三维适形放疗联合立体定向放射外科推量治疗颅内血管周细胞瘤

Treatment of intracranial hemanyiopericytoma with three-dimensional conformal radiotherapy combined with stereotactic radiosurgery

目的探讨三维适形放疗（3D-CRT）联合立体定向放射外科（SRS）推量治疗手术切除后颅内血管周细胞瘤（HPC）的疗效。方法广东三九脑科医院肿瘤综合治疗中心自2008年10月1日至2011年11月30日应用3D-CRT联合SRS推量治疗6例手术切除术后的颅内HPC患者，回顾性分析患者的临床表现、病理学特征、影像学表现和疗效。结果HPC患者的发病年龄在33～55岁之间，中位年龄46．5岁。临床表现主要为颅内压增高症状和肿瘤压迫、破坏周围组织所导致的局灶性症状；病理染色显示瘤细胞密集，呈纺锤形或多角形，胞膜不清，胞质略嗜酸性，可见核异型及核分裂；所有患者术后接受3D-CRT联合SRS推量治疗，随访14-44个月，2例完全缓解．4例部分缓解。结论HPC预后不良，易复发，偶有全身转移，手术切除是最佳治疗手段。对部分切除术后的患者，3D-CRT联合SRS推量可能进一步提高疗效。

Objective To evaluate the effect of three-dimensional conformal radiotherapy （3D-CRT） combined with stereotactic radiosurgery （SRS） on central nervous system hemanyiopericytoma （HPC） after the excision surgery. Methods The clinical manifestations, pathological characteristics, imaging features and treatment efficacy of HPC were analyzed retrospectively by examining the data of 6 patients with HPC after partial resection in our hospital fxom October 1, 2008 to November 30, 2011. Results Age of the HPC patients ranged from 33 to 55 years （median 46.5 years）. The main clinical manifestations included intracranial hypertension and focal symptoms caused by tumor oppression and destruction of the surrounding tissue. Pathological staining showed intensive tumor cells with spindle or polygonal shapes; the cell membrane was unclear; the cytoplasm was slightly eosinophilic; nuclear atypia and nuclear fission were visible. Follow up was performed in all the patients with 1 periods ranged from 14 to 44 months, showing 2 patients achieved complete remission and 4 partial remission. Conclusion HPC is an infrequent tumor of the central nervous system and has tendencies of recurrence and metastasis; Surgical resection is the best treatment; for the patients after partial resection, 3D-CRTcombined with SRS is likely to further improve the therapeutic effect.