立体定向放射治疗听神经瘤的疗效分析

Analysis on the therapeutic effects of streotactic radiotherapy for acoustic neuroma

目的评价立体定向放射治疗听神经瘤的局部控制率及不良反应。方法对82例听神经瘤患者进行立体定向放射治疗,所有患者均有患侧听力的进行性下降或肿瘤进行性增大,或两者兼有,MRI测量肿瘤的最大径平均为3.2cm(1.8～4.0cm)。有牙齿的患者采用分次治疗,接受剂量为20～24Gy/5～6次(80%等剂量曲线),无牙齿的患者采用单次治疗,剂量为11～13Gy(80%等剂量曲线),所有患者均设一个等中心。结果随访12～62个月,平均26个月,5年局部控制率为91.5%,听力保留率为75.8%,三叉神经功能保护率为91.4%,无面瘫、脑积水及其它并发症发生。结论立体定向放射治疗能有效的控制肿瘤的生长,听力保留率高,其它不良反应小。

Objective To evaluate the local control rate and adverse reactions in acoustic neuroma patients treated with streotactic radiotherapy. Methods Eighty-two patients were treated with streotatic radiotherapy. All the patients had progressive tumors,progressive symptoms,or both.Mean tumors max, diameter was 3.2cm,（1.8-4.0cm） on magnetic resonance （MR） scan. Dentate patients were given a dose of 20-24Gy/5-6 times and edentate patients were given a dose of 11-14Gy prescribed to the 80% iso- dosage curve,All the patients were treatd with a single isocenter. Results With a mean follow-up period of 26 （12-62） months,the local control rate within 5 years was 91.5%.The rate of hearing preservation within 5 years was 75.8% in previously-hearing patients.The local freedom from rigeminal nerve toxicity was 91.4% within 5 years.No patients developed nerve adverse reactions （such paralysis of facial nerve hydrocephalus） or other complications. Conclusion Single high-dose radiosurgery and fractionated streotactic radiotherapy can give excellent local control in acoustic neuroma,with a high rate of preservation of hearing and very low incidence of adverse reactions.