分次立体放疗和放射外科治疗颅内肿瘤对照分析

Fractionated stereotactic radiotherapy and single high-dose radiosurgery for intracranial tumor:early results and compared clincal study

目的 探讨分次立体放疗和放射外科治疗颅内肿瘤的临床疗效和并发症。方法 采用立体定向系统和三维治疗计划 ,对随机分为两组的病例进行治疗 ,采用分次立体放疗 (FSRT) 92例 ,次数为 3～ 10次 ,每次剂量为 3～ 10Gy ,总剂量为 36～ 5 2Gy ,边缘剂量曲线为 6 5 %～ 90 %;放射外科治疗 (SRS) 10 7例 ,采用单次治疗 ,每次剂量为 18～ 2 8Gy ,边缘剂量曲线为 6 0 %～ 90 %。结果 经过 2～ 4年随访 ,FSRT组总有效率 81.5 %(75 / 92 ) ,SRS组总有效率 6 9.2 %(74/ 10 7) ,两组对照疗效无显著差异。两组对胶质瘤的治疗进行对照分析 ,FSRT组CR +PR为83.7%(36 / 43) ,SRS为 5 6 .3%(2 7/ 48) ,两组经 χ2 检验有显著差异 (P <0 .0 1)。两组治疗后出现的并发症主要为脑水肿、神经功能受损和放射性脑坏死。FSRT组出现脑水肿有 2 5例 ,SRS组 6 7例 ,两组对照有显著差异 (P <0 .0 0 1) ;FSRT组出现神经功能受损有 5例 ,SRS组 17例 ,两组对照有显著差异 (P <0 .0 0 1) ;FSRT组出现放射性脑坏死有 2例 ,SRS组有 9例。结论 分次立体放射治疗与放射外科治疗颅内肿瘤均有较好疗效 ,分次立体放射治疗后并发症较少 ,对胶质瘤的治疗采用分次方法可能更好。

Objective To assess the local control and toxicity rate intracrnial tumors patients treated with linear accelerator-radiosurgery and frantionated stereotactic radiation therapy.Methods These groups were randomly divided into two sets.92 patients were treated by fractionated stereotactic radiotherapy(FSRT);The frequency was 3～10Gy/every time,and the whole dose was 36～52Gy to sever as 65%～90%.107 patients were treated by stereotactic radiosurgery(SRS),and the dosage was the extent from 18～28Gy.The marginal dosage lines was 60%～90%.Results Followed up 2～4(medium 2.5±0.6y)years,75(81.5%)cases were improved in the FSRT group,and 74(69.2%)cases were improved in the SRS group.Two groups of comtrast curative effects do haven't notable difference By χ 2 test,the difference for two groups was found to be statistically significant(P<0.01).Two groups of complications included brain edema and nerve function admage and radioactivity brain necrosis after curing.The FSRT group,the brain oedema has had 25 examples,and two sets of contrasts have notable difference(P<0.001)to 67 examples in the SRS group;The FSRT group has appeared the nerve function and receives the damage to have 5 examples,and two sets of comtrasts have notable difference(P<0.001)to 17 examples in the SRS group;The FSRT group has appeared the radioacivity brain necrosis and has had 2 examples,and there are 9 examples in the SRS group.Conclusion FRST and SRS are a good way to therapy intracranial tumors,Maybe the FSRT is better than SRS of curling gliomas,and it could decrease comlication and toxicity.