髓母细胞瘤的治疗与预后分析

Treatment and prognostic analysis of medulloblastoma

目的探讨儿童及成人髓母细胞瘤患者的治疗及预后情况。方法回顾性研究80例经病理证实的髓母细胞瘤，对其成人与儿童患者的生存情况与肿瘤切除程度、脑脊液分流情况、放疗方式对其预后的影响作多因素分析比较。结果61例（76％）获得6个月至14年随访。5年生存率与10年生存率分别为50．8％和27．9％。成人患者5年生存率较儿童高（P＜0．05），而10年生存率两组相近。肿瘤全切或次全切除生存率高于大部分切除（P＜0．05）。全脑加脊髓放疗可改善患者近期生存率（P＜0．05）。3例患儿生存超过Collins危险期。结论手术与术后常规放疗是治疗髓母细胞瘤的关键。全切除或次全切除肿瘤、全脑加脊髓放疗可明显提高生存率。少数患者有可能获得长期生存。

To analyse the treatment and prognosis of. medulloblastoma in bath child and adult. Methods A retrospective review was conducted in 80 cases with medulloblastoma confirmed by pathology. The influence of the extent of surgical excision. CSF diversion. type of radiotherapy as well as patients age on survival rate were analyzed and compared multivariately. Results 61 cases (76% ) were followed up from 6 months to 14 years. The overall 5 -year and 10--year survival rates for the present series were 50.8% and 27. 9% respectively. The 5 -year survival rate is higher in adults than in children (P< 0 .05). while the 10 year survival rate was similar. Patients with total or subtotal removal of the tumour had a better outeome those with partial removal (P< 0 .05). Craniospinal radiation could improve patients short--term survival (P< 0. 05). Only threepatients in this series were survived longer than Collins' riskperiod. Conclusions Surgical operation and postoperative regular radiotherapy were important therapeutic modalities for medulloblastoma. Total or subtotal removal of the tumor combined with craniospinal radiotherapy can improve patients' survival rate. Few patients may gain long-term survival.