摘要
背景与目的:目前放射外科治疗恶性胶质瘤是否能提高疗效尚有争议,本文总结直线加速器放射外科治疗脑深部恶性胶质瘤的疗效及影响疗效的因素。方法:脑深部恶性胶质瘤58例,肿瘤平均体积12.08cm3,放射外科治疗平均处方剂量19.42Gy。用Kaplan-Meier曲线和Cox回归分析病人生存期和影响预后的因素。结果:随访期间内44.8%患者肿瘤缩小,间变性星形细胞瘤中位控制时间15个月,胶质母细胞瘤9个月。1年肿瘤控制率37.9%,预期生存率79.3%。2年肿瘤控制率10.3%,预期生存率20.6%。Cox回归分析等中心数和肿瘤体积对肿瘤控制有显著影响,而适形指数对生存期有显著影响。如果考虑到肿瘤恶性程度,只有等中心数和肿瘤体积对肿瘤控制时间有显著影响。并发症发生率44.8%,脑水肿加重中位时间8个月,症状性脑水肿发生率31.0%。结论:直线加速器放射外科治疗脑深部恶性胶质瘤,可提高肿瘤局部控制率,延长患者生存期。肿瘤体积对肿瘤控制时间有显著影响,适形指数对预后有显著影响。
Background & Objective:Though radiosurgery has been used for more than 10 years,the value of radiosurgery for malignant glioma has not been clarified. This paper was designed to investigate efficacy of radiosurgery to malignant glioma by analyzing the prognostic factors affecting prognosis of malignant gliomas treated with linac radiosurgery. Methods:Fifty eight patients with deep situated malignant gliomas, 28 anaplastic astrocytomas(AA) and 30 glioblastomas(GBM), aged from 7 to 70 years, were analyzed. The mean volume of tumor was 12 08 cm3, and mean prescription dose for linac radiosurgery was 19 42 Gy. The results were analyzed with Kaplan Meier curve and Cox regression. Results:There were 44 8% of the tumors shrank. Median tumor local control interval was 10 months(15 months for AA and 9 months for GBM). Tumor local control probability was 37 9% for 1 year and 10 3% for 2 years. Median survival was 22 5 months for AA and 13 months for GBM and 15 months for all patients. The survival probability was 79 3% at 1 year and 20 6% at 2 years. Isocenter numbers and tumor volume were the prognostic factors for tumor control, but conformity index was prognostic factor for survival as determined by Cox regression analysis. Considered of pathology, only isocenter number and target volume significantly affected the tumor control interval. Complication appeared in 44 8% of the patients and the median interval of complication onset was 8 months. Symptomatic cerebral edema was observed in 31 0% of the patients. Conclusion:Linac radiosurgery can effectively improve tumor local control and elongate survival for the patients with deep situated malignant gliomas. Tumor volume is the prognostic factor for tumor control,while conformity index is prognostic factor for survival.
出处
《癌症》
SCIE
CAS
CSCD
北大核心
2002年第10期1149-1153,共5页
Chinese Journal of Cancer
