立体定向^32P内放射治疗老年颅咽管瘤

目的评价立体定向32P内放射治疗对老年颅咽管瘤的治疗效果。方法对26例老年颅咽管瘤患者进行立体定向放射性核素囊内置入内放射治疗。26例中,12例行无框架立体定向囊液抽吸＋32P内放疗术,14例行有框架立体定向囊液抽吸＋32P内放疗术,其中10例结合伽玛刀治疗肿瘤实体部分。结果立体定向穿刺抽出囊液1.5～27ml（平均11.3ml）。11例患者术后当日即出现视力及视野不同程度的改善。本组无严重并发症及手术死亡。共有22例获得12个月至6年（平均55个月）的随访。4例死亡。18例中,肿瘤有效控制率为83.3%。10例结合伽玛刀治疗者,9例得到随访,对实体部分的有效控制率为88.9%。结论老年颅咽管瘤患者,不能耐受开颅手术治疗或手术后残留、复发的,可采用立体定向囊液抽吸＋32P内放疗,对有实性部分者,联合伽玛刀治疗,是治疗老年颅咽管瘤的一种简单、安全、有效的方法。

Management of craniopharyngiomas in senior patients with stereotactic 32P intracavitary irradiation

Objective To examine the treatment results of 32P intracavitary irradiation in the senior patients with craniopharyngiomas.Methods Twenty-six senior patients were treated with stereotactic 32P intracavitary irradiation.Of 26 patients,12 received frameless stereotactic cystic fluid aspiration and phosphorus-32 intracavitary irradiation and 14 received frame stereotactic cystic fluid aspiration and 32P intracavitary irradiation.Among them,10 patients were treated with gamma knife surgery in solid part of the tumors.Results The volume of stereotactic cystic fluid aspiration varied from 1.5 to 27 ml（average 11.3 ml）.Visual acuity and fields improved in 11 patients at different degrees postoperative instantly.No severe complications occurred in these patients.Twenty-two patients were followed-up from 12 months to 22 years（mean,46 months）.Four patients were dead.The actuarial tumor control rates were 83.3% in 18 cases.Of 10 patients with combined therapy of gamma knife surgery,9 were followed-up.The control rates for solid part of tumors were 88.9%.Conclusion Stereotactic 32P intracavitary irradiation is a simple,safe and effective method for senior craniopharyngiomas.For the patients who cannot endure the craniotomy or has postoperative residual and recurrent craniopharyngiomas,stereotactic cystic fluid aspiration and intracavitary brachytherapy can be used for the cystic part and the gamma knife surgery for the solid part of the tumors.