伽玛刀治疗颅内转移瘤较手术切除肿瘤的疗效分析

Effect of gamma knife radiosurgery in the treatment of intracranial metastatic tumors compare with surgical resection of tumors

目的 分析伽玛刀治疗颅内转移瘤的临床疗效.方法 选取2011年1~12月本科因肺癌脑转移头部行伽玛刀患者68例（实验组）,同时选取同期手术治疗肺癌脑转移瘤的患者45例（对照组）,所有患者均结合相关化疗.分别于治疗前后行MRI、DWI及MRS（磁共振波谱分析）扫描,对比两组患者治疗前及治疗后3个月的MRI及MRS相关指标.同时在两组患者治疗后3个月、6个月和12个月进行头颅MRI平扫随访,对比两组患者的临床疗效和生存率.结果 两组患者治疗3月后nCho、Cho/Cr,Cho/NAA及Cho/cNAA均显著较术前降低,nCr均显著较术前升高,ADC值及rADC比值均显著较术前升高,P〈0.05;实验组治疗3月后nCho、Cho/Cr,Cho/NAA及Cho/cNAA均显著较对照组降低,nCr均显著较对照组升高,ADC值及rADC比值均显著较对照组升高,P〈0.05.实验组治疗后3月的临床有效率显著高于对照组,P〈0.05;实验组治疗后6月的临床有效率与对照组无显著差异,P〉0.05;实验组治疗后12月的临床有效率显著高于对照组,P〈0.05.实验组患者治疗后3个月生存率为100%（68/68）,6个月生存率为83.82%（57/68）,12个月生存率为61.76%（42/68）;对照组治疗后3个月生存率为100%（45/45）,6个月生存率为73.33%（33/45）,12个月生存率为53.33%（24/45）.结论 采取伽马刀治疗颅内转移瘤的临床疗效显著优于手术切除.

Objective To analysis the clinical curative effect of gamma knife treatment of intracranial metastases.Selection.Methods Between January 2011 and December 2011,our department from 68 patients with brain metastases from lung cancer lines of gamma knife head（experimental group）,and in the same period surgical treatment of patients with brain metastases of lung cancer 45 cases（control group）,all patients were combined with chemotherapy.MRI,DWI and MRS can on line before and after treatment respectively（resonance spectroscopy analysis） scanning,compared two groups of patients before and after treatment for 3 months of MRI and MRS related indicators.At the same time in the two groups of patients after treatment for 3 months,6 months and 12 months follow-up on cranial magnetic resonance imaging（MRI） scan,compared two groups of clinical curative effect and survival rate of patients.Results Two groups of patients after march nCho,Cho/Cr,Cho/NAA and Cho/cNAA were significantly reduced compared with preoperative,nCr were significantly higher than preoperative,ADC values and the rADC ratio were significantly higher than preoperative,P〈0.05;Group 3 months after treatment nCho,Cho/Cr,Cho/NAA and Cho/cNAA were significantly reduced than the control group,nCr were significantly higher than the control group,the ADC values and rADC ratio were significantly higher than the control group,P〈 0.05）.In march of the experimental group after treatment of clinical effectiveness is significantly higher than the control group,P〈 0.05;The experimental group after treatment the clinical efficient and the control group had no significant difference in June,P〉0.05;The experimental group in December after treatment of clinical effectiveness is significantly higher than the control group,P〈 0.05.Group 3 months after treatment in patients with survival rate was 100%（68/68）,the survival rate was 83.82%（57/68） at 6 months,12 months survival rate was 61.76%（42/68）;The control group after treatment for 3 months survival rate was 100%（45/45）,the survival rate was 73.33%（33/45） at 6 months,12 months survival rate was 53.33%（24/45）.Conclusion The clinical effects of Gamma knife could be better than surgery for the removing of intracranial metastases.