巨大脑胶质瘤伽玛刀分次治疗的理论与实践

Fractionated gamma knife radiosurgery for giant gliomas

目的探讨巨大脑胶质瘤伽玛刀分次治疗的理论依据及实际疗效。方法借鉴分割治疗及放射外科动物实验的理论结果,设计出巨大脑胶质瘤的伽玛刀分次治疗,治疗分2次或3次完成,每次间隔1d,分次照射的周边剂量为5～10Gy。治疗效果通过MRI和临床表现综合评估。结果随访3～33个月,28例巨大脑胶质瘤分次伽玛刀治疗有效率为78.6%,2例病人伽玛刀术后出现迟发性脑水肿。治疗效果与肿瘤分化程度有关,与肿瘤大小无关。结论巨大脑胶质瘤分次伽玛刀治疗的理论依据充分,实际治疗效果显著,其远期疗效尚需继续随诊。

Objective To explore the treatment of giant gliomas with fractionated gamma knife surgery according to the the-ory studied.Method Two or three courses of lowdose treatment were planned for fractionated gamma knife surgery in3or5days.The marginal dose of each radiation was5-10Gy.The Leksell frame was fixed on the patient's head for the entire period of treatment.Before the second and third treatment,the frame position was confirmed to be identical with that during the first treatment.The effects of treatment were evaluated not only by MRI but also by clinical presentations after radiosurgery.Re sult After a follow-up of3-33months,the growth-controlled rate of28gliomas treated with fractionated gamma knife surgery was78.6%,2cases showed delayed brain edema after radiosurgery.The outcome of treatment was related to the extent of differenti-ation of gliomas and the times of fractionated treatment,but not to the size of tumors.Conclu sion The preliminary clinical re-sult with fractinated gamma knife surgery is encouraging and the effect is correspond to the related theory about the irradiation biological theory.Further experimental studies and long-term follow-up of patients are necessary to confirm fractionated gamma knife radiosurgery as a safe and effective therapy for malignant gliomas.