伽玛刀治疗脑胶质细胞瘤的临床初步报告

The clinical preliminary report of Gamma knife radiosurgery for gliomas

目的：评价伽玛刀治疗对脑内胶质细胞瘤的疗效。方法：５７例病理诊断明确的脑胶质瘤患者进行了伽玛刀治疗，其中男３５例，女２２例，年龄７～６８岁，平均３０．８岁。病变位于大脑半球２７例，丘脑及基底节区２２例，脑干２例，小脑２例。病理诊断：星形细胞瘤Ⅰ级７例，Ⅱ级 ５例， Ⅰ— Ⅱ级 １８例，少枝胶质瘤 ４例，室管膜瘤２例，星形细胞瘤Ⅲ级２例，Ⅳ级２例，Ⅲ－Ⅳ级１３例，胶质母细胞瘤４例。周边剂量为１２～２２Ｇｙ，平均为１６．５Ｇｙ。结果：随访时间为６至４２个月，平均为２３个月。３６例低恶度胶质瘤的影像学复查结果：显效６例（１６．７％）；有效１４例（３８．９％）；微效５例（１３．９％）；无变化６例（１６．７％）；恶化５例（１３．９％）。有效率为５５．６％。２１例高恶度胶质瘤中２～３个月及远期影像学有效率分别为６６．７％和２３．８％。６，１２，２４，３６，个月的存活率分别为９５．２％（２０／２１）；８１．０％（１７／２１）；４７．ｌ％（８／１７）和３３．３％（３／９）。１５例病人（２６．３％）于治疗后１２个月内出现放射性水肿。结论：伽玛刀对体积较小，边界相对较清的低恶度胶质瘤的治疗是有效的。

Objective: To investigate the clinical effects of Gamma Knife radiosurgery on cerebral gliomas. Methods: 57 patients with gliomas were treated with Gamma Knife radiosurgery in Navy Gen- eral Hospital. There were 35 males and 22 females, and their ages ranged from 7 to 68 years, with an average of 30. 8 years. They were located in cerebral hemisphere in 27 cases, in basal area in 22, in brainstem in 2 and in cerebellum in 2. In all patients, there were definitive histological diagnoses: astro- cytoma grade I in 7 cases, grade Ⅱ in 5, grade Ⅰ - Ⅱ in 18, oligedendroglioma in 4, ependymoma in 2, astrocytoma grade Ⅲ in 2, grade Ⅳ in 2, grade Ⅲ - Ⅳ in 13 and glioblastoma in 4. The marginal dose ranged from 12 to 23 Gy, with an average of 16. 5 Gy. Results: All patients were followed up from 6 to 42 months (averaged 23 months). The imaging examination in 36 benign gliomas showed disappeared in 6 cases (16. 7% ) reduced more than 50% in 14 (38. 9% ), reduced from 25% to 50% in 5 (13. 9 % ), no changed (reduced< 25 % to increases< 25 % ) in 6 (16. 7% ), increased more than 25 % in 5 (13. 9 % ). The effective rate was 55. 6%. In 21 malignant gliomas, the effective rates in imaging ex- amination in 2 to 3 months and long - timed follow up (averaged 23 months) were 66. 7% and 23. 8 %, respectively. The survival rates in 6, 12, 24 and 36 months were 95. 2 % (20/21), 81. 0 % (17/21), 47. 1% (8/17) and 3. 3 % (3/9). The radioactive brain edema was found in 15 patients (26. 3 % ) within 12 months after treatment. Conclusions: Gamma Knife radiosurgery is an effective method to a selected group of patients with small - to - medium - sized, well - defined, histologically proven benign cerebral gliomas. Although Gamma Knife radiosurgery can effectively kill the tumor cells in the target area and prevent the rumor growth, it can not control the growth of the rumor cells outside the target area and prevent the recurrence of the tumor.