伽玛刀立体定向外科治疗颅内脑膜瘤副反应的相关因素分析

Analysis of related factors of side effects of gamma knife stereotactic surgery for intracranial meningiomas

目的分析测量肿瘤直径和体积以确定肿瘤生长情况的效果,并探讨立体定向放射外科治疗颅内1级脑膜瘤副反应的相关因素。方法回顾性分析2008年1月至2015年3月收治的主要或辅助行立体定向放射治疗且诊断为1级脑膜瘤的94例患者的临床资料,所有患者至少随访24个月。肿瘤在任一体积或直径上每年增长大于10%定义为肿瘤增长,小于10%为肿瘤稳定。体积测量使用T1增强的3TMRI扫描和ITK-SNAP软件计算。所有统计学资料使用SPSS20.0统计学软件分析,使用单变量分析来明确立体定向放射治疗后副反应的预测因素。结果通过肿瘤体积测定,52例(55.3%)患者肿瘤稳定无生长,且肿瘤以平均每年10.5%的比率在减小,其余42例(44.7%)患者肿瘤在立体定向放射外科治疗后以平均每年40.6%的比率在生长。29例(30.9%)患者在立体定向放射治疗后出现放疗副反应,包括头痛、颅神经损伤、震颤和共济失调。19例(20.2%)患者出现放疗后水肿。每年肿瘤生长率超过10%的患者更倾向于在放射治疗后出现长期的头痛(P=0.025)。放疗后的水肿(T2/FLAIR影像改变)与放疗后较低的放射治疗肿瘤协作组适形指数(CIRTOG)及治疗体积比(TVR)相关,震颤和共济失调与处方剂量相关(P<0.001)。结论鉴于肿瘤的复杂形态,立体定向放射治疗后通过测量体积明确脑膜瘤的生长情况可能更为精确。CIRTOG可作为放射治疗后水肿的预测指标。

Objective To analyze the effect of measuring the diameter and volume of the tumors to determine the growth of the tumors,and to explore the related factors of the side effects of stereotactic radiosurgery in the treatment of intracranial grade 1 meningiomas.Methods A retrospective analysis was made of the clinical data of 94 patients diagnosed as grade 1 meningioma who were treated with primary or secondary stereotactic radiotherapy from January 2008 to March 2015.All patients were followed up for at least 24 months.Tumor growth of more than 10%per year in any volume or diameter was defined as tumor growth and less than 10%was defined as tumor stability.Volume measurement used T1 enhanced 3T MRI scanning and ITK-SNAP software calculation.All statistical data were analyzed by SPSS20.0 statistical software,and univariate analysis was used to identify predictors of side effects after stereotactic radiotherapy.Results By measuring the volume of tumors,52 patients(55.3%)had stable and non-growth tumors,and tumors were decreasing at an average rate of 10.5%per year;the other 42 patients(44.7%)had tumors growing at an average rate of 40.6%per year after stereotactic radiosurgery.Twenty-nine patients(30.9%)had side effects after stereotactic radiotherapy,including headache,cranial nerve injury,tremor and ataxia.Nineteen patients(20.2%)developed post-radiotherapy edema.Patients with an annual growth rate of more than 10%were more likely to have long-term headache after radiotherapy(P=0.025).Edema after radiotherapy(T2/FLAIR imaging changes)were associated with lower radiotherapy oncology group conformal index(CI RTOG)and therapeutic volume ratio(TVR)after radiotherapy,tremor and ataxia were associated with prescription dose(P<0.001).Conlusion In view of the complex morphology of the tumor,it may be more accurate to determine the growth of meningiomas by measuring the volume after stereotactic radiotherapy.CI RTOG can be used as a predictor of edema after radiotherapy.