低分次伽玛刀治疗164例高级别脑胶质瘤的效果和安全性评估

Efficacy and Safety of Low-Dose Fractionated Gamma Knife Radiosurgery in Treatment of 164 Cases of High-Grade Brain Glioma

目的研究低分次伽玛刀治疗高级别脑胶质瘤的疗效和安全性。方法选取2003年1月至2016年9月收治的高级别脑胶质瘤164例,WHO分级Ⅲ级98例,Ⅳ级66例。采用Masep Superplan V3.0治疗计划系统进行低分次伽玛刀治疗。根据患者年龄、肿瘤体积、临床症状等给予单次6～8 Gy处方剂量,55%～60%的等剂量曲线覆盖肿瘤,分3次治疗,每次间隔2～3 d。平均随访时间为34.6个月。结果 164例患者,术后1年、3年生存率分别为68.75%、30.36%,中位数总生存期21个月。其中WHOⅢ级、Ⅳ级患者3年术后生存率分别为39.05%、17.27%,中位数生存期分别为28、15个月,Ⅲ级患者术后生存期较Ⅳ级显著提高(P<0.05)。总术后不良反应率为28.05%(46/164),其中Smith并发症Ⅱ级38例;Ⅲ级患者术后不良反应率较Ⅳ级显著降低(11.22%比53.03%,P<0.01)。结论 WHO分级影响胶质瘤患者术后生存时间和不良反应发生率,不良反应以Smith并发症Ⅱ级为主。低分次伽玛刀治疗高级别脑胶质瘤疗效确切,可有效提高患者生存期,且安全性好。

Objective To evaluate the efficacy and safety of low-dose fractionated gamma knife radiosurgery for brain glioma. Methods A total of 164 patients with brain glioma(WHO grade Ⅲ in 98 and gradeⅡ in 66) were treated with low-dose fractionated gamma knife radiosurgery by using Masep Superplan V3.0 system from January 2003 to September 2016.According to the age,tumor size and clinical symptoms,patients were given a single dose of 6-8 Gy prescription at 55%-60% isodose level three times every 2-3 days.The mean follow-up period was 34.6 months. Results The postoperative 1-and 3-year survival rates were 68.75% and 30.36% in 164 patients with brain glioma,respectively.The median overall survival time was 21 months.The 3-year survival rate and median overall survival time were respectively 39.05% and 28 months in WHO grade Ⅲ patients,and 17.27% and 15 months in grade Ⅳ patients.The median overall survival in WHO grade Ⅲ patients was significantly longer than that in grade Ⅳ patients( P <0.05).The total incidence of postoperative adverse reactions was 28.05%(48/162,38 patients with grade Ⅱ Smith complications).Furthermore,the incidence of adverse reactions in WHO grade Ⅲ patients was lower than that in grade Ⅳ patients(11.22% vs 53.03%, P <0.01). Conclusion WHO classificationa ffects the postoperative survival time and the incidence of adverse reactions,and the grade Ⅱ Smith complications were the main adverse reactions in patients with brain glioma.Low-dose fractionated gamma knife radiosurgery is effective and safe for improving the survival of patients with high-grade brain glioma.