儿童髓母细胞瘤手术及三维适形放疗

目的:探讨儿童髓母细胞瘤手术治疗三维适形放疗及预后。方法:29例髓母细胞瘤患儿均行头部CT或MRI检查,全部病例行手术切除肿瘤,病理证实。术后均接受三维适形放疗,使用CT定位技术,Picker公司PQS-CT和AcQsim,Cadplan三维治疗计划系统作剂量计算,并做剂量体积直方图DVHs,通过放射治疗信息管理和验证系统Varis(放疗科局域网)将治疗信息传至带多叶准直器(MLC)的直线加速器(Varian2100C/D)。结果:本组术后症状均获得明显改善,无死亡病例,1例术后合并颅内感染经治疗痊愈,肿瘤全切除23例,次全切除6例;术后3年无瘤生存28例,1例因脊髓椎管内复发死亡;23例(79.3%)出现了白细胞计数下降。结论:小脑髓母细胞瘤应尽量做到手术全切除,解除脑脊液循环梗阻;三维适形放射治疗能提高放射治疗的准确性和精确性,减少正常组织的照射剂量,从而能提高治愈率。

Surgery and 3-D dimensional raditherapy in pediatric medulloblastoma

Objective To discuss the diagnosis therapy,and prognosis of medulloblastoma in children.Methods Twenty-nine cases of medulloblastoma all received CT or MRI examination before surgery.The tumors were removed and certified postoperatively by pathological examination.All of the cases were executed by postoperative radiotherapy.Three-dimensional conformal radiotherapy was carried on after operation.PQS-CT,AcQsim and Cadplan TPS were separately used for CT localization,organ contouring,dose and DVHs calculation.Through information administration and verification system(Varis system)in radiotherapy department,treatment information was sent to Varian 2100C/D linear accelerator,which were armed with MLC(Multi-leaf Collimator).Results All of the cases survived after the operation and got good recovery.1 case was complicated with incranial infection and cured finally.28 cases survived without relapse for 3 years.1 case died of recurrence in spinal during the follow-up.And during the course of irradiation,leukocytopenia was observed in 79.3%(23/29).Conclusion Surgery combined with craniospinal irradiation could bring better therapeutic effect.Three-dimensional conformal radiotherapy can raise the accuracy of radiotherapy,reduce the dose of normal tissue,and control the local focus better.