38例髓母细胞瘤的放射治疗与预后关系

An Prognostic Analysis on Postoperative Radiotherapy Treatment of 38 Medulloblastoma Patients

目的 回顾分析38例髓母细胞瘤，探讨合理治疗方案及影响预后的因素。方法 手术后病理证实的38例髓母细胞瘤，先行直线加速器6MV—X—my或钴^60常规分割照射：全脑两侧野对穿照射DT30～36Gy后，缩野后颅窝瘤床追加DT15～25Gy。其中26例行全脊髓腔预防照射DT30Gy。23例患者放疗后行CCNU120mg口服化疗。结果 38例患者总的3、5年生存率分别为52．6％、34．2％。肿瘤全切除与次全切除3、5年生存率明显高于部分切除者。术后1个月内放疗组3、5年生存率比术后1个月后放疗组高。行原发灶照射加全脊髓腔预防照射者的3、5年生存率明显高于仅作原发灶照射者。原发灶剂量≥50Gy者存活率高于剂量〈50Gy者。结论 患者生存期与年龄、手术切除范围、术后放疗时间、剂量及范围有关。

Objective To review the clinical characteristics of medulloblastoma and discuss the reasonable plan of the treatment and the related prognostic factors. Methods Thirty-eight cases with histopathologically proved medulloblastoma were treated with postoperative radiotherapy . All patients received craniospinal irradiation with 6MV-ray or Co^60 gamma rays the prescribed dose was 30 - 36Gy to the whole brain, and a boost of 15 - 25 Gy to the tumor bed with shrinking fields. The dose to the whole spinal cord was 30 Gy. Twenty-three cases also received chemotherapy after radiation therapy. Results The overall 3,5 years survival rates were 52.6% ,34.2% respectively. The 3,5-years survival rates of the patients treated with the total and subtotal removal of turnout was higher than those with the partial one. The 3,5-years survival rates of the patients treated with postoperative radiotherapy within one month were different firm that over one month. The 3,5 years survival rates were 65 %, 46 % in the whole brain and spinal cord plus boosting to the tumor bed with shinking fields but only 25 %, 8 % in the whold brain plus boosting to the tumor bed with shinking fields（ P 〈 0.01 ）. The survival of the group receiving more DT50Gy at the tumor bed was better than the group receiving less DT50Gy（ P 〈 0.01 ）. Conclusion The survial time was related to patient＇s age and tumor＇s resection, period of postoperative radiation, radiation dose and method.