眼眶肿瘤立体定向放射外科治疗

Treating orbital tumor with stereotactic radiosurgery(SRS)

目的 分析立体定向放射外科 (stereotacticradiosurgery ,SRS)治疗方法在眼眶肿瘤综合治疗中的作用和适应征。方法 利用γ刀、X刀两种立体定向放射外科治疗方法 ,对 85例眼眶肿瘤病人进行放射治疗 ,其中 ,γ刀治疗 76例 ( 1995～ 2 0 0 1年 ) ,X刀治疗 9例 ( 2 0 0 1年 )。通过对3 1例γ刀治疗和 9例X刀治疗患者的随访观察 ,分析γ刀、X刀中心治疗剂量、边缘剂量、等剂量范围与病变大小、位置和类型等因素对治疗效果的影响。结果 γ刀放射治疗平均边缘剂量 3 6 60Gy( 3 0～ 45 5 0Gy) ,X刀平均边缘剂量 40 67Gy ( 3 0 0 0～ 5 0 0 0Gy)。经γ刀治疗患者 ,有 3 1例得到随访 ,平均随访时间 2 4个月 ( 3～ 12 0 ) ,γ刀治疗后肿瘤缩小或消失者 2 1例 ,有效率 67 74% ,肿瘤得到控制者 3例 ,增大者 1例 ,2例恶性肿瘤患者死亡 ,未作影像学检查者 4例。 2 4例脑膜瘤患者治疗前病变平均最大径为 2 5 4cm ,治疗后肿瘤缩小者 16例 ,消失者 1例 ,肿瘤无变化者 3例 ,增大者 1例 ,3例未作影像学检查 ;行 2次γ刀治疗者 2例。X刀治疗患者均为术后病人 ,包括 :泪腺腺样囊性癌、腺癌、非何杰金氏淋巴瘤和泪腺混合瘤等 ,平均随访时间 10个月 ( 6～ 16) ,除 1例眶缘低分化腺癌治疗后 6个月复发外 ,其余未见复发。?

Objective To analysis the effect and indication of treating orbital tumors with stereotactic radiosurgery(SRS).Methods 85 patients with orbital tumor were performed by SRS,31 cases with gamma knife and 9 cases with X knife were followed up by telephone or letter and taken imaging examination.Results The mean prescription dose of gamma knife received 36.60Gy(ranging from 30.00～45.50Gy),The mean prescription dose of X knife received 40.67Gy(ranging from 40.00～50.00Gy).At gamma knife therapy,the average duration of follow-up were 13 months(ranging from 3 months to 120 months),21 of 31 cases(67.74%)decreased in size,3 of 31 cases were contracted,1 cases was increase,2 cases of malignant tumor had died.28 cases of meningioma with gamma knife were analyzed before the treatment,the average maximum diameter was 2.54cm,average volume was 2.86 cm3.At post-treatment,8 of 28 cases decreased in size,7 cases decreased over 0.5cm,1 case disappear,3 cases were no change,1 case was increase.At X knife therapy,9 cases of post-operation included adenoid cystic carcinoma,adenocarcinoma,non-hodgkins lymphoma and pleomorphic adenoma,The average duration of follow-up with were 10 months(ranging from 6 months to 16 months),only 1 case was recrudescence.Conclusions The effects of treating orbital tumors with stereotactic radiosurgery were quite good and no persistent complication were found.The indication of SRS is(1)blood vessel malformation in orbital cavity,(2)meningioma of optic nerve sheath to spread into optic nerve canal,or residual or recurrent meningioma of orbit.(3)The tumor invaded orbital apex,and(4)synthesis treatment of malignant tumors.