手术切除联合放射性粒子永久性植入治疗复发性胶质瘤

Treatment of recurrent malignant brain glioma by surgical excision combined with ^(125)Ⅰ-seed-brachytherapy

目的探讨外科手术切除联合放射性粒子永久性植入治疗复发性胶质瘤的疗效。方法117例复发性胶质瘤完全随机分组,65例为间质放疗组,52例为普通放疗对照组,均行电磁导航辅助下显微神经外科手术全切除或次全切除。间质放疗组术中根据术前计算机三维治疗计划系统(TPS)在瘤床永久性植入125I放射性粒子进行组织间近距离连续照射,总量为50～60Gy。对照组术后行常规外照射,50～60Gy/25～30次。随访3～36个月,观察肿瘤再次复发率、中位生存期。结果间质化疗组第2次手术后12个月复发31例(47.7%);24个月复发46例(70.8%),较对照组(71.2%、86.5%)有显著差异;中位生存时间18.2月,较对照组13.5月显著延长;对照组并发症发生率53.8%,间质化疗组无显著的放疗并发症。结论力争手术全切除联合放射性粒子永久性植入对复发性恶性胶质瘤细胞近距离持续照射,疗效明显提高,安全且并发症少。

Objective To evaluate the outcome of recurrent malignant brain gliomas treated by surgical excision combined with 125^I seeds brachtherapy. Methods 117 patients with recurrent malignant brain glioma divided randomy into two groups, the tumors were total in or sub-total in resected, 125^I-seeds were permanently implanted in the tumor bed during operation at a total dose of 50- 60 Gy in group A, compared to group B received external radiotherapy. The patients were followed up from 3 to 36 months, the recurrent rate and the median survival were compared between groups. Results At 12,24 months after treatment, the recurrent rate of group A was 47.7% and 70.8% ,the median survival was 18.2 months,all were better than group B . All the patients had no apparent side-effects of radiotherapy. Conclusions Surgical treatment combined with 125^I-seed- brachtherapy improve the outcome of recurrent malignant brain gliomas compared to common radiotherapy after surgery.