伽玛刀联合立体定向间质内放疗治疗囊实体混合性颅咽管瘤的远期疗效分析

Mixed craniopharyngioma： long-term results after Gamma knife combined with stereotactic Brachytherapy

目的 评价伽玛刀联合立体定向囊内间质内放疗治疗囊实体混合性颅咽管瘤的远期疗效.方法 回顾性分析1996年10月至2005年12月接受伽玛刀联合立体定向囊内间质内放疗治疗并至少生存5年的67例囊实体混合性颅咽管瘤患者资料.男性39例,女性28例;年龄3～ 70岁,平均31.5岁.随访内容包括临床评估（神经检查、神经眼科和神经内分泌学检查）、综合生活质量评价、神经影像学检查、生存率和生存期分析.采用x2检验,Kaplan-Meier法计算生存率.结果 随访时间60～168个月,平均114个月,伽玛刀联合立体定向囊内间质内放疗治疗对大实体小囊性、大囊性小实体颅咽管瘤以及总体有效控制率分别为10/12、90.9％和89.6％.本组患者的平均生存时间为（110±9）个月.大实体小囊性和大囊性小实体肿瘤患者的平均生存时间为（97±12）和（120±14）个月,10年实际生存率分别为7/12和69.1％.两组患者的肿瘤控制率和10年生存率间差异无统计学意义（x2 =0.114和1.541,P ＞0.05）.5～10年的实际生存率分别为90.5％、85.7％、83.3％、76.4％、69.4％和60.0％.视力受损者术后6个月和长期随访的改善率分别为68.3％和70.0％.67例患者末次随访时综合生活质量评价28例（41.8％）优,19例（28.4％）良,17例（25.4％）可,3例（4.5％）差.治疗后6 ～12个月4例视力下降,4例出现新的丘脑下部功能受损表现,1例于术后5年出现一侧动眼神经不全麻痹,并发症发生率为13.4％.结论 伽玛刀联合立体定向间质内放疗为囊实混合性颅咽管瘤提供了良好的肿瘤控制率和理想的远期生存率,是一种安全有效的治疗选择.

Objective To evaluate the long-term results of combination treatment with Gamma Knife radiosurgery and stereotaetie intracavitary brachytherapy for mixed cystic and solid eraniopharyngiomas. Methods Sixty-seven consecutive patients with mixed cystic and solid eraniopharyngioma treated by Gamma Knife radiosurgery combined with stereotactic braehytherapy from October 1996 to December 2005 were selected for retrospective analysis. The inclusion criterion was the patients who survived for at least 5 years after combined treatment. There were 39 male and 28 female patients and the mean age was 31.5 years （ranged from 3 to 70 years）. The clinical evaluations including neurological, neuro-ophthalmological, and neuro-endocrinological examinations, assessment of comprehensive quality of life and neuroimaging examinations were performed periodically. The actuarial survival rates and the mean survival time were calculated by using Kaplan-Meier product limit method. The rates were compared using the X2 test. Results Follow-up period varied from 60 to 168 months, with an average of 114 months. The tumor response rate gained from combination treatment with Gamma Knife radiosurgery and stereotactic intraeavitary brachytherapy for predominantly solid and cystic craniopharyngiomas were 10/12 and 90.9% respectively, and 89.6% in all. Mean survival after combination treatment was （110 ± 9） months. The mean survival of patients with predominantly solid and cystic craniopharyngioma were（ 97 ± 12） months and （ 120 ± 14 ） months and the actuarial 10-year survival rates were 7/12 and 69. 1%. There was no statistics difference in tumor response rate and 10-year survival rate between 2 groups of patients with predominantly solid and cystic craniopharyngioma. The actuarial 5-, 6-, 7-, 8-, 9- and 10-year survival rates were 90. 5%, 85.7%, 83.3%, 76. 4%, 69. 4% and 60.0% respectively. The decreased visual acuity had improved in 68.3% at 6 months postoperatively and in 70. 0% in long term results. Comprehensive quality of life in long term follow-up of 67 patients was excellent in 28 cases（41.8% ）, good in 19 cases（28.4% ）, fair in 17 cases（25.4% ） and poor in 3 cases（4. 5% ）, respectively. The side effects that occurred 6 to 12 months after treatment were worsening of visual acuity （4 patients）, dysfunction of hypothalam （4 patients） and third nerve palsy was found in 1 patents 5 years after treatment. The rate of complications was 13.4%. Conclusion Combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy is highly effective and safety in the treatment of mixed cystic and solid craniopharyngiomas.