陀螺旋转式伽玛刀的临床应用

Clinical use of top rolling gamma knife

目的评价陀螺旋转式伽玛刀的临床应用效果。方法回顾性分析自2008年6月至2010年10月经陀螺旋转式伽玛刀治疗的161例患者，原发疾病中肺癌67例，脑瘤23例，食管癌22例，乳腺癌14例，其他包括直肠癌、胆管癌、肾癌、头颈部肿瘤共35例。治疗部位肺48例，脑93例，其中4例包括肺、脑两个部位，肝脏8例，其他部位14例。结果单靶点140例，多靶点21例，最多10个靶点。总剂量7．5～60．0GY，中位剂量42GY，分次数2—14次，单次剂量3—10GY。可评价近期疗效143例，有效率为36．4％（52／143），临床获益率（CR＋PR＋SD）为95．8％（137／143）。脑部病灶合并全脑放疗34例，合并化疗47例。失访65例，随访率为66．4％。随访期间出现进展55例，其中治疗部位进展15例，远处转移31例，一般状况恶化9例。中位疾病控制时间（OCT）5个月（1～24个月）。不良反应均可耐受。结论陀螺旋转式伽玛刀的合理应用可提高肿瘤患者生存质量，延长生存期，不良反应轻微。

Objective To analyze the clinical efficacy of top rolling gamma knife in the treatment of patients with tumors. Methods One hundred and sixty-one patients with KPS I〉60, from June 2008 to October 2010 retrospectively analyzed. In these cases, the primary diseases include 67 cases of lung cancers, 23 cases of brain tumors, 22 cases of esophageal cancers, 14 cases of breast cancers and 35 cases of others. Treatment sites included 48 cases of lungs, 93 cases of brains, in which 4 cases in- cluded lung and brain at the same time, 8 cases of livers and 14 cases of other sites. Results One hun- dred and forty cases were treated by single target, 21 cases were treated by more than one target. All received 3 - 10 Gy per fraction to the 50% -isodose line, 3 days in one week, total dose was 7.5 - 60 Gy （median 42 Gy）. One hundred and forty-three patients can be analyzed by efficacy. The response rate （RR） was 36. 4% （52/143）, the clinical benefit rate（CBR） was 95.8% （137/143）. The follow-up rate was 66.4% （65/143）. The median disease control time was 5 months（ 1 - 24 months）. Fifteen patients underwent local failure and thirty-one patients with distant failure. The adverse effects were all acceptable. Conclusions Among patients with tumors, rational application of top rolling gamma knife could get excellent symptom-control and local control survival with low adverse effects.