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目的探讨手术后残存脊索瘤的伽玛刀治疗效果。方法回顾性分析自1998年4月至2012年10月伽玛刀治疗的49例脊索瘤手术后残留病例,其中男性26例,女性23例;年龄17~79岁,平均43.2岁。靶区体积3.8~37.5cm~3,平均11.4cm~3;照射剂量:肿瘤周边剂量8~18 Gy,平均14.1Gy;肿瘤中心剂量17.8~36.0Gy,平均29.7 Gy。结果随访12~186个月(中位数66个月)评估临床及影像学结果。38例患者(77.6%)生存,11例患者(22.4%)死亡:8例死于肿瘤进展,1例(3%)继发瘤内出血,2例原因不明。SRS后实际总生存率在3,5和7年分别为95.9%,83.3%和61.9%。影像随访,完全消失6例(12.2%),部分肿瘤退缩14例(28.6%),肿瘤稳定15例(30.6%),肿瘤进展14例(28.6%)。SRS总的肿瘤控制率为71.4%。38例SRS前存在颅神经功能受损患者中,12例患者(31.6%)神经功能改善。15例患者(30.6%)症状稳定,无明显改善。11例患者(28.9%)神经症状和体征加重。结论对开颅手术残留的脊索瘤,特别是残留部分较小时,伽玛刀是一种较好的的治疗方法。有益于延长患者生存期,提高生存质量。
Objective To investigate the therapeutic effect of gamma knife radiosurgery on residual chordoma. Methods A retrospective analysis of 49 cases of chordoma after surgery treated with gamma knife from April 1998 to October 2012 was performed. There were 26 males and 23 females, aged from 17 to 79 years with an average of 43.2 years old. The target volume was 3.8 ~ 37.5cm ~ 3, with an average of 11.4cm ~ 3. The radiation dose was 8 ~ 18 Gy, average 14.1Gy. The tumor center dose was 17.8 ~ 36.0 Gy, with an average of 29.7 Gy. Results The patients were followed up for 12 to 186 months (median 66 months) to evaluate clinical and imaging findings. Thirty-eight patients (77.6%) survived and 11 patients (22.4%) died: 8 died of tumor progression and 1 (3%) developed secondary intra-tumor haemorrhage, with two unexplained causes. The actual overall survival after SRS was 95.9%, 83.3% and 61.9% at 3,5 and 7 years, respectively. Follow-up images showed complete disappearance in 6 cases (12.2%), partial tumor regression in 14 cases (28.6%), stable tumor in 15 cases (30.6%) and tumor progression in 14 cases (28.6%). The total tumor control rate of SRS was 71.4%. Among 38 patients with cranial nerve impaired before SRS, neurological function was improved in 12 patients (31.6%). Fifteen patients (30.6%) had stable symptoms with no significant improvement. Eleven patients (28.9%) had neurological symptoms and signs worsened. Conclusion Gamma knife is a better treatment for residual chordoma in craniotomy, especially when the residual part is small. Beneficial to extend patient survival and improve quality of life.