脑胶质瘤伽玛刀放射外科治疗的临床初步观察

Clinical study of gamma knife radiosurgery for cerebral glioma

目的:探讨伽玛刀治疗对脑胶质瘤的临床疗效及反应。方法:自2002年7月至2008年12月对604例病理诊断明确的脑胶质瘤患者进行了伽玛刀治疗,其中男358例,女246例,年龄5-80岁,平均46.2岁。病理诊断:星形细胞瘤411例(68%),其中Ⅰ-Ⅱ级262例,(63.7%),Ⅲ-Ⅳ级149例(36.3%)。室管膜瘤55例(9.1%),少枝胶质细胞瘤93例(15.4%),脉络丛乳头状瘤14例(2.3%),髓母细胞瘤31例(5.1%)。肿瘤周边剂量为8-30Gy,平均15.4Gy,中心剂量为25-62.5Gy,平均40.2Gy。结果:随访时间为6至60个月,平均19个月。低度恶性胶质瘤的疗效明显优于高度恶性胶质瘤(P<0.005),伽玛刀治疗的总有效率为82.8%。低度恶性胶质瘤生存期大于高度恶性胶质瘤,生存1年以上和生存2年以上均有显著性差异,(P<0.005)。结论:伽玛刀对低恶性胶质瘤患者的治疗效果优于高恶性胶质瘤,并且能有效延长生存时间,提高生存质量。对体积较小,脑深部或脑干胶质瘤,伽玛刀能有效杀死肿瘤细胞并延缓肿瘤生长。

Objective： To explore the clinical effect and reaction of gamma knife radiosurgery treatment on cerebral gliomas. Methods： From July 2002 to December 2008, 604 patients with gliomas had been treated with gamma knife radiosurgery. There were 358 males and 246 females ages ranged from 5 to 80 years with an average of 46.2 years. In all patients, histological diagnoses were astrocytoma in 411 cases （ 68% ）. Grade I-II in 262 cases （63.7%）, grade III-IV in 149 cases （36.3%）, ependymoma in 55 cases （9.1%）, oligodendroglioma in 93 cases （15.4%）, choroids papilloma in 14 cases （2.3%）, medulloblastoma in 31 cases （5.1%）. The marginal dose ranged from 8 to 30 Gy with a mean of 15.4 Gy. The maximal dose was 25 to 62.5 Gy with a mean of 40.2 Gy. Results： All patients had been followed up from 6 to 60 months （ average 19 months）. The curative effect of the low grade gliomas was obviously better than high grade tumors, （P0.005）.The total effectiverate of gamma knife radiosurgery treatment for gliomas was 82.8%. the higher grade glioms, the shorter time of survival.There were significant difference in more than 1 year survival and more than 2 years survival（P0.005）. Conclusion： Gamma knife radiosurgery is better method to lower grade gliomas than to higher grade gliomas and can effectively prolong the survival time and improve quality of life. For relatively small, deep brain or brain stem glioma, gamma knife can be effective in killing tumor cells and delay tumor growth.