光动力学疗法辅助手术治疗复发性脑胶质瘤：附11例报告

本文对11例复发性脑胶质瘤进行了术前光动力学(PDT)辅助治疗。按常规开颅,次全或大部分切除肿瘤,瘤床应用氩离子泵浦染料激光和(或)倍频 YAG 泵浦染料激光照射。全部病人应用 PDT 后未增加脑水肿的发生,亦未发生过敏或光毒反应,均于手术后15天内出院。     

膀胱内灌注血卟啉衍生物加抗坏血酸全膀胱激光照射预防膀胱癌复发

目的探讨预防膀胱癌术后复发的新疗法，评价经膀胱内灌注血卟啉衍生物加抗坏血酸行激光全膀胱照射的光动力疗法预防复发的疗效。方法采用经膀胱内灌注血卟啉衍生物癌光啉（ＰｓＤ－００７）加抗坏血酸行全膀胱激光照射方法，治疗３０例膀胱癌术后患者。结果３０例患者随诊３０个月，其肿瘤复发率为２３．３％（７／３０）。无一例发生膀胱挛缩以及皮肤光毒副反应。结论用膀胱内灌注血卟啉衍生物加抗坏血酸全膀胱照射能有效地预防膀胱癌的复发。在治疗过程中，受治患者无需避光护理，为治疗提供了方便。     

间质内高剂量率放射治疗脑重要功能区胶质瘤

目的：探讨术后在瘤床及残瘤腔内行高剂量率放射治疗对脑重要功能区胶质瘤的疗效。方法：手术中尽可能多切除肿瘤,并在瘤床及残瘤腔内放置后装管,术后行间质内高剂量率放射治疗。结果：该项措施能明显延长患者的生存期及改善生存质量,全组42例患者1年生存有36例（86％）,2年生存有28例（67％）,3年生存有22例（52％）;1例治疗后死亡。结论：术中置管术后对瘤床及残瘤行间质内高剂量率放射治疗脑重要功能区胶质瘤,能延长生存期。改善生存质量,是一种可供选择的综合治疗脑重要功能区胶质瘤的有效方法。     

脑胶质瘤术后早期癫痫发生情况及相关影响因素研究

目的 探讨脑胶质瘤术后早期癫痫的发生情况及其相关的影响因素。方法 选取96例脑胶质瘤患者为研究对象，记录其术后早期癫痫的发生情况。分析其术后早期癫痫发生的相关影响因素。结果 96例脑胶质瘤患者术后早期发生癫痫的有37例，占比38.54%(37/96)。单因素分析显示：性别、年龄、循环系统疾病、代谢疾病、肿瘤形状与脑胶质瘤术后早期癫痫的发生无关(P>0.05),术前癫痫史、瘤周水肿、肿瘤大小、术前运动障碍、术后预防用药、术前预防用药与术后早期癫痫的发生有关(P<0.05);多因素分析显示：术前有癫痫史、瘤周水肿>2 cm、肿瘤直径>5 cm、术前有运动障碍、术后无预防用药、术前无预防用药是脑胶质瘤术后早期发生癫痫的独立危险因素(P<0.05)。结论 脑胶质瘤患者术后早期癫痫的发生率较高，而术前有癫痫史、瘤周水肿>2 cm、肿瘤直径>5 cm、术前有运动障碍、术后无预防用药、术前无预防用药是其主要影响因素，临床需加以重视。     

神经导航显微手术辅以光动力疗法治疗脑胶质瘤

背景与目的:神经导航引导下显微手术和光动力疗法均是治疗脑胶质瘤的新技术,本文探讨此二种方法有机结合治疗脑胶质瘤的效果。方法:在12例脑胶质瘤手术中,先应用GE350磁导航系统引导显微镜下切除肿瘤,再应用波长为630nm半导体激光器直接照射肿瘤残腔(200J/cm2),在照光前3小时静脉滴注血卟啉单甲醚5mg/kg。结果:术后近期效果满意,无严重神经功能障碍并发症。1例于术后2个月出现脑水肿,给予对症处理后恢复,无治疗相关死亡。结论:神经导航引导下显微手术和光动力疗法有机结合治疗脑胶质瘤是可行的。     

膀胱内灌注血卟啉衍生物加抗坏血酸全膀胱激光照射预防膀胱癌…

目的 探讨预防膀胱癌术后复发的新疗法,评价经膀胱内灌注血卟啉衍生物加抗坏血酸行激光全膀胱照射的光动力疗法预防复发的疗效。方法 采用经膀胱内灌注血卟啉衍生物癌光啉（ＰｓＤ－００７）加抗坏血酸行全膀胱激光照射方法,治疗３０例膀胱癌术后患者。结果 ３０例患者随诊３０个月,其肿瘤复发率为２３．３％（７／３０）。无一例发生膀胱挛缩以及皮肤光毒副反应。结论 用膀胱内灌注血卟啉衍生物加抗坏血酸全膀胱照射能有效地     

全脑照射对大鼠脑胶质瘤内顺铂浓度的影响

[目的]探讨大鼠脑胶质瘤受照射后瘤内顺铂(DDP)浓度的变化,为脑胶质瘤放疗提高依据。[方法]50只大鼠平均分为5组,采用立体定向方法在右侧尾状核接种C6细胞,肿瘤接种20d后MRI检查,确定肿瘤体积。60Coγ线行全脑单次外照射,剂量分别为0Gy、10Gy、15Gy、20Gy和30Gy。照射24h后经尾静脉注入DDP(8mg/kg),2h后取脑,分离肿瘤,以石墨炉原子吸收分光光度法测定DDP量浓度。[结果]0Gy、10Gy时,胶质瘤体较健侧半脑DDP质量浓度显著升高(P<0.05);胶质瘤体受照射10Gy后未见DDP质量浓度显著升高(P>0.05),受照射20Gy后出现DDP质量浓度显著升高(P<0.05),受照射30Gy后未见继续升高(P>0.05)。[结论]胶质瘤体内血脑屏障功能部分存在,受一定剂量照射后能够开放,超过一定剂量强度以后,胶质瘤血脑屏障通透性不再增加。照射剂量与DDP浓度的相关性有待进一步研究。     

显微手术切除后瘤腔植入缓释5-氟尿嘧啶化疗联合125I增敏放疗治疗恶性脑胶质瘤

 目的　探讨外科显微手术切除后瘤床内植入5-氟尿嘧啶（5-Fu）多聚缓释体局部化疗联合125I粒子局部增敏放疗治疗恶性脑胶质瘤的临床疗效。方法　对65例脑胶质瘤患者行开颅显微手术切除,术中于瘤床周围植入5-Fu多聚缓释体和125I粒子,术后（3个月～1年）立体定向引导下再次植入1～2次。随访6～36个月,观察疗效、瘤周水肿情况和患者不良反应。并与同时期经随访的40例接受显微镜下全切后常规放化疗的脑胶质瘤患者相比较。结果　术后1周内患者头痛明显,脑脊液WBC不同程度升高,瘤周水肿较单纯手术明显,经治疗所有患者都顺利出院。44例患者获完全随访,生存期明显延长,半年内复发4例（9.1 %）,无死亡;1年内复发14例（31.8 %）,无死亡;2年内复发20例（45.5 %）,死亡12例（27.6 %）;3年内复发29例（65.9 %）,死亡20例（45.5 %）。未发现明显的不良反应,患者生存质量得到明显改善。结论　显微镜下手术全切肿瘤是治疗的关键,术后于瘤床内植入5-Fu多聚缓释体局部化疗联合125I局部增敏放疗,是一种可供选择的治疗人类脑恶性胶质瘤的安全有效方法。     

显微手术在脑胶质瘤治疗中的应用

目的 探讨显微手术在脑胶质瘤治疗中的应用及疗效.方法 回顾性总结显微手术治疗69例脑胶质瘤患者,术后瘤体及创面周边送病理检查及头颅MRI复查,分析手术切除肿瘤的程度及疗效.结果 手术全切49例,次全切和大部分切除20例.无1例手术死亡及严重并发症发生.结论 显微手术可以在尽可能保护重要功能区、血管和脑神经的前提下最大程度地切除肿瘤,提高脑胶质瘤的全切率,不失为治疗脑胶质瘤较好的方法 .     

38例肺癌脑转移瘤放射治疗效果分析

目的：探讨立体定向放射治疗加全脑照射治疗肺癌脑转移瘤疗效，结合文献复习对其治疗原则做一探讨。方法：38例肺癌脑转移瘤患者均行立体定向放射治疗加全脑照射的放射治疗，24例先行立体定向放射治疗，14例先行全脑照射。立体定向放射治疗周边剂量10-28Gy，单次或分次完成；全脑照射DT30-40Gy/3-4周，均用瓦里安6MV的直线加速器实施治疗。结果：38例中位生存时间9.8个月，肿瘤控制率92.1%，1年生存率39.5%。治疗失败原因为肿瘤复发或全身多部位转移。结论：立体定向放射治疗加全脑照射在肺癌脑转移瘤的治疗效果明显低于常规的全脑照射加缩野推量技术。     

Early post-operative MRI: correlation with progression-free survival and overall survival time in malignant gliomas

Forty-seven patients with Glioblastoma (42) and Anaplastic Astrocytoma (5) were studied with MR 24 hrs after surgery. In order to evaluate the role of early MR in defining the extent of surgical resection and its relation with the prognosis of malignant glioma patients, three categories of surgical resection were considered: gross total, sub-total and partial resection. The results were correlated with progression-free survival (PFS) and overall survival (ST). As demonstrated by early-MR, gross total resection was performed in 17 patients, sub-total and partial resection in 19 and 11 patients, respectively. The PFS was 6 months in gross total resection, 6 and 3 months in sub-total and in partial resection, respectively. The median survival time was 16 months in total resection patients, 13 months and 7 months in sub-total resection and partial resection patients, respectively. The study confirms that early-MR has to be considered an accurate technique for monitoring the extension of malignant glioma surgical resection and shows a good correlation between early-MR findings, PFS and ST.     

Radiation Therapy for IDH-Mutant Grade 2 and Grade 3 Diffuse Glioma: An ASTRO Clinical Practice Guideline

PurposeThis guideline provides evidence-based recommendations for adults with isocitrate dehydrogenase (IDH)–mutant grade 2 and grade 3 diffuse glioma, as classified in the 2021 World Health Organization (WHO) Classification of Tumours. It includes indications for radiation therapy (RT), advanced RT techniques, and clinical management of adverse effects.MethodsThe American Society for Radiation Oncology convened a multidisciplinary task force to address 4 key questions focused on the RT management of patients with IDH-mutant grade 2 and grade 3 diffuse glioma. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength.ResultsA strong recommendation for close surveillance alone was made for patients with oligodendroglioma, IDH-mutant, 1p/19q codeleted, WHO grade 2 after gross total resection without high-risk features. For oligodendroglioma, WHO grade 2 with any high-risk features, adjuvant RT was conditionally recommended. However, adjuvant RT was strongly recommended for oligodendroglioma, WHO grade 3. A conditional recommendation for close surveillance alone was made for astrocytoma, IDH-mutant, WHO grade 2 after gross total resection without high-risk features. Adjuvant RT was conditionally recommended for astrocytoma, WHO grade 2, with any high-risk features and strongly recommended for astrocytoma, WHO grade 3. Dose recommendations varied based on histology and grade. Given known adverse long-term effects of RT, consideration for advanced techniques such as intensity modulated radiation therapy/volumetric modulated arc therapy or proton therapy were given as strong and conditional recommendations, respectively. Finally, based on expert opinion, the guideline recommends assessment, surveillance, and management for toxicity management.ConclusionsBased on published data, the American Society for Radiation Oncology task force has proposed recommendations to inform the management of adults with IDH-mutant grade 2 and grade 3 diffuse glioma as defined by WHO 2021 classification, based on the highest quality published data, and best translated by our task force of subject matter experts.     

Surgery and adjuvant dendritic cell-based tumour vaccination for patients with relapsed malignant glioma, a feasibility study

Patients with relapsed malignant glioma have a poor prognosis. We developed a strategy of vaccination using autologous mature dendritic cells loaded with autologous tumour homogenate. In total, 12 patients with a median age of 36 years (range: 11-78) were treated. All had relapsing malignant glioma. After surgery, vaccines were given at weeks 1 and 3, and later every 4 weeks. A median of 5 (range: 2-7) vaccines was given. There were no serious adverse events except in one patient with gross residual tumour prior to vaccination, who repetitively developed vaccine-related peritumoral oedema. Minor toxicities were recorded in four out of 12 patients. In six patients with postoperative residual tumour, vaccination induced one stable disease during 8 weeks, and one partial response. Two of six patients with complete resection are in CCR for 3 years. Tumour vaccination for patients with relapsed malignant glioma is feasible and likely beneficial for patients with minimal residual tumour burden.     

颈动脉灌注尼莫司汀化疗加立体定向适形放疗治疗脑胶质瘤的研究

背景与目的：脑胶质瘤很难经手术彻底切除，术后易复发。本研究探讨经颈动脉灌注尼莫司汀化疗加立体定向适形放疗针对术后脑胶质瘤的临床治疗效果。方法：对35例经手术切除脑胶质瘤的患者，于术后7-21天行颈动脉灌注尼莫司汀1次．每次2．5mg／kg，每个月1次，3次为1个疗程。同时术后第14-28天开始行立体定向适形放疗，约5～6周后结束。术后6个月再根据复查情况决定是否进行第2个疗程治疗。结果：随访6个月至4年，肿瘤消失12例（34．2％），肿瘤明显缩小10例（28．5％），复发经2次手术而且行本方案治疗后肿瘤消失4例（11．4％），病情恶化4例（11．4％），死亡5例（14．2％）。结论：经颈动脉灌注尼莫司汀化疗加立体定向适形放疗对术后脑胶质瘤具有明显的辅助治疗作用。     

光动力治疗中晚期中央型肺癌的临床初探

目的:初步探讨光动力疗法对中晚期中央型肺癌患者近期的疗效。方法:选择同意接受光动力治疗的有支气管阻塞症状,或上腔静脉综合征的中晚期中央型肺癌患者10例,在治疗前按2mg/kg体质量剂量静注光敏剂Photofrin或Photoson,36～48h后在纤支镜下用630nm波长的红光激光照射肿瘤500s。结果:10例患者SR7例,MR2例,NR1例。结论:光动力治疗能明显缓解中央型肺癌患者的梗阻症状,近期疗效明显,能改善其生活质量。     

A retrospective analysis of 52 cases of spinal cord glioma managed with radiation therapy

PURPOSE: To describe the outcome of primary spinal cord glioma treated with radiation therapy after surgery and to identify variables predictive of outcome. METHODS AND MATERIALS: A chart review of 52 patients with a diagnosis of spinal cord non-ependymoma glioma at the Princess Margaret Hospital was conducted. Thirty-two patients (62%) were male and 20 (38%) were female. Median age was 32 years (2-76 years). Median follow-up was 3.7 years (2 months to 27 years). Initial surgical management consisted of biopsy alone in 27 (52%) cases, subtotal resection in 20 (38%) cases, and gross total resection in 5 (10%) cases. All patients received postoperative radiation therapy; median total dose was 50 Gy, given in 25 daily fractions (20-60 Gy). Actuarial survival rates were calculated and the influence of patient-, tumor-, and treatment-related variables on outcome was determined. RESULTS: Five-year overall, cause-specific, and progression-free survivals were 54%, 62%, and 58%, respectively. Ten-year survivals were 45%, 50%, and 43%, respectively. A total of 29 (56%) patients died during the period of review. For 23 (79%) of these patients, death was cancer specific. Progression of tumor was documented in 28 of 52 (54%) patients. The following factors predicted for improved outcome on univariate analysis: age < 18 years, low-grade histology, and length of symptoms prior to diagnosis > 6 months. CONCLUSION: The outcome of patients in this series is consistent with that of other similar published reports. Specific recommendations are made for the management of this tumor.     

5-氨基乙酰丙酸介导鼠脑C6胶质瘤荧光特性的研究

背景与目的：5．氨基乙酰丙酸（5-ALA）荧光引导手术切除神经胶质瘤的基础研究一直较为薄弱，本文旨在探讨5-AM诱导C6胶质瘤内生性卟啉荧光随时间的动力学变化及卟啉在C6胶质瘤和正常鼠脑中的分布。方法：将C6细胞与5-ALA共培养后，使用流式细胞仪检测细胞内原卟啉Ⅸ（Protoporphyrin Ⅸ，PpⅨ）含量。经股静脉向C6／Wistar大鼠脑胶质瘤模型体内注入5-ALA后，使用荧光显微镜和激光扫描共聚焦显微镜观察C6胶质瘤和正常鼠脑组织中卟啉荧光的分布。用鼠的冻伤皮质切片分析血脑屏障的破坏在卟啉产生中的影响。结果：体外C6细胞在加入5-ALA后1h检测到卟啉生成，主要集中在5～15h，11h达到高峰。C6胶质瘤切片荧光主要集中在注入5-ALA后2～10h，6h表现出最强荧光。肿瘤整体荧光呈斑片状分布，边界欠清楚。给药后对侧脑组织未检测到低水平荧光。给药后5h在皮质冻伤切片中检测到微量荧光。无瘤鼠脑组织在注入5-ALA后没有检测到荧光。结论：5-AM能诱导卟啉在C6细胞中积聚，其荧光表现是一个动态过程。5-ALA介导胶质瘤内生性卟啉蓄积与血脑屏障具有密切关系。肿瘤与正常脑组织具有不同荧光表现强度。可以为临床选择性应用5-ALA荧光引导胶质瘤切除术提供有益的指导作用。     

A new limb salvage surgery in cases of high-grade soft tissue sarcoma using photodynamic surgery, followed by photo- and radiodynamic therapy with acridine orange

BACKGROUND: To maintain excellent limb function after tumor resection in patients with high-grade malignant sarcomas, we developed and established a new surgical adjuvant therapy using acridine orange (AO) after intra-lesional or marginal resection while sparing normal tissues of major nerves, vessels or bones adjacent to the tumor. METHOD: Our AO therapy procedure was combined with photodynamic surgery (PDS), photodynamic therapy (PDT) and radiodynamic therapy (RDT). In this study, 26 patients with primary high-grade soft tissue sarcomas were treated with AO therapy. RESULT: Results showed a low local recurrence rate (7.7%) and good local recurrence-free rate (88%) after AO therapy. Limb function of all patients was maintained at 100% of ISOLS criteria. CONCLUSION: Based on these results, we concluded that AO therapy is useful for local control after margin-positive tumor resection and for preserving excellent limb function in patients with high-grade soft tissue sarcomas.