Clinical outcomes following salvage Gamma Knife radiosurgery for recurrent glioblastoma

Glioblastoma multiforme(GBM) is the most common malignant primary brain tumor with a survival prognosis of 14-16 mo for the highest functioning patients. Despite aggressive, multimodal upfront therapies, the majority of GBMs will recur in approximately six months. Salvage therapy options for recurrent GBM(r GBM) are an area of intense research. This study compares recent survival and quality of life outcomes following Gamma Knife radiosurgery(GKRS) salvage therapy. Following a Pub Med search for studies usingGKRS as salvage therapy for malignant gliomas, nine articles from 2005 to July 2013 were identified which evaluated rG BM treatment. In this review, we compare overall survival following diagnosis, overall survival following salvage treatment, progression-free survival, time to recurrence, local tumor control, and adverse radiation effects. This report discusses results for rG BM patient populations alone, not for mixed populations with other tumor histology grades. All nine studies reported median overall survival rates(from diagnosis, range:16.7-33.2 mo; from salvage, range:9-17.9 mo). Three studies identified median progression-free survival(range:4.6-14.9 mo). Two showed median time to recurrence of GBM. Two discussed local tumor control. Six studies reported adverse radiation effects(range:0%-46% of patients). The greatest survival advantages were seen in patients who received GKRS salvage along with other treatments, like resection or bevacizumab, suggesting that appropriately tailored multimodal therapy should be considered with each rG BM patient. However, there needs to be a randomized clinical trial to test GKRS for rG BM before the possibility of selection bias can be dismissed.

Gamma knife treatment for refractory epilepsy in seizure focus localized by positron emission tomography/CT

A total of 80 patients with refractory epilepsy were recruited from the Inner Mongolia Medical College Affiliated Hospital. The loci of 60% of the patients could be positioned using a combined positron emission tomography/CT imaging modality. Hyper- and hypometabolism foci were examined as part of this study. Patients who had abnormal metabolism in positron emission tomography/CT imaging were divided into intermittent-phase group and the seizure-phase group. The intermittent-phase group was further divided into a single-focus group and a multiple-foci group according to the number of seizure foci detected by imaging. Following gamma knife treatment, seizure frequency was significantly lower in the intermittent-phase group and the seizure-phase group. Wieser＇s classification reached Grade I or II in nearly 40% of patients. Seizure frequency was significantly lower following treatment, but Wieser＇s classification score was significantly higher in the seizure-phase group compared with the intermittent-phase group. Seizure frequency was significantly lower following treatment in the single-focus group, but Wieser＇s classification score was significantly higher in the single-focus group as compared with the multiple-foci group.

Gamma knife treatment of rat glioma Influences of irradiation dose on apoptosis and necrosis

BACKGROUND： Apoptosis and necrosis are cellular death mechanisms that are induced in glioma cells following gamma knife irradiation. Increased apoptosis is essential for maintaining and enhancing treatment efficacy. OBJECTIVE： To observe apoptotic and necrotic mechanisms of rat glioma models induced by gamma knife treatment and to analyze the influences of irradiation doses on apoptosis and necrosis. DESIGN： Controlled animal experiment. SETTING： Cancer Hospital of Tianjin Medical University and Gamma Knife Center of Hefei Brain Hospital. MATERIALS： Eighteen female specific pathogen free Sprague Dawley rats, weighing 180 210 g and 5 6 weeks old, were purchased from the Experimental Animal Center, Medical College of Suzhou University. Rat C6 glioma cells were purchased from the cell bank of Chinese Academy of Sciences. Annexin V-FITC Reagent Kit （Bender Med System. Company, USA） and a flow cytometer （Becton Dickinson FACSCalibur） were provided. METHODS： The experiment was conducted at the Cancer Hospital of Tianjin Medical University and Gamma Knife Center of Hefei Brain Hospital from December 2006 to May 2007. All rats were inoculated with C6 glioma cells, i.e., 4 μL of a C6 glioma cell suspension was injected 5 mm deep in the cortex. All rats were divided randomly into a model group, 9-Gy treatment group, and 12-Gy treatment group. There were six rats in each group. MAIN OUTCOME MEASURES： Apoptosis and necrosis of normal brain tissue and glioma were observed by Flow Cytometry one week after irradiation, and pathological changes to tumor tissue were identified by HE staining. RESULTS： Eighteen rats were initially selected for the study： two rats from the model and 12-Gy treatment groups died from accidental anesthesia. The remaining 16 rats were included in the final result analysis. Cellular apoptosis and necrosis： apoptosis and necrosis were significantly increased in the treatment groups after gamma knife irradiation, compared to the model group （P 〈 0.05）. Apoptosis was greater in the 9-Gy treatment group compared to the 12-Gy treatment group （P 〈 0.01 ）. Necrosis was significantly reduced in the 9-Gy treatment group compared to the 12-Gy treatment group （P 〈 0.01）. Pathological changes： The necrosis of the center of tumor tissue appeared in the 9, 12 Gy treatment group. Cells dispersed in the necrosis region and the density of cells was higher with the longer distance from the necrosis region. There were patches of pycnotic cells with different period between the edge and center of the necrosis region, and the cellular dropsy could be seen. Moreover, the amount of necrosis was greater with increasing doses of irradiation. CONCLUSION： Apoptosis and necrosis are cellular death mechanisms induced by gamma knife treatment of gliomas. Cellular necrosis increased with greater irradiation doses.

Treatment for arteriovenous malformation of the brain Comparison between microsurgery and gamma knife

Microsurgery and gamma knife are the mainly ways to treat arteriovenous malformation of brain in grade Spetzler-Martin I -III; however, therapeutic effects of them need to be further studied. OBJECTIVE： To compare the therapeutic effects between microsurgery and gamma knife on the treatment of arteriovenous malformation of brainin grade Spetzler-Martin I-III. DESIGN： Retrospective analysis. SETTING： Department of Neurosurgery, the Third Hospital Affiliated to Sun Yat-sen University; Guangdong Microinvasion Center. PARTICIPANTS： A total of 86 patients with arteriovenous malformation of the brain were selected from the Department of Neurosurgery, the Third Hospital Affiliated to Sun Yat-sen University and Guangdong Microinvasion Center from January 1997 to February 2007. After DSA, CT and/or MRI examinations, patients were evaluated in grade Spetzler-Martin I -III. All patients were divided into microsurgery group （n = 34） and gamma knife group （n =52）. There were 22 males and 12 females in the microsurgery group and their mean age was 26 years, while there were 34 males and 18 females in the gamma knife group and their mean age was 28 years. The grade of Spetzler-Martin was comparable in the two groups. All their relatives provided the confirmed consent and the study was allowed by ethics committee of our hospital. METHODS： Under complete anesthesia, patients were given microsurgery and the operative approach was chosen based on diseased regions. Firstly, feeding artery was blocked; secondly, it was separated along band of gliosis between malformation vessel mass and brain tissue; finally, draining vein was cut off and malformation vessel mass was resected. On the other hand, patients in the gamma knife group received Leksell-2300B gamma knife treatment. Leksell-G stereotaxis headframe was installed; GEl .STMR scanning device was used for localization; r-PlanS.2 workstation was used for target design and dosage program; Leksell B gamma knife was used during the whole operative procedure. The target was l - 4 and peripheral dosage was 12- 28 Gy. At 0.5, l and 2 years after operation, angiography was used to detect vascular occlusion in the two groups. Meanwhile, focal hemorrhage and new neurological function defect （including hemiplegic paralysis, language disorder, cerebellar function disorder, increasing frequency of epilepsy, etc.） were also observed. MAIN OUTCOME MEASURES： Rate of vascular occlusion, focal hemorrhage and neurological function defect at different time points after operation. RESULTS： All 86 patients were involved in the final analysis. Vascular nest of patients in the microsurgery group disappeared completely; while, two patients （6%, 2/34） had new neurological function defect but did not have rehaemorrhagia and death after operation. On the other hand, vascular nest of 43 patients （83%, 43/52） in the gamma knife group disappeared completely, and 8 （l 5%, 8/52） had new neurological function defect. There was significant difference between the two groups （ x^2=2.63, P 〈 0.05）. Six patients （12%, 6/52） in the gamma knife group had rehaemorrhagia after operation, and one （2%, 1/52） died. CONCLUSION： Both microsurgery and gamma knife have great effects on the treatment of arteriovenous malformation of brain in grade Spetzler-Martin I-III;however, the therapeutic effects ofmicrosurgery are superior to those of gamma knife.

Current gamma knife treatment for ophthalmic branch of primary trigeminal neuralgia

AIM: To probe into problems existing in gamma knife treatment of ophthalmic branch of primary trigeminal neuralgia (TN), and propose a safe and effective solution to the problem. METHODS: Through sorting the literature reporting gamma knife treatment of refractory TN in recent years, this article analyzed the advantages and problems of gamma knife treatment of primary TN, and proposed reasonable assessment for existing problems and the possible solution. RESULTS: Gamma knife treatment of TN has drawn increasing attention of clinicians due to its unique non-invasion, safety and effectiveness, but there are three related issue; to be considered. The first one is the uncertainty of the optimal dose (70-90GY); the second one is the difference in radiotherapy target selection (using a single isocenter or two isocenters); and the third one is the big difference of recurrent pains (specific treatment methods need to be summarized and improved). CONCLUSION: For patients with refractory TN, gamma knife treatment can be selected when the medical treatment fails or drug side effects emerge. The analysis of a large number of TN patients receiving gamma knife treatment has shown that this is a safe and effective treatment method.

Entrapment of the temporal horn secondary to postoperative gamma-knife radiosurgery in intraventricular meningioma: A case report

BACKGROUND Entrapment of the temporal horn (ETH) is a rare pathologic condition. It is a kind of focal hydrocephalus caused by obstruction of flow pathway of cerebrospinal fluid. It is caused by various conditions, but ETH secondary to postoperative gamma-knife radiosurgery (GKS) is extremely rare. CASE SUMMARY A 52-year old previously healthy woman underwent resection of a large intraventricular meningioma. A small fragment of residual tumor with no obvious enlargement of the temporal horn was observed 3 mo after surgery, and she was referred for GKS. Two months after GKS, she complained of headache and progressive paralysis of the left limb. Magnetic resonance imaging revealed enlargement of the temporal horn. There was a second procedure to resect the residual tumor 8 mo after GKS. After the second procedure, she recovered smoothly. As of the date of this writing, she has remained in good condition. CONCLUSION This case reminds us that ETH should be considered in the treatment of intraventricular meningiomas, especially before GKS.

Time-dependent changes of astrocytes following microinjection of kainic acid and irradiation by gamma-knife in adult rat brain

objective: Two groups of rats were microinjected with kainic acid (KA) and irradiated with gam ma knife respectively on unilateral nucleus caudate-putamen to compare the response of astrocytes. Methods: The astrocytes were identified with anti-GFAP immunohistochemical ABC method and the progress of their reaction to the 2 insults was examined from 3 h to 30 d after the lesion. Results: Both lesions could induce hyperplasia and hypertrophy of astrocytes and 2 types of GFAP-ir cells were found, one with small cell body and thin process, and the other with hypertrophic cell body and thick and long process. The timecourse of GFAP expression in the 2 groups was different. In KA microinjection group, large necrotic area was ob served in the target within 24 h. Three days later, a few astrocytes appeared around the necrosis. With in crease of the survival time, hyperplasia and hypertrophy of astrocytes began to increase. Whereas in gamma knife group, hyperplasia and hypertrophy were evident from 3 h to 7 d and necrotic dots could be seen in the target on day 14. On day 30, necrosis was tnore obvious with gradual variations in GFAP expression around the necrotic area. Conclusion: The above results indicated that GFAP could be used as a marker for CNS in jury; the difference in their timing and distribution pattern suggested different mechanisms in KA microinjec tion group and gamma-knife irradiation group.

Proof of Concept in a Case Study of Glioblastoma Multiforme Successfully Treated with IV Quercetin in Combination with Leading Edge Gamma Knife and Standard Treatments

The Stupp protocol has become standard of care for the treatment of glioblastoma (GBM) (since its publication in 2005) and has led to some limited survival improvements. This protocol, consists of radiotherapy and concomitant chemotherapy with temozolomide, an alkylating agent. Temozolomide + radiation, compared to radiation alone had added in average 3 months additional life span, 16 percent improved survival at 2 years. That said since 2005, the standard of care has not changed in regards to the treatment of early diagnosed aggressive or multifocal GBM, and unfortunately the expected survival is still poor with 75 percent of patients dying in less than 2 years and average survival of 15 months. In patients with multifocal tumors (such as the case below) the average survival is even worse with less than 4 months at her age [1]. Here we present a case study of a patient with advanced multifocal, and rapidly progressing Glioblastoma Multiforme treated with STUPP protocol in combination with IV Quercetin. The patient experienced improved quality of life and response, compared to historical data. It is our recommendation to investigate such combinational approach in patients with Glioblastoma, as in our case it proved to be safe and effective with improved quality of life and performance as well as clinical response and survival.

Comparison of the Improvement Effect of MVD and Gamma Knife on Pain,Anxiety and Depression of Patients after Treatment of Primary Trigeminal Neuralgia

Objective:To explore the effects of microsurgical vascular decompression(MVD)and gamma knife respectively on the treatment of pain,anxiety and depression in patients with primary trigeminal neuralgia.Methods:From February 2011 to June 2017,we treated 108 patients with primary trigeminal neuralgia.According to the treatment plan of the patients,they were divided into an observation group and a control group,54 cases each.The observation group underwent microsurgical vascular decompression(MVD)for the treatment of primary trigeminal neuralgia,while the control group received gamma knife treatment.The effects of pain,improvement of anxiety and depression were compared between two groups at 1 week,3 months,and 6 months after treatment.Results:The pain,anxiety and depression scores of the observation group was significantly lower than that of the control group(P<0.05).Conclusion:MVD can relieve patients'pain,anxiety and depression symptoms,as well as improve quality of life and restore self-confidence in life.

Efficiency of Gamma Knife Radiosugery and Acupuncture Therapy on Primary Trigeminal Neuralgia

Objective:To compare the clinical effectiveness of gamma knife radiosugery combined with acupuncture therapy and microvascular decompression in the treatment of idiopathic trigeminal neuralgia.Methods:A total of 93 patients with primary trigeminal neuralgia added to Nanchang University Hospital from November 2016 to October 2018 were selected,it was divided randomly into the control group(45 cases)and the study group(48 cases).The control group was treated with microvascular decompression and the study group used gamma knife radiosurgery combined with acupuncture therapy.The study compared the immediate pain relief rate,Visual Analogue Scale(VAS)scores,completion rate,recurrence rate,hospitalization days,total treatment duration,total treatment cost and total effective rate of treatment in 2 groups.Results:Comparison of the same group after treatment:the VAS score with 24 hours of treatment in the control group was(5.33±0.49),with a significant difference from the pre-treatment VAS score(8.62±0.13);The VAS score with 24 hours of treatment in the study group was(5.96±0.58),with a significant difference from the pre-treatment VAS score(8.54±0.25).After treatment,immediate effect,parent effect,acute and chronic complements of the control group was 25,5,2 and 7 cases,and the study group was 6,25,7 and 1,respectively.There were significant differences between the two groups;The comparison of hospitalization days,total treatment duration,total treatment cost was statistically significant(P<0.05);There were no significant difference in immediate pain rate,VAS score,total incidence of complications,recurrence rate,and total effectiveness of treatment between the two groups(P>0.05).Conclusion:Both microvascular decompression and gamma knife radiosurgery combined with acupuncture therapy can safe and effective treatment idiopathic trigeminal neuralgia patients,and for patients with good health,can tolerance all-hemp surgery,there are contraindicaindications to acupuncture therapy,microvascular decompression treatment can be chosen,while patients who are weak,cannot tolerante all-hemp surgery or resist surgery,economic difficulties,and can choose gamma knife radiosurgery combined with acupuncture therapy treatment.

复发高级别脑胶质瘤患者伽玛刀放疗预后危险因素及风险预测模型构建

目的分析复发高级别脑胶质瘤患者伽玛刀放疗预后的危险因素,并构建风险预测模型。方法回顾性收集2019年1月至2022年1月于医院接受伽玛刀放疗的85例复发高级别脑胶质瘤患者临床资料,依据随访1 a期间预后情况将资料分为病死组(n=40)与存活组(n=45)。采用Cox回归分析影响复发高级别脑胶质瘤患者伽玛刀放疗预后的因素,根据回归分析结果构建风险预测模型,利用R软件构建列线图,并绘制受试者工作特征曲线评估风险模型的预测效能。结果病死组年龄、最大肿瘤直径大于存活组,而靶区周边剂量、放疗前Karnofsky功能状态(KPS)评分低于存活组,差异有统计学意义(P<0.05);经Cox回归分析显示,年龄、最大肿瘤直径为复发高级别脑胶质瘤患者伽玛刀放疗后病死的危险因素(HR>1,P<0.05),而靶区周边剂量、放疗前KPS评分为复发高级别脑胶质瘤患者伽玛刀放疗后病死的保护因素(HR<1,P<0.05);绘制列线图构建复发高级别脑胶质瘤患者伽玛刀放疗预后病死风险预测模型,验证模型区分度显示一致性指数(C-index)值=0.876,具有良好的区分度;绘制标准曲线显示,校准曲线与Y-X直线相近,模型准确度良好。结论年龄、靶区周边剂量、最大肿瘤直径、KPS评分为复发高级别脑胶质瘤患者伽玛刀放疗预后的影响因素,基于以上因素构建的风险模型对于复发高级别脑胶质瘤患者伽玛刀放疗预后的预测价值较高,具有良好的临床应用价值。

伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的影响因素

目的:分析伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的影响因素。方法:回顾性分析2022年1月至2023年1月在该院接受伽马刀立体定向放射治疗的121例肺癌脑转移瘤患者的临床资料。统计伽玛刀立体定向放射治疗肺癌脑转移瘤患者的预后情况,采用Logistic回归分析伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的影响因素。结果:121例伽马刀立体定向放射治疗肺癌脑转移瘤患者预后不良40例,设为预后不良组,预后良好81例,设为预后良好组;预后不良组脑转移瘤最大直径≥3 cm、血清鳞状细胞癌抗原(SCC-Ag)≥3.80 ng/mL、血清细胞角蛋白19片段(CYFRA21-1)≥7.52 ng/mL、血清神经元特异性烯醇化酶(NSE)≥50.81μg/L占比均高于预后良好组,差异有统计学意义(P<0.05);Logistic回归分析结果显示,血清SCC-Ag≥3.80 ng/mL、血清NSE≥50.81μg/L均为伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的危险因素(OR>1,P<0.05)。结论:血清SCC-Ag≥3.80 ng/mL、血清NSE≥50.81μg/L均为伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的危险因素。

颅脑结构性病变所致癫痫的伽玛刀治疗及随访研究

目的探讨颅脑结构性病变所致癫痫的伽玛刀(γ-刀)治疗方法,评价治疗效果及视频脑电图(VEEG)随访的意义。方法回顾性分析山东省戴庄医院伽玛刀治疗科和神经科2017-01—2021-06确诊的60例颅脑结构性病变所致癫痫患者的临床资料,根据是否采用γ-刀治疗将其分为单纯药物治疗组(对照组)和γ-刀联合药物治疗组(γ-刀组),每组30例,进行随访观察,分析γ-刀治疗的效果及随访VEEG检测结果。结果在1~2 a的随访期内,γ-刀组患者癫痫总改善率76.67%,对照组为36.67%,差异有统计学意义(P<0.05);γ-刀组EEG痫样放电检出率30.00%,对照组为66.67%;γ-刀组癫痫控制显效组EEG正常率为50%,明显高于有效组的11.11%及无效组的0,显效组EEG痫样波检出率(7.14%)明显低于有效组(22.22%)和无效组(85.71%)。γ-刀治疗后随访期内癫痫发作改善率分别为0.5~1 a 63.33%,>1~2 a 76.67%,>2~3 a 80.77%,3 a以上82.61%;VEEG痫样波检出率分别为0.5~1 a63.33%,>1~2 a 30.00%,>2~3 a 23.08%,3 a以上21.74%。术后并发放射性脑水肿3例(10.00%)。结论γ-刀治疗颅内结构性病变所致的难治性癫痫效果明确,VEEG有助于γ-刀治疗方案的设计、评估治疗效果和指导治疗后用药。

前庭神经鞘瘤放射外科计划剂量均匀性研究

目的研究前庭神经鞘瘤放射外科治疗计划中的剂量均匀性指数(homogeneity index,HI)的影响因素,以及HI更简便的替代计算方法。方法回顾性分析301例前庭神经鞘瘤伽玛刀治疗计划,298例病人采用经典单次治疗,3例采用连续低分割治疗。根据国际辐射单位和测量委员会(ICRU)-83标准,计算计划的HI,并评估可能影响HI的因素。计算靶区的剂量变异系数(dose coefficient of variation,Dcv),评估其作为HI替代方案的可行性。结果治疗计划的平均HI为0.60±0.08。单因素分析发现除周边剂量外,所有计划参数与HI的相关性均有统计学意义(均P<0.05)。多因素分析显示:处方剂量线、覆盖率、选择性、梯度指数和靶区体积是有统计学意义的相关因素(均P<0.05)。Dcv可很好拟合HI。结论HI与治疗计划多个参数关系密切。Dcv可试用作为更简便计算HI的替代方法。

颞叶海马硬化所致的难治性癫痫外科手术治疗与GAMMA刀治疗临床分析

[目的]探讨颞叶海马硬化所致难治性癫痫采用外科手术治疗与GAMMA刀治疗的疗效及治疗费用。[方法]本文通过1998￣2003年在我研究所就诊的颞叶海马硬化所致的难治性癫痫患者进行评估后根据患者意愿分别给予外科手术治疗与GAMMA刀治疗。[结果]外科手术组治疗近期疗效92.8%,GAMMA刀治疗近期疗效53.84%,外科手术组平均治疗费用8500元(人民币),GAMMA刀治疗组平均治疗费用18000元(人民币)。[结论]外科手术治疗与GAMMA刀治疗颞叶海马硬化所致的难治性癫痫安全有效,外科手术治疗近期疗效优于GAMMA刀治疗,但平均治疗费用低于GAMMA刀治疗。

退役伽马刀源再利用技术研究

退役伽马刀源仍具有很高放射性,合理再利用可以缓解退役伽马刀源处置压力,延长放射源安全使用寿命,实现废源减量化和再利用。研究利用退役伽马刀源制备新型工业辐照源,开展新型工业辐照源结构设计、自动焊接工艺研究、密封源安全等级试验等工作,确保新型工业辐照源符合国家标准相关要求;并按照放射性物品运输规程要求,成功取得特殊形式放射性物品设计批准书,满足市场应用需求。

美国新一代立体定向放射外科技术——GammaART-6000^(TM)非对称性旋转伽玛系统

伽玛刀技术1967自诞生以来奠定了立体定向放射外科技术的地位。而近20年随着调强放疗技术的发展和成熟,伽玛刀技术吸收调强放疗成为了新的发展趋势。美国GAMMAART-6000TM非对称性旋转伽玛系统就从放射源的非对称分布设计、自动病人定位系统(APS)、治疗计划系统(TPS)以及QA系统方面将调强放疗技术有机的结合在了伽玛刀技术中,从而代表了立体定向放射外科技术的最新发展。

A gamma-ray therapeutic system applied to treatment of body tumors

In order to treat malignant tumors in human body, a stereotactic gamma-ray whole-body therapeutic system has been developed. This system is a typical large mechatronics treatment machine. In this paper, its main working principles and characteristics are introduced. This system comprises a special gallows frame with an open vertical structure, a changeable collimator device by which the size of convergence center can be chosen, and a 3D treatment couch. A computer brings the couch to target position automatically. Therefore precise and dynamic rotary converging therapy for tumors located anywhere in the body has been realized. The system's performance has been proved in practice, which includes good curative effect, reliable automation, and safe and secure operation.

头部伽马刀治疗非小细胞肺癌脑转移的临床效果及预后情况分析

目的 探讨头部伽马刀治疗非小细胞肺癌(NSCLC)脑转移的临床效果及预后相关影响因素。方法 回顾性分析82例NSCLC脑转移患者临床资料。所有患者均行头部伽马刀治疗,术后评价近期疗效,并随访1年,依据患者存活情况分为存活组与死亡组,收集2组年龄、性别、体质量指数、病理类型、原发癌部位、卡氏功能状态(KPS)评分、肺癌分级预后评估系统(GPA)评分、颅外转移、脑转移数目、脑转移瘤最大直径、胸部手术等资料,先开展单因素分析,得到有差异的项目后再行Logistic回归分析,获取影响头部伽马刀治疗NSCLC脑转移预后的独立危险因素。结果 82例NSCLC脑转移患者治疗后完全缓解13例,部分缓解48例,稳定14例,进展7例,总控制率为91.46%(75/82)。随访1年,82例NSCLC脑转移患者共存活39例,存活率为47.56%(39/82);单因素分析显示,年龄、KPS评分、GPA评分、颅外转移、脑转移数目、脑转移瘤最大直径、脑转移位置与头部伽马刀治疗NSCLC脑转移的预后相关,差异有统计学意义(P<0.05);多因素分析显示,≥65岁、KPS评分<70分、GPA评分≤1.5分、有颅外转移、脑转移数目>3个、脑转移瘤最大直径>2 cm为影响头部伽马刀治疗NSCLC脑转移预后的高危因素(P<0.05且OR>1)。结论 头部伽马刀治疗NSCLC脑转移可取得较为理想的近期疗效,但≥65岁、KPS评分<70分、GPA评分≤1.5分、有颅外转移、脑转移数目>3个、脑转移瘤最大直径>2 cm等的NSCLC脑转移患者预后欠佳,临床需针对性开展干预措施,提高整体生存率。

豆纹动脉动脉瘤及其治疗策略研究进展

豆纹动脉动脉瘤(LSAs)是一种较为少见的颅内动脉瘤,其破裂出血是导致深部脑出血的罕见原因,可表现为基底节实质内出血(IPH),易误诊为非动脉瘤性高血压脑出血(HICH)而延误治疗。近年来由于影像学检查技术手段的快速进步,LSAs检出率逐渐提高。LSAs的发生发展常受到多种因素的影响,但其具体的病因及自然病程尚未完全明确。目前,对于LSAs的治疗主要采用开放手术夹闭、血管内治疗(EVT)以及伽玛刀放射外科治疗(GKS)。然而大多数关于LSAs的报道都是通过个案或小病例系列来阐述的,不同治疗方式效果、预后等仍存在较大的争议。该文对LSAs及其治疗策略最新研究进展进行综述。