脑转移瘤的立体定向放射手术(附272例临床报告)

Stereotactic radiosurgery for brain metastasis (272 cases reported)

目的探讨立体走向放射手术（伽玛刀）治疗脑转移瘤的临床疗效。方法对272例脑转移瘤病人，用1．5Tesla磁共振仪和Gamma－Plan计算机联网定位，Leksell伽玛刀实施放射手术，其中单发156例，多发116例；男181例，女91例，年龄18－86岁，平均58岁。肿瘤直径3．5－50．1mm；周边剂量10－35Gy，平均18．SGy，中心剂量27－70Gy，平均46Gy；靶点数1－11个，平均4．3个。结果本组病例随访10－46个月，平均28个月，272例病人396个病灶，完全缓解326个（82．3％），部分缓解38个（9．5％），无变化及进展32个（8．2％）。平均生存期136个月。结论伽玛刀是治疗脑转移瘤安全，可靠的手段之一，而且并发症少，有效率高，可延长病人寿命，减少病人痛苦，提高生存质量。伽玛刀治疗脑转移瘤体积小于或等于3cm×3cm×3cm，周边剂量大于或等于18Gy时，疗效较好。

Objective To evaluate the clinical effect of gamma knife stereotactic radionsurgery on brain metastasis. Method 272cases with brain metastasis were treated by Leksell ganlma knife. The localization of the tumor was defined hy 1.5 Tesla MRI andtransmit the images from the network workstation to the plan system of the gamma knife. Among them, 156 cases with single lesion,116 cases with multiple lesions, 181 males and 91 females. Their ages ranged from 18 to 86 years, mean 58 years. The diameter oftumors ranged from 3.5 to 50.1mm. the peripheral doses ranged from 10 to 35 Gy, mean 18.8 Gy. The center dose ranged from 27 to70 Gy, mean 46 Gy. The number of shots ranged from 1 to 11, mean 4.3 shots respectively. Result All the patients followed upfrom 10 to 46 months, mean 28 months. In 272 cases- there are 396 metastatic lesions, tumors disappear of in 326 cases (82.3%),raduction of more then half of tumor size in 38 cases (9.5%), no change and increased in volume of tumor in 32 cases (8.2%). Themedian survival time was 13.6 months. Conclusion Gamma knife radiosurgery was a safe and effective meth0d in the treatment ofhrain metastasis, and few complication occurred. It call prolong the survival time and improve the life quality of the patients. If thevolume of tumor < 3cm×3cm×3cm and peripheral doseage >18Gy, the effect of gamma knife radiosurgery will be better.