伽玛刀分次治疗泌乳素型垂体腺瘤的临床意义

目的探讨分次伽玛刀治疗泌乳素型垂体腺瘤的疗效。方法应用分次伽玛刀治疗泌乳素型垂体腺瘤56例,瘤周边剂量为28～31.8GY,每次剂量为5.3～7GY,隔日一次,共4～6次,50%等剂量曲线。结果随访1～5年,56例患者中,48例症状改善,1例肿瘤消失,36例肿瘤缩小,12例患者激素水平恢复正常。结论分次伽玛刀治疗能有效控制泌乳素型垂体腺瘤生长,有利于内分泌功能的恢复,且副作用小。     

经内镜胆管支架或鼻胆管置放结合γ刀治疗晚期胰腺癌的临床观察

目的 探讨经十二指肠镜胆管支架或鼻胆管置放与γ刀结合治疗晚期胰腺癌的疗效.方法 有35例晚期胰腺癌病人接受治疗,其中26例被放置塑料支架,6例放置鼻胆管,均行γ刀治疗10～12次/疗程,总剂量为40～50 Gy.结果 插管成功率91.4%,并发症3例,并发症发生率9.4%,2例急性胰腺炎,1例急性胆管炎.血清胆红素由310 μmol/L下降到术后1周的126 μmol/L.治疗后3个月、6个月存活率分别达96%及80%.结论 经内镜胆管支架置放或鼻胆管置放结合γ刀治疗晚期胰腺癌是安全、有效的方法.     

Gamma-knife radiosurgery for the treatment of ovarian cancer metastatic to the brain

BACKGROUND: Central nervous system (CNS) metastases from an ovarian malignancy are uncommon. The long-term prognosis for these patients is poor, with studies reporting a mean survival of less than 12 months. CASES: We present three ovarian cancer patients who developed metastatic disease to the brain. All patients were heavily pre-treated prior to the development of CNS disease. Following detection of CNS disease, they all were treated with multi-modality therapy including gamma-knife radiosurgery (GKRS). At this time, one patient is alive at 26 months following treatment with GKRS. The second and third patients survived for 88 and 22 months respectively, before succumbing to their disease. CONCLUSION: Local control of ovarian cancer metastatic to the brain can be achieved in some patients with GKRS. Additional investigation into GKRS is warranted.     

伽马刀治疗31例原发性肝癌门脉和/或下腔静脉癌栓临床观察

目的:分析伽马刀治疗原发性肝癌门脉和/或下腔静脉癌栓的疗效及预后影响因素。方法:2006年至2012年我院收治31例原发性肝癌门脉癌栓和/或下腔静脉癌栓患者行伽马刀立体定向放射治疗。以40%-60%等剂量曲线为处方剂量线,中位处方剂量44Gy（范围:32-52Gy）,1次/日、5次/周、3.5-5Gy/次,8-13次完成,临床靶区根据需要为癌栓包括或不包括肝原发病灶。治疗后每1-3个月复查血常规、血生化、肿瘤标志物、影像学检查（CT或MRI）。随访时间4-50个月,中位随访时间12个月,随访结束时间2013年6月。结果:总生存期4-50个月,中位生存期（MST）12个月,癌栓有效率（CR+PR）83.9%,其中CR 15例（48.4%）,PR 11例（35.5%）,SD 4例（12.9%）,PD 1例（3.2%）。1年生存率58.1%,2年生存率9.7%。Kanplan-meier单因素分析显示癌栓部位（P=0.039）、处方剂量（P=0.009）的生存差异有统计学意义（IVC组好于PVTT组,处方剂量>44Gy组好于≤44Gy组）,COX模型多因素分析显示处方剂量是影响预后的有意义因素（P=0.015）。结论:伽马刀治疗原发性肝癌门脉/下腔静脉癌栓安全有效、毒副反应轻、并发症少,可延长生存期,是原发性肝癌门脉/下腔静脉癌栓治疗可选方式,处方剂量是影响预后的有意义因素。     

Intratumoral hemorrhage after remote subtotal microsurgical resection and gamma knife radiosurgery for vestibular schwannoma

Summary Our report describes the occurrence of intratumoral hemorrhage in a vestibular schwannoma, which was treated with microsurgical resection thirteen years and gamma knife surgery (GKS) more than two years prior to the event. Although rare, it is apparent that bleeding into a vestibular schwannoma remains a possibility, even after the tumor has responded favorably to GKS. Long-term followup of patients with vestibular schwannoma who have been treated with GKS is advisable to assess treatment response and to detect adverse events (e.g. hemorrhage) suspected on clinical grounds.     

介入联合伽玛刀治疗肝脏转移性肿瘤的近期效果

目的探讨介入联合伽玛刀治疗肝脏转移性肿瘤的近期疗效。方法22例肝脏转移性肿瘤患者,分别行TAI+伽玛刀+TAI,并随访。结果22例患者全部完成治疗,总有效率77.3%;生存时间为3,6,9,12个月者分别为22、22、20和18例;无明显严重副反应。结论介入联合伽玛刀治疗肝脏转移性肿瘤有较好的近期效果,可提高治疗的有效率和患者的生存期;副反应发生率无明显增加。     

手术和伽马刀治疗较小听神经瘤的Meta分析

目的 比较手术及伽马刀治疗＜3 cm听神经瘤的优劣.方法 由2名研究人员分别检索1990年1月1日-2010年3月31日四川大学网上图书馆CENTRAL、ISI、Medline、Embase、NLM Gateway、CBMdisc等数据库的相关论文,选择证据级别最高的文献,使用Cochrane图书馆提供的RevMan ...     

Gamma-Knife Surgery for Secreting Pituitary Adenomas

Summary We report our preliminary results concerning 25 patients with secreting pituitary adenomas treated with stereotactic radiosurgery after partial transsphenoidal surgery and followed over a 6–36 month-period. Among the 15 acromegalic patients, a decrease of 65% in mean GH levels was achieved after 6 months and of 77% at 12 months after radiosurgery. Presently, only 3 patients (20%) are considered as in remission (mean GH and IGF1 level into the normal range). A decrease of 46% and 65% was observed at 6 and 12 months after radiosurgery in 4 patients with prolactinomas although no normalization of PRL levels occurred. Presently, 3/4 patients have individual PRL levels slightly above the normal range. A normalization of Urinary Free Cortisol (UFC) was noticed in 4/6 (66%) patients with Cushing's disease within 6–12 months. No pituitary deficiency was noticed in this series with the exception of 4/25 patients (16%) who received subtotal or total pituitary irradiation for postoperative remnants of secreting adenomas poorly defined on MRI. One woman, who had undergone previously a conventional irradiation and presenting with a cavernous sinus adenoma reaching the optic nerve, developed an optic neuropathy. A second woman, with a cavernous sinus remnant, presented a cranial nerve palsy (VI) after the irradiation. We can conclude that radiosurgery using the Cobalt-60 Gamma-unit is, at least, as effective as conventional radiotherapy in the control of pituitary hormone hypersecretion from postoperative adenomas remnants with less adverse effects.