生殖细胞瘤全中枢螺旋断层放疗的近期临床观察

Clinical analysis of intracranial germinoma's craniospinal radiotherapy using helical tomotherapy

目的评价解放军总医院使用螺旋断层（helical tomotherapy,HT）全中枢放疗（craniospinal irradiation,CSI）23例颅内生殖细胞瘤患者的近期治疗效果。方法 2008年1月-2012年7月收治23例经螺旋断层全中枢放疗的颅内生殖细胞瘤患者,平均年龄20岁。全中枢放疗剂量：27~36 Gy/15~20 F（1.5~2.0 Gy/F）,局部剂量46~60 Gy/30~50 F,女性行全中枢照射的患者均从腰5以下采用三维适形放疗,左右对穿野照射以保护卵巢功能,DT 30~36 Gy/15~20 F,单次剂量1.8~2 Gy。中位随访时间30.9（5~67）个月。总生存率采用SPSS19.0软件Kaplan-Meier法。结果中位随访30.9（5~67）个月,在17例可评价原发肿瘤的患者中,治疗结束后复查9例（52.9%）完全缓解（CR）,7例（41.2%）部分缓解（PR）,1例（5.9%）疾病稳定（SD）。血液学毒性是放疗过程中最严重的不良反应,本组病人中白细胞减少1~4级比例分别为8.7%、30.4%、34.8%、21.7%,;血小板减少1~4级比例分别为8.7%、30.4%、21.7%、8.7%;血红蛋白减少1~4级比例分别为26.1%、13.0%、8.7%、0。全组病例3年无复发生存率、3年无转移生存率、3年总生存率分别为95.2%、100%、91.3%。结论对于原发于颅内的生殖细胞瘤,使用HT进行CSI既简化放疗程序、增加了放疗精确性,又能更好地保护周围危及器官、保证治疗效果,所产生的急性及晚期毒性可以接受,是临床上首选的放疗模式。

Objective To evaluate the short-term clinical outcomes of intracranial germinoma patients treated with craniospinal irradiation（CSI） using helical tomotherapy（HT） system. Methods Twenty-three patients who were treated with CSI in our center from January 2008 to July 2012 were collected, with an average age of 20 years old. The total doses were 27-36 Gy/15-20 F（1.5-2 Gy per fraction）, and the total local doses were 46-60 Gy/30-50 F（5 fractions per week）. All female patients for CSI were treated with left-right parallel-opposed field irradiation to protect their ovarian functions. The SPSS19.0 software was applied, and the overall survival was calculated using the Kaplan-Meier method. Results The median follow-up time was 30.9 months（5-67 months）. Of all the 17 patients with assessable tumors, 9 cases（52.9%） were CR, 7 cases（41.2%） were PR, and 1 case（5.9%） was SD. Hematological toxicity was the severest side-effect that occurred in the procedure of CSI. The level 1-4 acute leukopenia were 8.7%, 30.4%, 34.8% and 21.7% and the level 1-4 acute thrombopenia were 8.7%, 30.4%, 21.7% and 8.7%, respectively. Conclusion For primary intracranial germinomas, HT can be used to implement CSI for simplifying radiotherapy procedures, improving radiotherapy accuracy, enhancing protection of peripheral organs at risk and guaranteeing therapeutic effects. With the acceptable acute and longterm toxicity, CSI using HT in intracranial germinoma patients is a safe and alternative mode.