脑转移瘤的X-刀治疗(附23例报告)

The X-knife treatment of brain metastases (report of 23 cases)

目的:总结我院用X-刀治疗脑转移瘤的经验。方法:以Brain ScanⅡ型X-刀治疗脑转移瘤病人23例,共38个病灶。治疗计划为:病灶体积为13.40±9.35cm^3,等中心数目1至3个不等,准直仪直径为10～40mm,中心剂量为22.25±3.24Gy,肿瘤边缘剂量为15.75±2.93Gy。其中17例加作了全脑放射治疗。结果:随访8.52±3.54个月,病灶经X-刀治疗后局部控制率为89.47％。病人因脑转移瘤而产生的症状均明显改善或消失,其平均生存时间为7.88±3.24个月,加作全脑放疗者的平均生存时间明显较单纯X-刀治疗为长。未发现放射性水肿、坏死及自发性瘤内出血等严重的并发症。已死亡8例,死亡原因与X-刀听治疗的转移灶无关。结论:X-刀或其它立体定向放射神经外科是治疗脑转移瘤的良好方法,但应慎重选择适应证,加强术后处理,并结合其它治疗手段。

To present our experience in the treatment of brain metastases by X-knife. Method: Twenty-three patients with brain metastases were treated by Brain Scan II X-knife. The total number of lesions were thirty-eight. The plan of treatment was as follows: the average volume of lesion was 13. 40 = 9. 35 cm^3, the number of isocenters was 1 to 3,the diameter of collimators was 10 mm to 40 mm,the dose of isocenter was 22.25 = 3.24 Gy, the dose of tumor margin was 15. 75 = 2. 93 Gy. The whole brain radiation therapy was added in 17 patients. Result: The follow-up period was 8. 52 r 3. 54 months, the local control rate of the targets was 89.47% after treatment, the symptom of metastasis was improved or disappear, the mean survival time of patients was 7.88 = 3.24 months, and it was longer in the group of adding whole brain radiation therapy. The severe complications were radiation edema. Necrosis and spontaneous intratumoral hemorrhage were absent. Eight cases died during the follow-up period, the cause of death was not related to the X-knife treatment. Conclusion: X-knife radioneurosurgery is the valuable methods of treatment for brain metastasis, but its indications should be carefully selected , the postoperative management should be intensified, and it would be better combined with other therapeutic methods.