论文部分内容阅读
目的探讨手术后残存脊索瘤的伽玛刀治疗的相关因素。方法回顾性分析本中心自1996年6月至2004年底伽玛刀治疗的31例手术残存脊索瘤病例,其中男性20例,女性11例;年龄8-70岁,平均40．2岁。伽玛刀治疗的肿瘤体积0．47-27．6cm3,平均(11．4±7．4)cm3;射点数3 -12个,平均(6．5±2．4)个;肿瘤边缘剂量10-16Gy,平均(12．7±1．2)Gy;最大剂量20．8-40Gy,平均(29．2±4．0)Gy。结果本组28例得到治疗后6-102个月(平均30．2个月)的临床随访;和6-78 个月,平均28个月的影像随诊。用Kaplan-Meier生存分析,患者3年和5年的总生存率为90．9％和 75．8％。而影像学随诊中3年和5年的肿瘤实际控制率为64．2％和21．4％。伽玛刀治疗后1年左右多数肿瘤体积缩小;临床症状也相应缓解。随着时间延长,肿瘤复发比例增高。本组肿瘤增大的9 例中,7例为伽玛刀靶区外生长;再次伽玛刀治疗4例,再手术4例,继续临床观察1例。本组共2例死亡。尚未发现伽玛刀相关的严重并发症。结论对开颅手术残存的脊索瘤,伽玛刀是一种可选的治疗方法。治疗要及时,并要充分认知肿瘤的习性和对伽玛刀治疗的反应,有益于延长患者生存期, 提高生存质量。
Objective To investigate the related factors of gamma knife treatment of residual chordoma after operation. Methods Retrospectively analyzed 31 cases of residual chordoma treated by gamma knife from June 1996 to the end of 2004, including 20 males and 11 females, aged from 8-70 years (average 40.2 years). Gamma knife treatment of tumor volume 0.47-27.6cm3, an average of (11.4 ± 7.4) cm3; shot number 3 -12 months, an average of (6.5 ± 2.4); edge of the tumor dose of 10 -16 Gy, mean (12.7 ± 1.2) Gy; maximum dose 20.8-40 Gy, mean (29.2 ± 4.0) Gy. Results The group of 28 patients received 6-102 months after treatment (average 30.2 months) of the clinical follow-up; and 6-78 months, an average of 28 months follow-up of the images. With Kaplan-Meier survival analysis, patients had a 3-year and 5-year overall survival of 90.9% and 75.8%. The actual follow-up of 3 and 5 years in imaging follow-up was 64.2% and 21.4%, respectively. Gamma knife treatment 1 year after the majority of tumor size reduced; clinical symptoms are also alleviated. With the extension of time, the proportion of tumor recurrence increased. In the group of 9 cases of tumor enlargement, 7 cases of gamma knife target area growth; again gamma knife treatment in 4 cases, reoperation in 4 cases, continue to clinical observation in 1 case. A total of 2 patients died in this group. Gamma Knife-related serious complications have not been found. Conclusions Gamma knife is an alternative treatment for chordoma remaining from craniotomy. Treatment should be timely, and to fully understand the tumor’s habits and response to gamma knife treatment, beneficial to prolong the survival of patients and improve the quality of life.