中枢神经系统生殖细胞肿瘤11例临床分析

目的总结中枢神经系统生殖细胞肿瘤临床表现、检查和治疗特点。方法1997年至2007年共治疗11例，治疗方法有手术、放射治疗和化学治疗。结果术后单纯放疗7例有效率为71．43％。术后放疗结合化疗9例有效率为88．89％。结论手术联合化疗和放疗的综合性治疗可提高中枢神经系统生殖细胞肿瘤的疗效。     

经蝶窦显微外科手术治疗垂体腺瘤的长期疗效观察

目的：研究经蝶窦显微外科手术治疗垂体腺瘤的长期治疗效果。方法：对经蝶窦显微外科治疗的２４９例垂体腺瘤，从临床、血清激素水平测定及影像学检查进行３～１２年，平均４．６年的随访，以判断手术疗效。结果：随访期肿瘤控制率为７９％，复发率为３．６％。结论：经蝶窦手术能控制大多数垂体腺瘤。肿瘤大小、术前激素水平、以及术中肿瘤切除程度是影响远期疗效的重要因素。大型向鞍外生长的肿瘤，术前血清激素水平过高及术中肿瘤切除不完全者，肿瘤常不能控制，术后复发率可达５．９％～２０％，为防止肿瘤复发，这些病例应给予放射治疗。     

小儿胶质瘤术后残留灶立体定向适形放射治疗

目的 评价小儿脑胶质瘤术后残留灶的立体定向适形放射治疗的疗效。方法 对28例有残留灶患者采用6MVX线多角度适形放疗．总剂量45-55Gy。结果 6个月、1年、2年生存率分别为100％、92％、82％，未发现放射性脑损伤。结论 立体定向适形放疗小儿脑胶质瘤术后残留，是一种安全、有效的方法。     

立体定向后装高剂量率^192Ir间质内放射治疗脑胶…

本文报告应用ＣＴ引导下立体定向或术中插植施源管后，应用后装高剂量率＾１９２Ｉｒ间质内放射治疗２９例脑胶质瘤及２例转移瘤的初步随访结果。随访时间３￣２１个月，结果表明：有２４例（７７．４％）症状体征改善，肿瘤缩小及消失者２１例（６７．８％）。７例随访一年以上者中，一年生存率为７１．４％，到目前为止，平均生存期为１５个月，认为间质内放疗具有疗程短，疗效佳，并发症少等优点。     

立体定向后装高剂量率~（192）Ir间质内放射治疗脑胶质瘤及转移瘤

本文报告应用ＣＴ引导下立体定向或术中插植施源管后，应用后装高剂量率￣（１９２）Ｉｒ间质内放射治疗２９例脑胶质瘤及２例转移瘤的初步随访结果。随访时间３～２１个月，结果表明：有２４例（７７．４％）症状体征改善，肿瘤缩小及消失者２１例（６７．８％）．７例随访一年以上者中，一年生存率为７１．４％，到目前为止，平均生存期为１５个月，认为间质内放疗具有疗程短，疗效佳，并发症少等优点。     

微波加热加~（192）Ⅰr间质内放射治疗复发性脑胶质瘤（摘要）

微波加热加~（１９２）Ⅰｒ间质内放射治疗复发性脑胶质瘤（摘要）李振士，马世忠，于君，姚颖波，解连强，梁振文热疗加间质内放射治疗是近几年开展的治疗脑胶质瘤的方法。本组报告自１９９２年４月至１９９３年１１月采用术中瘤腔微波热疗加术后１９２Ⅰｒ间质内放射治?..     

鼻腔神经组织肿瘤临床病理与预后

３１例鼻腔神经组织肿瘤临床与病理分析表明：该类肿瘤是鼻腔内比较少见的肿瘤，可见于各年龄组。病理分类：嗅神经母细胞瘤１８例，黑色素瘤１例，脑膜瘤６例，胶质瘤４例，神经鞘瘤２例。良性肿瘤需手术切除，预后良好，恶性肿瘤不需要手术彻底且术后加用放射治疗。对１３例恶性肿瘤进行随访，其１年生存率（１２／１３）为９２．３％，３年生存率（７／１３）为３２．８％，５年生存率（３／１３）为２３．０８％。结合临床表现分     

第三脑室毛细胞型星形细胞瘤的治疗

目的总结第三脑室毛细胞型星形细胞瘤的临床特点和治疗经验。方法回顾分析过去9年间我们收治的8例第三脑室毛细胞型星形细胞瘤的临床资料。本组8例，占同期住院胶质瘤的0．6％，发病年龄平均为19岁，病变在第三脑室前部突向下丘脑／视路的2例，位于第三脑室中后部的6例。8例均行显微手术治疗，肿瘤位于第三脑室前部突向下丘脑／视路的采用经翼点入路；第三脑室中后部肿瘤选择经胼胝体-透明隔入路。结果肿瘤全切6例；2例部分切除，术后给予放射治疗。术后8例患者均治愈出院，7例患者出院随访1年无明显不适。结论毛细胞型星形细胞瘤为良性肿瘤，预后较好，显微手术切除和恰当的术后放射治疗效果较满意。     

20例原发脊髓内肿瘤术后放射治疗的分析（摘要）

２０例原发脊髓内肿瘤术后放射治疗的分析（摘要）肖泽芬，苗延浚，殷蔚伯，汪楣，张志贤，杨宗贻，谷铣之椎管内原发肿瘤的发病率约为０．９～２．５／１０万每年。而原发髓内肿瘤占椎管内肿瘤的２．５％。现将我科１９６１年１月～１９８９年１２月收治的２０例原发脊髓...     

影响脑肿瘤间质内放射治疗疗效问题的探讨

目的：为了提高深部脑肿瘤间质内放射治疗效果，寻找影响疗效的原因。方法：回顾性总结１３６例内放射治疗脑深部肿瘤的病例。结果：全部病人均得到随访，时间为１０～６９个月。全组１３６例中，其中１０９例为胶质细胞瘤，４８例死亡，死亡率为４４．０３％，死亡病例中胶质瘤Ⅰ级６例，Ⅱ级１８例，多形胶质母细胞瘤２４例。转移瘤１４例中，存活１年以内者２例，２年以内者９例，３年以内者３例，其余性质肿瘤患者均存活。结论：安放施源管的位置是否正确和内放射治疗的剂量设计和分布是否合理及肿瘤大小、恶性程度是影响治疗结果的关键     

伽玛刀治疗脑转移瘤的疗效观察

目的 观察伽玛刀治疗脑转移瘤的临床治疗效果.方法 采用国产OUR-XGD型头部伽玛刀,结合手术、放疗、化疗等综合治疗手段治疗112例脑转移瘤患者.结果 随访85例患者,随访期36-72个月,肿瘤控制率95%.生存期1-48个月,平均生存期14.3个月,中位生存期12个月,0.5年生存率86%,1年生存率59%,2年生存率21%.结论 伽玛刀治疗脑转移瘤是一种安全有效的治疗手段,配合科学合理的综合治疗措施可进一步提高疗效.

Abstract：

Objective To explore the efficacy of gamma knife radiosurgery for brain metastases.Method 112 cases with brain metastases were treated by gamma knife.Among them, most cases were combined surgery with whole brain radiation therapy and chemotherapy.Results 85 cases were followed up for 36-72 months,the total local control rate was 95%, the mean survival time of all patients was 12 months,0.5 year survival rate was 86%, 1 year survival rate was 59%, 2 year survival rate was 21%.Conclusions The treatment of gamma knife radiosurgery for brain metastases is an effective and safe method.     

复发性脑胶质瘤的手术治疗

目的探讨复发性脑胶质瘤的手术特点。方法回顾性分析86例复发性脑胶质瘤手术患者的临床资料,归纳其临床、影像学、病理学的特点、分析其手术治疗效果。结果复发性脑胶质瘤的诊断并不困难,再次手术全切除率较高,无死亡率。但是判断手术效果的关键是观察患者手术后是否会改善症状或者是延长生命。结论复发性脑胶质瘤的其生物学行为常常发生明显的变化,多呈浸润性生长,而且生长迅速。病人的生存时间与肿瘤复发后的分级,第一次手术到复发的时间,颅内的部位,肿瘤的形态学的特点和病人的年龄与全身情况有关。但目前对复发性脑胶质瘤通常采用的治疗方案仍以手术为主结合放疗和化疗的综合治疗。精确的手术治疗虽然不能显著提高生存时间,但是可有效地减少死亡率和致残率。     

伽玛刀治疗脑转移瘤的临床研究(附112例临床分析)

目的 探讨伽玛刀治疗脑转移瘤的临床疗效及相关因素.方法 采用伽玛刀治疗为主,结合手术、放疗、化疗等综合治疗手段治疗112例脑转移瘤患者.结果 随访83例患者,随访期6～32个月,肿瘤控制率94%,中位生存期10.8个月,1年生存率55.9%,2年生存率15.8%.结论 伽玛刀治疗脑转移瘤是一种安全有效的治疗手段,配合科学合理的综合治疗措施可进一步提高疗效.     

Medulloblastoma in childhood: comparative results of partial and total resection.

51 medulloblastomas under 12 years of age were treated from 1966 through 1977. 50 patients underwent craniotomy and 39 of them completed postoperative radiation therapy. Surgical mortality rate of primary posterior fossa craniotomy was 8%. One year survival rate was 71.4%, 3 years 45.6% and 5 years 34.5%. Extent of surgical resection was found to affect the survival, and a group of radical or visibly total resection showed higher postoperative survival. Female patients enjoyed longer survival. The patients under 12 months of age showed poor prognosis. Reexploration of the posterior fossa failed to prolong the survival by more than 3 months.     

Treatment failure in intracranial primary germinomas

Object A radiation dose of 40–50 Gy is able to produce a cure rate of more than 90% in intracranial pure germinoma. However, many attempts have been made to reduce the dose and volume of radiation without compromising the disease control rate because of the toxicity of irradiation. This retrospective study is intended to provide the physician with an appropriate therapeutic strategy. Materials and methods We reviewed a series of 10 recurrent germinomas among 117 germinomas diagnosed histologically or clinically between 1979 and 2002. These patients involved underwent three different treatment modalities; radiation alone (N = 71), chemotherapy alone (N = 9), and combined therapy (N = 37). The 10-year overall and relapse-free survival rates were 97 and 93% in the radiation alone group, 89 and 67% in the chemotherapy alone group, and 92 and 92% in the combined therapy group, respectively. As expected, both radiation therapy and combined therapy were effective in controlling the disease. Tumor recurrence was closely related to the volume of radiation but not to the dose of radiation. If the tumor bed and craniospinal axis were fully covered, the radiation dose might be reduced. Chemotherapy alone showed earlier recurrence and a higher tumor recurrence rate. In the case of combined therapy, chemotherapy was useful in reducing the radiation dose but revealed some toxicity (death of two patients). Conclusions The investigation of a possible further dose reduction seems worthwhile. Radiation therapy alone with a dose of less than 40 Gy should be compared with ongoing chemotherapeutic protocols combined with low-dose irradiation.     

Radiosurgery for Recurrent Brain Metastases after Whole-Brain Radiotherapy : Factors Affecting Radiation-Induced Neurological Dysfunction

Objective

We retrospectively analyzed survival, local control rate, and incidence of radiation toxicities after radiosurgery for recurrent metastatic brain lesions whose initial metastases were treated with whole-brain radiotherapy. Various radiotherapeutical indices were examined to suggest predictors of radiation-related neurological dysfunction.

Methods

In 46 patients, total 100 of recurrent metastases (mean 2.2, ranged 1-10) were treated by CyberKnife radiosurgery at average dose of 23.1 Gy in 1 to 3 fractions. The median prior radiation dose was 32.7 Gy, the median time since radiation was 5.0 months, and the mean tumor volume was 12.4 cm³. Side effects were expressed in terms of radiation therapy oncology group (RTOG) neurotoxicity criteria.

Results

Mass reduction was observed in 30 patients (65%) on MRI. After the salvage treatment, one-year progression-free survival rate was 57% and median survival was 10 months. Age (<60 years) and tumor volume affected survival rate (p=0.03, each). Acute (≤1 month) toxicity was observed in 22% of patients, subacute and chronic (>6 months) toxicity occurred in 21%, respectively. Less acute toxicity was observed with small tumors (<10 cm³, p=0.03), and less chronic toxicity occurred at lower cumulative doses (<100 Gy, p=0.004). "Radiation toxicity factor" (cumulative dose times tumor volume of <1,000 Gy×cm³) was a significant predictor of both acute and chronic CNS toxicities.

Conclusion

Salvage CyberKnife radiosurgery is effective for recurrent brain metastases in previously irradiated patients, but careful evaluation is advised in patients with large tumors and high cumulative radiation doses to avoid toxicity.     

Photodynamic therapy of malignant brain tumours

Fifty patients with malignant supratentorial tumours were treated with intra-operative photodynamic therapy (PDT); in 33 cases the tumour was recurrent. In 45 patients the tumour was a cerebral glioma and in 5 cases a solitary cerebral metastasis. All patients received a porphyrin photosensitizer 18-24 hours pre-operatively. Photoillumination was carried out at 630 nm to a tumour cavity created by radical tumour resection and/or tumour cyst drainage. The light energy density ranged from 8 to 175 J/cm2. In 8 patients additional interstitial light was administered. The operative mortality was 4%. Follow up has ranged from 1 to 30 months. The median survival for the 45 primary malignant tumours was 8.6 months with a 1 and 2 year actuarial survival rate of 32% and 18%, respectively. In 12 patients a complete or near complete CT scan response was identified post PDT. These patients tended to have a tumour geometry (eg. cystic) that allowed complete or near complete light distribution to the tumour. The median survival for this group was 17.1 months with a 1 and 2 year actuarial survival of 62% and 38%, respectively. In the 33 cases who did not have a complete response the median survival was 6.5 months with a 1 and 2 year actuarial survival of 22% and 11%, respectively. Photodynamic therapy of malignant brain tumours can be carried out with acceptable risk. Good responses appear to be related to adequate light delivery to the tumour.     

Reirradiation of recurrent meningioma

Management of meningioma includes observation, resection, and radiation therapy (RT). For patients with recurrent disease, similar options exist. However, the control rate following a second course of RT for recurrent disease is unknown. We reviewed an institutional database of patients with meningioma treated with stereotactic radiosurgery or fractionated stereotactic RT who underwent a second course for recurrent disease. Cox regression model was used for analysis. Variables tested included tumor volume, RT type, tumor grade, age at diagnosis, time to progression, and interval between RT. Eleven of 19 patients (58%) experienced disease progression. Median time to second progression was 10 months. Freedom from progression at one year was lower in patients with grade II or III tumors compared to those with grade 1 or unknown histology (17% compared to 92%, p = 0.0054). Cox regression showed that a grade II–III tumor affects progression-free survival (PFS), with a hazard ratio of 5.37 (p = 0.011). Median time to progression (MTP) for patients with grade II–III tumors was eight months. MTP was not reached for patients with grade 1/unknown tumors. Reirradiation for recurrent meningioma yields modest tumor control rates but for patients with grade II or III tumors, outcomes are poor.     

Temozolomide Salvage Chemotherapy for Recurrent Anaplastic Oligodendroglioma and Oligo-Astrocytoma

Objective

To evaluate the efficacy of temozolomide (TMZ) chemotherapy for recurrent anaplastic oligodendroglioma (AO) and anaplastic oligoastrocytoma (AOA).

Methods

A multi-center retrospective trial enrolled seventy-two patients with histologically proven AO/AOA who underwent TMZ chemotherapy for their recurrent tumors from 2006 to 2010. TMZ was administered orally (150 to 200 mg/m²/day) for 5 days per 28 days until unacceptable toxicity occurred or tumor progression was observed.

Results

TMZ chemotherapy cycles administered was median 5.3 (range, 1-41). The objective response rate was 24% including 8 cases (11%) of complete response and another 23 patients (32%) were remained as stable disease. Severe side effects (≥grade 3) occurred only in 9 patients (13%). Progression-free survival (PFS) of all patients was a median 8.0 months (95% confidence interval, 6.0-10.0). The time to recurrence of a year or after was a favorable prognostic factor for PFS (p<0.05). Overall survival (OS) was apparently differed by the patient''s histology, as AOA patients survived a median OS of 18.0 months while AO patients did not reach median OS at median follow-up of 11.5 months (range 2.7-65 months). Good performance status of Eastern Cooperative Oncology Group 0 and 1 showed prolonged OS (p<0.01).

Conclusion

For recurrent AO/AOA after surgery followed by radiation therapy, TMZ could be recommended as a salvage therapy at the estimated efficacy equal to procarbazine, lomustine, and vincristine (PCV) chemotherapy at first relapse. For patients previously treated with PCV, TMZ is a favorable therapeutic option as 2nd line salvage chemotherapy with an acceptable toxicity rate.     

BNCT for recurrent intracranial meningeal tumours - case reports

OBJECTIVES: The investigation was designed to explore the efficacy of boron neutron capture therapy (BNCT) as treatment for recurrent intracranial meningeal tumours. MATERIALS AND METHODS: Three patients with meningeal tumours, recurring after initial surgery, radiation therapy and several reoperations, were evaluated for treatment with BNCT by determination of the accumulation of boronophenylalanine fructose (BPA-F) in tumour and in surrounding tissue. Two of these patients were subsequently treated by BNCT. RESULTS: The present results indicate that BNCT could be effective in prolonging time to recurrence, and thus in extending survival time, for patients with recurrent intracranial meningeal tumours. CONCLUSIONS: BNCT is potentially an effective radiation treatment modality for malignant intracranial meningeal tumours, which could increase progression-free survival, thus reducing the need for additional surgical interventions. Indications for BNCT would be even larger if recurrent grade II meningiomas could be treated, as indicated by the results of the boron uptake study.