松果体生殖细胞瘤放射治疗分析

Analysis of Radiotherapy in the Pineal Germ-cell Tumor

目的 探讨立体定向放射治疗技术联合常规放疗在松果体生殖细胞瘤治疗中的应用及治疗效果。方法 1996年4月— 1997年 9月 7例松果体生殖细胞瘤患者接受放射治疗 ,其中 2例应用γ 刀立体定向单次大剂量放射治疗加全脑全脊髓放射治疗 ,3例应用X 刀立体定向分次放射治疗加全脑全脊髓放射治疗 ,2例应用常规放疗加全脑全脊髓放射治疗。结果 5例患者行γ 刀、X 刀立体定向放射治疗联合全脑全脊髓放射治疗 ,治疗结束后 4例患者肿瘤消失 ,1例肿瘤明显缩小 ;2例行常规放疗联合全脑全脊髓放射治疗者 ,治疗结束后肿瘤均明显缩小 ;所有患者在治疗过程中均有轻度恶心呕吐 ,白细胞下降 ,治疗结束后临床症状均明显减轻。 1例患者因严重消化道反应及白细胞下降终止治疗 ,于 5个月后出现脊髓转移。 2例随访 2 6个月 ,1例随访 18个月 ,2例随访 12个月 ,均无肿瘤复发。结论 应用立体定向放射治疗技术联合常规放疗能有效控制肿瘤 ,不良反应小 ,安全可靠 ,可能成为松果体生殖细胞瘤首选治疗方法。

Objective To investigate the application and the effect of stereotactic radiotherapy combined with conventional radiotherapy in the pineal germ-cell tumor. Methods From April, 1996 to september, 1997. Seven patients of pineal germ-cell tumor were treated by radiotherapy. Two of the patients were treated by γ-ray stereotactic radiotherapy with a single high-dose plus craniospinal irradiation, three of the patients were treated by X-ray stereotactic fraction radiotherapy plus craniospinal irradiation, two of the patients were treated by conventional radiotherapy plus craniospinal irradiation. Results Four patient's tumor disappeared, one patient's tumor was obviously reduced with γ-ray and X-ray stereotactic radiotherapy plus craniospinal irradiation after treatment, two patient's tumor were obviously reduced with conventional radiotherapy plus craniospinal irradiation after treatment. Six of the patients had appeared longitudinal nausea, vomit and leukopenia in the treatment, but their clinical symptom were obviously alleviated after treatment. One patient stoped treatment because of serious reaction of digestive and leukopenia, and had appeared spinal cord metastasis after five months. The follow-up showed that two patients survived without tumor recurrence over twenty-six months, one patient over eighteen months, two patients over twelve months. Conclusion Stereotactic radiotherapy combined with conventional radiotherapy could control tumor effectively, and had lower side effect, maybe a preferred method to treat the pineal germcell tumor.