.8(%9/11)、50.0(%3/6),无病生存率为72.2(%8/11)、33.3%(2/6)。辅助化疗对提高高危组的生存率有一定意义。放疗中最常见的副反应主要为白细胞下降,83.3(%30/36)的病例出现了白细胞计数下降(<4.0×109/dl),其中2、3级的血液系统毒性占55.6(%20/36);放疗后甲状腺功能改变发生率为44.4(%16/36)。结论髓母细胞瘤通过手术与放、化疗结合能取得较好疗效。手术与放疗间隔时间对生存率及复发率有一定影响,放疗中最常见的副反应为血液毒性和甲状腺功能改变,辅助化疗可以改善高危组的生存率。
[Objective] To analyze the treatment effects and prognostic factors of the thirty six patients with eerebellar medulloblastoma. [Methods] 36 patients with medulloblastoma, by Chang＇s staging system M0 and ≥M1 were admitted in our prognostic analysis. All patients received operation entirely or largely turnout resection. 6 of those received the radical cure operation by which turnout and 1.5cm tissue around it were reseeted. The patients who received the radical cure operation were irradiated with the technique： 24 Gy delivered to the whole craniospinal axis followed by a 24 Gy boost to the posterior fossa, with a median fraction dose of 1.8 Gy. All others patients were irradiated with the technique： 30 Gy delivered to the whole eraniospinal axis followed by a 20-25 Gy boost to the posterior fossa, with a median fraction dose of 1.8 Gy. All≥M1 patients also received chemotherapy. [Results] All patients had finished the radiotherapy and/or chemotherapy. The overall 3 and 5 year survival rates were 69.4%（25/36） and 61.1% （22/36） respectively. The 3 and 5 year survival rates of the 6 patients, who received the radical cure operation and CSI 24 Gy followed by a 24 Gy boost to the posterior fossa, were 83.3%（5/6） and 83.3 %（5/6） respectively. The 3 and 5 year survival rates of all other M0 patients, who received entirely or largely tumour resection and complete dose radiotherapy, were 70.6%（12/17） and 58.8%（10/17） respectively. The 3 and 5 year survival rates of All ≥M1 patients were 61.5%（8/13） and 53.8%（7/13） respectively. Patients whose radiation treatment had been started within 21 days after operation showed a better survival than those beyond the 21th day, with 3 year overall survival of 81.8%（9/11）, 50.0%（3/6）, and 3 year disease free survivals of 72.2%（8/11）, 33.3%（2/6） respectively. During the course of irradiation, the most common side effect was hematological toxicity, especially the WBC reduction which was observed in 83.3%（30/36） of patients, with 55.6%（20/36） of them suffering from grade 2-3 hematological toxicity. 44.4%（16/36） of the thyroid function lowered after radiotherapy. [Conclusions] Surgery plus craniospinal irradiation and chemotherapy is able to give a good result for medulloblastoma. The interval between surgery and radiation is a significant prognostic factor for disease free survival .The most common side effect is hematological toxicity and lower thyroid function.
出处
《中国医学工程》
2006年第6期653-656,共4页
China Medical Engineering
