脉络膜恶性黑色素瘤的伽玛刀治疗

目的评价立体定向放射外科治疗脉络膜恶性黑色素瘤的价值.方法对6例脉络膜恶性黑色素瘤病人行伽玛刀治疗,中心剂量80 Gy,边缘剂量40 Gy,边缘剂量曲线50%,等中心数2～8个,均选用4 mm准直器.结果随访24～96个月,中位时间58个月.病人均存活,仅1例2年后出现玻璃体内增殖物,无其他眼部和全身并发症,未见眼外及颅内外蔓延和转移.视力提高2例,保持治疗前水平3例,下降1例.肿瘤缩小4例,消失1例,1例观察8年未增长.结论伽玛刀治疗眼球后部脉络膜恶性黑色素瘤有效,部分病人达到了既控制肿瘤又保留眼球和部分视力的目的.     

伽玛刀治疗眼底脉络膜黑色素瘤7例临床报告

报告7例脉络膜黑色素瘤应用γ-刀治疗后早期随访结果.男4例,女3例.平均年龄32岁.瘤体最人直径8～25mm.肿瘤边缘剂量14～24Gy,平均19.5Gy;中心剂量3O～60Gy,平均425Gy.γ角50°～70°.治疗后3个月开始随访.平均随访15个月.至最后一次随访时.7例病人全部存活,肿瘤生长控制率100%.无局部复发及转移,无与γ-刀治疗有关的严重并发症.γ-刀是治疗眼部局限件脉络膜黑色素瘤的一种安全有效的方法,长期疗效需进一步观察.     

影响脑转移瘤伽玛刀治疗效果相关因素分析

目的　探讨影响伽玛刀治疗脑转移瘤治疗效果的因素。方法　用伽玛刀治疗脑转移瘤 2 72例共 396个病灶。中心剂量 2 5～ 70Gy ,周边剂量 1 0～ 35Gy;靶点数 1～ 1 1个。并对肿瘤体积、数目、照射剂量、原发灶控制和全脑放疗等影响疗效因素进行统计分析。结果　本组病例随访 1 0～ 46个月 ,平均 2 4个月。 396个病灶完全缓解 32 6个 (82 3 % ) ,部分缓解 38个 (9 5 % ) ,无变化及进展 32个 (8 2 % ) ,平均生存期 (1 3 6± 7 9)个月。原发灶控制好者、伽玛刀治疗前后结合放疗、化疗者 ,其生存期较长。结论　伽玛刀是治疗脑转移瘤安全可靠的手段之一。并发症少、有效率高。伽玛刀治疗脑转移瘤的疗效主要与病灶体积、周边剂量等密切相关。肿瘤体积小于 1 5cm3,周边剂量大于 1 8Gy时 ,完全缓解率较高。     

眶部肿瘤的伽玛刀放射外科治疗

目的总结评价伽玛刀放射外科治疗眶内肿瘤的适应证、疗效和并发症.方法本组32例,男10例,女22例,年龄2.5-80岁,病程3-¨3个月,32例中20例首选伽玛刀治疗,12例为术后残留或复发.神经鞘瘤6例,脑膜瘤例16例,视神经胶质瘤7例,视网膜母细胞瘤1例,静脉性血管瘤1例,脉络膜黑色素瘤1例;肿瘤最大直径0.7-4.0cm,平均为2.08cm;用伽玛刀进行治疗,选定边缘剂量5～40Gy,平均15.93Gy,中心剂量8.33～80Gy,平均31.18Gy,边缘等剂量线40～60%,等中心数目3～13个,平均7.6个.结果随访期3～59个月,平均27.5个月,其中临床好转18例,无变化10例,恶化4例,总有效率87.50%;影像学随访结果显示肿瘤消失2例,缩小17例,无变化9例,增大4例,有效率87.50.治疗后早期反应少见,中期反应多于治疗后3个月左右,可持续6个月～12个月.结论伽玛刀放射外科是一种安全有效的治疗眶部肿瘤的方法.既可以作为眶部肿瘤的首选治疗,也可作为手术后残余或复发肿瘤的补充治疗,弥补手术治疗不完全的缺憾.     

伽玛刀治疗眼底脉络膜黑色素瘤7例临床报告

报告7例脉络膜黑色素瘤应用γ-刀治疗后早期随访结果。男4例，女3例，平均年龄32岁，瘤体最大直径8-25mm，肿瘤边缘剂量14-24Gy，平均19.5Gy；中心剂量30-60Gy；平均42.5Gy，γ角50°-70°。治疗后3个月开始随访，平均随访15个月，至最后一次随访时，7例病人全部存活，肿瘤生长控制率100%，无局部复发及转移，无与γ-刀治疗有关的严重并发症。γ-刀是治疗眼部局限性脉络膜黑色素瘤的一种安全有效的方法，长期疗效需进一步观察。     

伽玛刀治疗三叉神经鞘瘤疗效观察

目的 回顾性分析评价伽玛刀对三叉神经鞘瘤的临床疗效.方法 分析2004年2月至2010年5月于本中心应用Leksell“C”型伽玛刀治疗三叉神经鞘瘤41例,其中13例为术后复发或残留,28例经MRI诊断首选伽玛刀治疗.肿瘤平均直径22 mm,肿瘤的平均体积9 cm3.照射肿瘤的平均中心剂量为29.2 Gy,平均周边剂量12.8 Gy.结果 平均随访时间38个月.症状变化:首选伽玛刀治疗的患者8例症状完全消失;18例好转,11例症状无变化或轻微加重,4例因肿瘤增大症状加重.肿瘤变化:7例肿瘤基本消失,22例肿瘤缩小,8例肿瘤未增大,4例体积增大,肿瘤控制率90.2％.结论 伽玛刀对中小型三叉神经鞘瘤治疗安全有效,有良好的中长期控制作用,并可有效地改善其临床症状,保护周围脑神经,肿瘤控制剂量为12～13 Gy.     

巨大垂体腺瘤伽玛刀放射治疗体会(附62例报道)

目的通过回顾性分析62例巨大垂体腺瘤的伽玛刀临床治疗资料,探讨其治疗策略。方法从1997年到2003年,有62例巨大垂体腺瘤病人接受伽玛刀治疗,50%等剂量曲线包绕肿瘤体积1/2或2/3,肿瘤基底部周边剂量14~18Gy,中心剂量30~45Gy,视通路控制在10Gy以下。结果伽玛刀治疗后随访平均27个月,临床症状、MRI检查肿瘤大小及形态的改变、内分泌检查相关激素的变化、视力视野均得到显著改善。结论伽玛刀采用体积分割治疗垂体大腺瘤是一个新的治疗手段。     

颈静脉球瘤的伽玛刀治疗（附9例报告）

目的探讨伽玛刀治疗颈静脉球瘤的临床疗效。方法回顾性分析9例颈静脉球瘤的临床资料。肿瘤体积2．8～38．6cm^3．平均13．8cm^3。均采用Leksell伽玛刀治疗,边缘剂量12～15Gy,中位数15Gy,等剂量曲线40％～55％。结果所有病人均未出现新的脑神经受损症状,临床症状基本消失1例,改善4例,无变化3例,听力症状加重1例。随访时间9～72个月,平均30.3个月。肿瘤体积缩小4例,无明显变化4例,肿瘤继续进展1例。结论伽玛刀治疗能较好地控制肿瘤生长,副作用轻微,可作为较小肿瘤或不适合手术病人的首选治疗方法,同时也是术后肿瘤残留或复发的重要治疗手段。     

巨大垂体腺瘤的伽玛刀治疗(附42例报道)

目的总结42例巨大垂体腺瘤的伽玛刀治病与随访资料,评价其疗效及安全性,探讨一种巨大垂体瘤新的治疗方法.方法采用1.5T MRI定位,OUR-XGD型旋转式伽玛刀治疗42例巨大垂体瘤患者.肿瘤直径3.0～5.5cm,等剂量曲线45%～60%（平均50%）,肿瘤基底部边缘剂量12～18Gy（平均14Gy）,中心剂量24～33Gy（平均28Gy）,视神经视交叉受量小于9Gy.结果随访4～39个月,平均18个月,近期肿瘤控制率100%,功能性垂体瘤内分泌症状改善8/15（53%）.各种并发症发生率低于5%.结论只要病例选择适当,治疗规划合理,伽玛刀对于不适宜开颅或拒绝开颅的巨大垂体瘤患者仍是一种安全有效的治疗方法.     

三叉神经鞘瘤的伽玛刀治疗

目的 探讨伽玛刀治疗对三叉神经鞘瘤的临床疗效.方法回顾性分析1994年12月至2003年12月于本中心行伽玛刀治疗并随访的58例三叉神经鞘瘤,肿瘤平均体积4.6cm3,平均周边剂量13.1Gy,平均中心剂量28.3Gy.结果平均随访期42.5个月,影像随访证实4例肿瘤基本消失,34例明显萎缩,16例体积变化不明显,4例体积增大,肿瘤总控制率93%.28例患者的临床症状明显改善,23例临床症状无变化,7例临床症状持续加重.13例伴有继发性三叉神经痛的患者中,10例伽玛刀治疗后明显缓解或消失.结论伽玛刀治疗对中小型三叉神经鞘瘤安全有效,并可有效地改善其临床症状,保护瘤周颅神经的功能.     

显微外科手术及伽玛刀治疗Ⅱ型神经纤维瘤病(附68例报告)

目的探讨显微外科手术及伽玛刀治疗Ⅱ型神经纤维瘤病的疗效。方法回顾分析68例NF2患者资料,68例患者中的35例至少有1个肿瘤直径>3cm,存在脑组织受压,神经功能受损,先行显微外科手术治疗,术后补充伽玛刀治疗;另外33例肿瘤最大直径<3cm,直接行伽玛刀治疗。伽玛刀治疗分次或单次进行,剂量:肿瘤中心剂量25～32Gy,边缘剂量12～16Gy,平均14Gy。结果68例患者随访6个月至58个月。伽玛刀治疗组肿瘤控制有效率为87.5%,33例患者均保留不同程度听力,新出现面瘫1例,占3%。无瘫痪、失明等并发症,无死亡,33例中1例因梗阻性脑积水行右侧脑室-腹腔分流术,2例因肿瘤明显增大行手术全切除肿瘤,2例凸面脑膜瘤因顽固性脑水肿行手术全切除肿瘤。手术结合伽玛刀治疗组35例肿瘤控制有效率为96.6%。除1例术前双侧听力均丧失者,其余患者至少保留一侧不同程度听力,治疗前伴有癫痫症状的3例患者中2例好转,1例无变化,新发癫痫1例,新发永久性面瘫5例,占14.3%,瘫痪2例,真性球麻痹1例,新发共济失调2例,死亡2例。结论肿瘤直径小于3cm,可采用伽玛刀治疗。肿瘤直径大于3cm,先手术治疗。对于凸面或镰旁脑膜瘤,无论大小,都应手术治疗。残余肿瘤可补充伽玛刀治疗。     

Gamma-knife for treating pituitary adenomas in 501 cases： Retrospective case analysis

BACKGROUND: Gamma-knife is characterized by low risk and low death rate, without trauma, bleeding or infection. MRI has replaced CT as a method of location, and provides a good choice for treating pituitary tumors. OBJECTIVE: To analyze the effectiveness and complications of 501 cases with pituitary adenoma by using gamma-knife retrospectively. DESIGN: Case-analysis. SETTING: Gamma-knife Center, the 363 Hospital of Chinese PLA. PARTICIPANTS: A total of 501 cases were selected from Gamma-knife Center, the 363 Hospital of Chinese PLA from January 1997 to December 2002. All patients were certainly diagnosed with CT and MRI scanning. There were 186 males and 315 females. Their ages ranged from 15 to 84 years with the mean age of 39 years. All patients provided confirmed consent. METHODS: All 501 cases with pituitary adenomas were treated by gamma-knife or combined with operations. The average iso-dose curve was 50% (30%–65%), peri-dose was 14 Gy and the average target number was 5.17. ① At 35 months after treatment, patients received follow-up including clinical symptoms, imaging symptoms and endocrine symptoms. ② Patients who received second gamma-knife treatment were analyzed and their complications were observed after operation. MAIN OUTCOME MEASURES: ① Follow-up results of clinical symptoms, image and endocrine indexes; ② second gamma-knife treatment; ③ postoperative complications. RESULTS: Among 501 accepted patients, 275 cases were involved in the follow up of clinical symptoms, 154 in image symptoms and 98 in endocrine symptoms. ① Follow-up results of clinical symptoms, image and endocrine indexes: Follow up of clinical symptoms demonstrated that clinical symptoms of 169 cases were relieved, of 68 disappeared, and of 38 deteriorated. Follow-up of image symptoms indicated that pituitary tumor of 25 cases disappeared, of 84 shortened, of 42 not changed, and of 3 enlarged. Follow-up of endocrine symptoms suggested that endocrine of 50 cases was abnormal, of 29 recovery to normal value, and of 19 not changed obviously. ② Second gamma-knife treatment: At 6–24 months after gamma-knife treatment, 15 patients with pituitary tumor received second gamma-knife treatment; especially, one patient received for the three times. The conditions in details were recorded as follows: The peri-dose for the first treatment ranged from 8 to 12 Gy; in addition, that for the second one ranged from 6 to 12 Gy. ③ Postoperative complications: The complications were as follow: hypopituitarism occurred in 2 patients (0.7%); tumor apoplexy in 2 patients (0.7%); weakened eyesight in 5 patients (1.8%); 3 of which recovered with dehydration and hormone treatment; 2 patients received tumor resection and optical nerve decompression operation with dehydration and hormone treatment ineffectively. CONCLUSION: Gamma-knife is effective and safe for pituitary adenoma.     

伽玛刀治疗听神经瘤疗效分析

目的探讨伽玛刀治疗听神经瘤的疗效。方法连续应用Leksell伽玛刀治疗92例听神经瘤。结果随访12-36个月。肿瘤生长控制率为93.5％（86／92），无死亡及严重并发症发生。在65例可评价病例中，听力保留38例，保留率58.5％。治疗后4～8周8例（8.7％，8.92）出现轻度周围性面瘫，半年后逐渐恢复；6例（6.5％，6.92）出现三叉神经受损症状，表现为面部麻木。6～12个月后恢复。结论伽玛刀治疗听神经瘤安全、有效，患者生存质量高。     

A case of TSH-secreting pituitary adenoma associated with an unruptured aneurysm: successful treatment by two-stage operation and gamma-knife]

We report a successfully treated case of invasive TSH-secreting pituitary adenoma associated with an unruptured internal carotid artery aneurysm by two-stage operation and gamma-knife radiosurgery. A 64-year-old woman was admitted to our department with a 3-year history of general fatigue and 1-year history of anxiety, palpitation and hyperhydrosis. Endocrinological examination revealed hyperthyroidism with elevated TSH, GH and somatomedin C. Magnetic resonance images demonstrated a tumor in the sella turcica which extended into the left cavernous sinus, furthermore, indicated aneurysm-like flow void at the ventral part of the left internal carotid artery. The aneurysm was confirmed by conventional angiography. Neck clipping of the aneurysm was performed through pterional approach as the first operation. One month later, at the second operation, the pituitary adenoma except for cavernous sinus portion was resected via the transsphenoidal approach. Immunohistological examination revealed positive for TSH and GH. Gamma-knife radiosurgery with a central dose of 33.3 Gy and peripheral dose of 17 Gy was carried out for residual tumor at the cavernous sinus under both MRI and CT guidance. Posttreatment course was uneventful with normalization of thyroid function at 16 months after gamma-knife. Two-stage operation and gamma-knife radiosurgery is effective for TSH-secreting adenoma extending into the cavernous sinus associated with an unruptured aneurysm.     

眼眶肿瘤的伽玛刀放射外科治疗

目的 总结评价Leksell伽玛刀治疗眼眶肿瘤的中长期疗效.方法 223例患者年龄4～85岁,平均(37.5±15.6)岁.男91例,女132例；125例为手术后残留或复发者,98例根据典型临床及影像表现进行诊断；肿瘤容积0.03～35.60 cm3,平均(5.4±1.9)cm3;肿瘤边缘剂量10～40 Gy.结果 随访18 - 114个月,平均(35.7±16.2)个月,肿瘤缩小129例(57.8％),无变化80例(35.9％),14例(6.3％)肿瘤增大,肿瘤控制率为93.7％；142例患者治疗后视力得到保留,其中视力提升79例,减退19例；21例曾出现一过性球结膜水肿.结论 伽玛刀治疗眼眶肿瘤可取得良好肿瘤控制率,多数患者可保留视力,并发症少,可成为眼眶肿瘤的主要治疗方法之一.     

伽玛刀治疗肺癌脑转移瘤疗效分析

目的 探讨伽玛刀对肺癌脑转移瘤治疗后肿瘤局部控制情况及病人生存期。方法 回顾旋转式伽玛刀治疗的37例原发肺癌的脑转移瘤，颅内单个转移灶14例，多发转移灶23例。其中15例在术前或术后接受了全脑放疗。患者术前通过肺部活检明确病理，其中小细胞癌ll例，鳞癌10例，腺癌13例，鳞腺混合癌3例。随访内容包括影像学检查肿瘤变化的情况，生存质量评分(KPS)，伽玛刀治疗后生存时间及死亡原因。结果 随访6～26个月，平均14个月。仅2例病人因脑内肿瘤未控制死亡。6个月生存率腺癌69．2％(9／13)、鳞癌60％(6／10)、小细胞癌63．6％(7／11)；12个月生存率腺癌38．5％(5／13)、鳞癌20％(2／lO)、小细胞癌27．3％(3／11)。肿瘤局部控制率腺癌87．9％；鳞癌94．1％；小细胞癌100％；鳞腺混合癌94．7％。结论 伽玛刀治疗原发肺癌的脑转移瘤安全有效，肿瘤局部控制率高，能改善病人的生活质量。     

Clinical outcomes of 114 patients who underwent Gamma-knife radiosurgery for medically refractory idiopathic trigeminal neuralgia

The optimal radiation dose and target of Gamma-knife radiosurgery (GKRS) for medically refractory idiopathic trigeminal neuralgia (TN) are contentious. We investigated the effects and trigeminal nerve deficits of GKRS using two isocenters to treat a great length of the trigeminal nerve. Between January 2005 and March 2010, 129 patients with idiopathic TN underwent GKRS at the West China Hospital of Sichuan University. A maximum central dose of 80-90 Gy was delivered to the trigeminal nerve root with two isocenters via a 4 mm collimator helmet. One hundred and fourteen patients were followed-up periodically by telephone interview to determine the effects, trigeminal nerve deficits and time to the onset of pain relief. The mean follow-up duration was 29.6 months. One hundred and nine patients had complete or partial pain relief and the treatment failed in five patients. Nine patients experienced a recurrence after a mean time of 12.7 months, following an initial interval of pain relief. There were no significant differences between patients with different grades of pain relief with respect to central doses. The mean time to the onset of pain relief was 3.6 weeks. The time to the onset of complete pain relief was significantly shorter than that for partial pain relief. Forty-nine patients reported mild-to-moderate facial numbness and one patient experienced paroxysmal temporalis muscle spasms two weeks after the treatment. GKRS treatment for medically refractory idiopathic TN with two isocenters resulted in an initial pain improvement in 95.6% of patients. The early response to the treatment might suggest a good outcome but, given the high incidence of nerve deficits, GKRS for TN with two isocenters is not recommended as a routine treatment protocol.     

3D conformal radiotherapy and cisplatin for recurrent malignant glioma

PURPOSE: To determine the maximum tolerated dose of 3D conformal radiotherapy in combination with Cisplatin for patients with recurrent malignant gliomas. METHODS: From 1999-2003, nine patients with recurrent malignant glioma received fractionated radiotherapy and Cisplatin (20 mg/m2/d IV on days 1-5) in a Phase I radiation dose escalation trial. Three sequential dose levels were evaluated: 25 Gy, 30 Gy, and 35 Gy, using 5 Gy fractions. All patients received prior external beam radiation (median dose 59.4 (20-60) Gy) and five patients received prior chemotherapy. RESULTS: Six male and three female patients were enrolled with a median age of 52 years, and a median Karnofsky performance status score of 70. The median re-irradiated tumor volume was 18.9 (0.1-78.5) cm3 and the median follow-up was 8.8 (3.2-31.2) months. One patient (30 Gy/ 6 fractions) experienced medically reversible acute grade 3 toxicity. A second patient (35 Gy/ 7 fractions) experienced acute grade 2 toxicity and histology showed tumor and radiation effect. A third patient (25 Gy/ 5 fractions) experienced late grade 3 toxicity from radiation necrosis. The radiological responses consisted of complete response (1 patient), partial response (1 patient), and stable disease (2 patients). The median overall survival was 8.8 months (95% CI 8.0-9.9), and the median disease free interval was 2.0 months (95% CI 1.4-4.4). Seven patients received chemotherapy following re-irradiation and Cisplatin. CONCLUSION: The maximum tolerated dose of 3D conformal fractionated radiotherapy was 30 Gy in 6 fractions with low dose Cisplatin, which was well tolerated in terms of acute toxicity for our patient population. This regimen demonstrated only modest efficacy in the treatment of recurrent malignant glioma. Combinations of conformal re-irradiation and other systemic agents may merit investigation. Currently our recommended dose is 30 Gy in 6 fractions for selected patients.     

射波刀治疗听神经瘤的初步结果

目的 总结射波刀分次治疗听神经瘤的初步结果和设计治疗计划技巧.方法 应用射波刀分次治疗29例听神经瘤.肿瘤平均最大直径为31 mm.肿瘤平均体积为13.2 cm3 (0.3～36.0 cm3).设计治疗计划时,将射线束控制在150～ 200条之间,使治疗计划有良好的适形性,同时提高肿瘤内高剂量区范围.2例巨大肿瘤照射4次,3例小肿瘤照射2次,其余24例照射3次.平均随访时间21个月.结果 1例巨大肿瘤患者在治疗后10个月死亡,其余28例肿瘤中,6例缩小50％以上,15例缩小20％,7例肿瘤无变化.13例保持原有有效听力,1例听力明显下降,1例听力从无效改善为有效,其余患者为无效听力.无面瘫,3例患者出现脑积水,1例出现脑干水肿,治疗后水肿消失.结论 射波刀分次治疗听神经瘤的初步疗效满意,不良反应较轻;为高龄、不适合手术、部分肿瘤较大的听神经瘤患者提供又一治疗手段,但长期疗效和不良反应有待进一步随访.