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目的探讨脑胶质瘤立体定向放射治疗的疗效及放疗副反应。方法从1995年6月到1998年12月,用立体定向放射治疗的方法共治疗脑胶质瘤病人389例,其中用立体定向放射外科(stereotacticradiosurgery,SYS)方法治疗151例,分次立体定向放射治疗(fractionatedstereotatieradiotherapy,FSRT)方法治疗238例。SRS组单次周边剂量20-30Gy,靶点1-6个,平均2.48个,照射弧5-21个,平均8.45个;FSRT组每日或隔日照射,每次周边剂量8-12Gy,共照射2-5次,靶点1-6个,平均2.53个,照射弧6-20个,平均8.25个。结果治疗结束后3个月,SRS组完全缓解(CR)21例,占13.9%,部分缓解(PR)69例,占45.7%,稳定(SD)26例,占17.2%,进展(PD)35例,占23.2%,总有效率(PR+CR+SD)为76.8%;FSRT组完全缓解(CR)47例,占19.7%,部分缓解(PR)114例,占47.9%,稳定(SD)49例,占20.6%,进展(PD)28例,占11.8%,总有效率(PR+CR+sD)为88.2%,两组差别有显著性(χ2=9.874,P=0.020)。全部病人的1、3、5年生存率分别为54.3%、29.3%、16.5%;SRS组和FSRT组的1、3、5年生存率分别为52.3%、26.5%、11.9%和55.5%、31.1%、19.3%,两组差别没有显著性意义(χ2=2.16,P=0.1417);放射治疗的主要副反应为脑水肿,SRS组较FSRT组为重(χ2=4.916,P=0.027)。结论立体定向放射治疗对脑胶质瘤有较好的疗效,FSRT与SRS相比,具有疗效好副作用小的优点。
Objective To investigate the efficacy of stereotactic radiation therapy of glioma and radiotherapy side effects. Methods From June 1995 to December 1998, 389 patients with glioma were treated with stereotactic radiosurgery (stereotacticradiosurgery, SYS), and treated with stereotactic radiosurgery (SYS) Treatment of 238 cases with fractionated steatotatieradiotherapy (FSRT). In the SRS group, the single peripheral dose was 20-30 Gy and the target was 1-6, with an average of 2.48 and the irradiation arc was 5-21, with an average of 8.45. The FSRT group was irradiated daily or every other day with a dose of 8-12 Gy per peripheral dose, 2-5 times, target 1-6, with an average of 2.53, arc 6-20, an average of 8.25. Results In the SRS group, CR was 21 (13.9%), partial response (PR) 69, 45.7%, stable (SD) 26, 17.2%, and progression 35 The total effective rate (PR + CR + SD) was 76.8% in the FSRT group, 47 cases (19.7%) in the FSRT group, and 114 cases (47.9%) in partial response (PR) The total effective rate (PR + CR + sD) was 88.2% in 49 cases (20.6%) and 28 cases (11%) in progression (χ2 = 9.874, P = 0.020). The 1, 3, 5-year survival rates of all patients were 54.3%, 29.3% and 16.5% respectively. The 1, 3, 5-year survival rates of SRS group and FSRT group were 52.3%, 26.5%, 11.9% and 55.5% (Χ2 = 2.16, P = 0.1417). The main side effect of radiation therapy was cerebral edema. The SRS group was more severe than the FSRT group (χ2 = 4.916, P = 0.027). Conclusion Stereotactic radiotherapy has a good effect on glioma. Compared with SRS, FSRT has the advantages of good curative effect and small side effect.