局限性脑干胶质瘤的伽玛刀分次治疗研究

The study of dose fractionated gamma knife radiosurgery for local brainstem gliomas

目的分析和评价伽玛刀分次低剂量治疗局限性脑干胶质瘤的临床疗效。方法我中心应用OUR-G旋转式伽玛刀治疗局限性脑干胶质瘤42例进行历史前瞻性研究,按就诊先后顺序随机分成两组,一组采用常规一次性照射,肿瘤边缘剂量为10.0～12.0Gy,等剂量曲线50%～60%;另一组采用分次低剂量(2次)治疗,每次边缘剂量为7.5Gy,等剂量曲线50%～60%。结果全部病例随访时间3～37个月;平均28.4个月,单次治疗组:好转5例(23.8%),稳定4例(19.0%),恶化7例(33.3%),死亡5例(23.8%),有效率为42.9%;分次治疗组:好转9例(42.9%),稳定7例(33.3%),恶化4例(19.0%),死亡1例(4.8%),有效率为76.2%。结论伽玛刀分次低剂量治疗局限性脑干胶质瘤效果较单次治疗组明显,大大提高了病人的生存率、生活质量,是一种相对有效的治疗局限性脑干胶质瘤的方法。

Objective To analyze and appraise the clinical effect of gamma knife radiosurgery for local brainstem gliomas in short-term dose fraction. Methods The historical prospective cohort study of my department treated 42 cases of local brainstem gliomas with OUR-G Rotating Gammma Knife. According to visiting sequence, divided into two groups. One was treated once, peripheral dose 10. 0-12. 0 Gy, isodose 50%-60%; the other was treated twice, peripheral dose 7. 5Gy, isodose 50%-60%. Results All cases were followed 3-37m, average 28. 4m, single group： improved 5 cases, no changed 4 cases, worsened 7 cases, died 5 cases, effective rate 42. 9%; fractionated group： improved 9 cases, no changed 7 cases, worsened 4 cases, died 1 case, effective rate 76.2%. Conclusion Gamma knife radiosurgery for local brainstem gliomas in short-term dose fraction is better than single high dose group. It provides good local control and survival rate, also improves patients＇ symptoms and life equality.