西部地区松果体区肿瘤治疗模式的初步调查

Preliminary investigation on treatment modes of pineal region tumors in Western China

目的调查分析我国西部地区松果体区肿瘤治疗模式,为其临床路径的建立提供依据。方法回顾性分析我国西部地区9家三甲医院脑外、放疗科近8年松果体区肿瘤治疗资料,重点分析其手术、放射治疗的选择及治疗方法、步骤等。结果共收集219例,其中手术治疗58例,肿瘤全切除52例,肿瘤次全切6例;放射治疗196例:脑室-腹腔分流术和三脑室造瘘术后放疗99例、直接单纯放疗58例、手术切除加放射治疗39例。在放射治疗中,采用立体定向放射治疗153例、直线加速器放疗43例(其中先行诊断性放疗25例),其中常规分割全中枢照射放疗21例。结论脑室-腹腔分流术/三脑室造瘘术+放疗是松果体区肿瘤治疗的最多见模式,其次为肿瘤切除+放疗模式,放射治疗在照射方式与照射剂量方面差异巨大,提示松果体区肿瘤的治疗极不规范,建立松果体区肿瘤的诊治规范是极为重要和迫切的。

Objective To investigate and analyze the treatment modalities in large hospitals in Western China in order to provide basis for establishing clinical guidelines for the treatment of pineal region tumors. Methods Retrospective analysis of pineal region tumor treatment data of 9 top, large hospitals in Western China was carried out, focusing on the treatment options such as surgery, radiation therapy, their sequence, specific procedures and so on. Results A total of 219 patients’ medical records were collected, of which 58 were treated with surgery and 196 with radiotherapy. In the surgical group, tumor complete resection in 52 cases and subtotal tumor resection in 6 cases were found. The radiotherapy group included 99 cases treated after ventriculo-peritoneal shunt or three ventriculostomy, 58 cases of direct radiotherapy, and 39 cases of tumor resection surgery followed by radiotherapy. As for the radiotherapy pattern, it was found that 153 cases were treated with stereotactic radiotherapy technique, 43 cases with linear accelerator radiation, of which 25 with diagnostic radiotherapy, and 21 cases with whole central nervous system radiation. Conclusion Radiotherapy after ventriculo-peritoneal shunt/three ventriculostomy is the most common treatment mode of pineal region tumor, followed by tumor resection plus radiotherapy. There are huge differences in the selection of radiotherapy techniques and doses. The results indicate a lack of specification in the treatment of pineal region tumors in Western China. It is important and urgent to give much concern for the establishment of diagnosis and treatment standard.