射波刀分次治疗鞍区和鞍旁肿瘤的初步研究

Preliminary research of fractionated radiotherapy with cyberknife for sellar and parasellar tumors

目的总结射波刀分次治疗鞍区或鞍旁肿瘤的疗效。方法回顾性分析30例术后残留、复发或不适合手术的鞍区或鞍旁肿瘤的临床资料,其中垂体瘤8例,脑膜瘤9例,颅咽管瘤、海绵窦血管瘤和三叉神经鞘瘤各4例,脊索瘤1例。均应用射波刀分次治疗,照射肿瘤的周边剂量15～24 Gy,平均19 Gy;中心剂量23～35 Gy,平均29 Gy;等剂量曲线62%～70%,平均67%。结果术后视力障碍改善3例,无变化2例;眼球运动障碍改善4例,无变化1例;面部麻木改善3例,未改善2例,无新增脑神经受损症状。随访12～27个月,平均17个月;复查MRI显示:肿瘤缩小21例,保持原有大小9例。结论射波刀分次治疗鞍区或鞍旁肿瘤初步疗效满意,可提高脑神经对射线的耐受剂量,长期疗效有待进一步随访。

Objective To summarize the therapeutic efficacy of fractionated radiotherapy with cyberknife for sellar and parasellar tumors.Methods Clinical data of 30 patients with residual,recurrent or inoperable tumor in the sellar and parasellar regions were analyzed retrospectively,including pituitary adenoma in 8 cases,meningioma in 9,craniopharyngioma in 4,cavernous sinus hemangioma in 4,trigeminal schwannoma in 4 and chordoma in 1.Fractionated radiation by cyberknife was performed in all the patients.The mean of irradiation dose was 19 Gy,ranged from 15 Gy to 24 Gy in the surrounding tumors,while the mean of 29 Gy,from 23 Gy to 35 Gy in the center of tumors.The mean percent of isodose curves was 67%,ranged from 62% to 70%.Results Visual acuity was improved in 3 cases and unchanged in 2.Ocular movement was improved in 4 cases and unchanged in 1.Facial numbness was improved in 3 cases and unchanged in 2.No new cranial nerve deficits were found postoperatively.All the patients were followed up for mean of 17 months,ranged from 12 to 27 months.Tumor volume decreased in 21 cases and kept unchanged in 9 according to MRI examination.Conclusions Fractionated radiation by cyberknife can increase the dose the cranial nerve can tolerate.The preliminary results demonstrate that tumors could be controlled well,but long-term follow-up studies are needed.