CT引导立体定向32P内放疗治疗囊性颅咽管瘤

目的探讨囊性颅咽管瘤的最佳治疗方法。方法对30例囊性颅咽管瘤患者行CT立体定向Ommaya管置入术结合^32P内放疗治疗。其中男性19例,女性11例,平均32岁。CT或MRI显示均为单个囊性病变。结果全部病例临床症状持续改善,无手术死亡及严重并发症。随访16～56个月,26例囊腔明显缩小,4例囊腔缩小。无手术死亡及严重并发症。结论Ommaya管置入结合^32P内放疗治疗颅咽管瘤安全有效,本方法应作为治疗囊性颅咽管瘤的首选方法。     

186Re内放射治疗颅咽管瘤的临床疗效

目的 评价应用立体定向肿瘤囊腔内注射186Re治疗颅咽管瘤的临床效果.方法 应用立体定向穿刺置管注射186Re方法治疗囊性或囊实性颅咽管瘤19例,其中男性12例,女性7例.年龄5～58岁,平均37.2岁.肿瘤呈囊性者12例,囊实性者7例.注射核素186Re前,颅咽管瘤囊性部分的平均体积为8390 mm3.结果 随访6个月至3年,有7例患者囊腔完全消失,囊腔体积缩小>50%以上者5例,囊腔体积缩小≤50%者7例.治疗前视力减退的8例患者中,5例患者治疗后视力显著改善.治疗前垂体功能正常者无一例出现垂体功能低下;而治疗前垂体功能低下的4例患者中,1例治疗后垂体功能改善.治疗前表现为尿崩症的5例患者中,3例治疗后尿崩症状改善.结论 立体定向肿瘤囊腔内注射186Re是治疗囊性或囊实性颅咽管瘤简单、安全、有效的方法.     

立体定向32P内照射治疗囊性颅咽管瘤

目的研究立体定向放射性核素内照射治疗囊性颅咽管瘤的方法、疗效、安全性及影响预后的因素。方法30例颅咽管瘤患者(囊腔大小平均为20．6cm^3)，均采用立体定向穿刺抽液后直接注入^32P胶体的方法进行治疗，给药量”P活度18．5～166．5MBq，平均88．8MBq。通过临床症状观察与复查CT，所有患者进行术后1～3个月及1～4年随访。结果所有患者无手术死亡及严重并发症，早期及1年以上有效率均≥90％，疗效与年龄、性别、初发或复发无明显相关性，而与病情轻重及肿瘤囊腔大小相关。结论立体定向^32P内照射治疗囊性颅咽管瘤方法简便、安全，疗效确切。早期治疗、精确操作、准确估算是治疗成功的关键。     

立体定向内放疗术治疗脑囊性肿瘤20例

目的 探讨放射性核素p32胶体立体定向囊腔内放疗治疗脑囊性肿瘤的疗效.方法 回顾性分析采用CT引导立体定向穿刺直接注入放射性核素p32胶体囊腔内放疗治疗脑囊性肿瘤20例.结果 20例患者颅内压迫症状均得到缓解,意识逐渐清醒,头痛、恶心、呕吐症状消失.随访1～6年(平均3年).20例患者术后临床症状均有改善,CT或MRI显示肿瘤缩小或消失者15例,占75%,无变化者3例,占15%,肿瘤增大者2例,占10%.结论 放射性核素p32是治疗脑囊性肿瘤安全有效的放疗方法.     

立体定向瘤腔介入32P微球内照射治疗颅咽管瘤二例

颅咽管瘤手术治疗安全性小，复发率高。外照射放疗会因肿瘤囊性部分急剧膨胀而出现脑受压等急性并发症。我们采用立体定向穿刺置留Ｏｍｍａｙａ囊，由囊管注入３２Ｐ玻璃微球至肿瘤囊腔，治疗２例颅咽管瘤，并进行随访。材料方法：Ｏｍｍａｙａ囊为美国ＰＳ医疗公司生产的...     

颅咽管瘤的预后分析

198 2年 1月至 1 993年 2月术后放疗颅咽管瘤 4 4例。 5年生存率为 78 9%。其中 ,成人 1 5例 ,儿童 2 9例。儿童颅咽管瘤与成人的比较 :5年生存率高 ,疗后生存质量差 ,但无统计学差异。儿童颅咽管瘤术后放疗剂量 5 6 1～ 6 0Gy组与 4 5～ 5 6Gy组比较 :5年生存率无差别 ,但疗后闭经 -性功能障碍发生率增加 (P <0 0 5 ) ;疗后生存质量Ⅱ～Ⅲ级的比例明显增加 (P <0 0 1 )。我们建议对儿童颅咽管瘤部分切除术后应给予放疗 ,术后放疗剂量以 4 5～ 5 6Gy/ 5～ 6周为宜。     

伽玛刀治疗儿童颅咽管瘤临床研究

背景与目的:颅咽管瘤是先天性良性肿瘤,多发于儿童。由于肿瘤位于脑深部、与重要神经结构毗邻,手术切除并发症严重,死亡率高。手术残余肿瘤,术后易于复发,最终导致不良后果。Mckissock(1960)、Kramer(1961)等报告,次全切除手术加放射治疗可延缓肿瘤复发,有利于提高生存率。但放疗缺乏精确定位,儿童对射线耐受性差,更易发生视通路,下丘脑等放射性损伤并发症。伽玛刀这项立体定向放射技术,具有定位精确,创伤小,并发症少的优点。方法:1997年1月至2007年1月,成都空军医院应用伽玛刀治疗15岁以下的颅咽管瘤患者55例。立体定向术、开颅手术 伽玛刀40例;单纯伽玛刀治疗15例。37例行分次(2次)伽玛刀治疗,分次治疗边缘剂量8～10Gy,中心剂量16～22.2Gy,两次治疗间隔时间6～8个月。18例行单次伽玛刀治疗,边缘剂量12～16Gy,中心剂量26～32Gy。结果:55例中,40例获得1～10年随访,平均随访期5.7年。肿瘤消失、缩小33例(82.5%)、无变化4例、增大3例。8例(20.0%)治疗后1.5～8年(平均4.6年)肿瘤复发,接受手术治疗或再次伽玛刀治疗。40例中,生存5年及5年以上的共27例(67.5%)。全组无治疗并发症、无死亡。结论:对于儿童颅咽管瘤患者,无论手术肿瘤全切,或放疗,均具有高并发症,高死亡率的风险。本组结果提示,伽玛刀治疗儿童颅咽管瘤,具有确切的疗效。且创伤小,安全、并发症少。应选择手术残留肿瘤;向鞍上发展的无视力视野障碍者;肿瘤突入三脑室、中脑脚间池的实性肿瘤,梗阻性脑积水已作处理,或囊性肿瘤囊液已抽吸分流者。     

颅咽管瘤的MRI诊断及鉴别诊断颅咽管瘤的MRI诊断及鉴别诊断

目的:研究颅咽管瘤的MRI诊断及鉴别诊断。方法:回顾性分析经病理证实的13例颅咽管瘤的MRI表现。结果:9例呈圆形或类圆形,4例呈不规则形。平扫6例表现为长T1长T2信号,3例表现为等T1长T2信号,2例短T1长T2信号,1例等T1短T2信号,1例混杂T1混杂T2信号。其中囊内见出血1例,分层征象2例,钙化3例,壁结节4例,3例DWI弥散不受限呈低信号。增强后3例实性颅咽管瘤和5例囊实性颅咽管瘤实性部分明显均匀或不均匀强化,5例囊实性和4例囊性颅咽管瘤囊壁呈弧形或环形强化,4例囊性颅咽管瘤壁结节明显强化,1例囊性颅咽管瘤未见明显强化。结论:颅咽管瘤的MRI影像表现具有一定特征,但需注意与垂体腺瘤、Rathke囊肿、生殖细胞瘤等鉴别。     

儿童颅咽管瘤术后放射治疗临床分析

为探讨儿童颅咽管瘤术后放疗的疗效 ,回顾性分析 1976年 1月至 1992年 8月间收治的儿童颅咽管瘤 48例。 5、10年生存率分别为 89.6 %、5 1.7%。术后放疗剂量 45～ 5 5 Gy组与 5 6～ 6 3Gy组比较 5、10年生存率无差别 ,但疗后生存质量 - 级的比例及并发症方面后者明显增加。 Karnofsky≥ 80者疗效优于≤ 70者 (P<0 .0 1) ,肉眼全切及部分切除加放疗的疗效较分流术加放疗为好。我们建议对儿童颅咽管瘤行术后补充放疗剂量以 45～ 5 5 Gy/ 5～ 6周为宜     

颅咽管瘤24例临床分析

目的：研究颅咽管瘤常见症状及不同的治疗方法与预后的关系。方法：回顾性分析24例颅咽管瘤患者手术切除后放射治疗的结果。结果：24例颅咽管瘤患者全切术后放疗6例，复发1例，5a生存率100％。次全切除术后放疗10例，复发2例，5a生存率90％。部分切除加放疗8例，复发4例，5a生存率62．5％。结论：颅咽管瘤手术加放疗是综合治疗的主要手段，患者的预后与手术切除的程度及放疗剂量有关。     

Radioisotope therapy of cystic craniopharyngeomas

Eighteen patients suffering from cystic craniopharyngeoma were treated with intracavitary irradiation. The beta-emitting radioisotope ⁹⁰y (2.25 MeV) was instilled into the cyst following stereotactic puncture of the space-occupying lesion. The surgical approach was planned using angiograms and reconstructed transmission computer tomography (TCT) coronal and saggital sections. Therapy was devised to deliver 20,000 rad to the cyst's wall. Eleven patients received follow-up TCT examinations after four months. Eight of 11 patients had a significant volume decrease in the craniopharyngeoma cyst. In two patients, the cystic volume remained unchanged; one had progression of disease. It is concluded that the intracavitary treatment of cystic craniopharyngeoma will result in a reduction of the size of the space-occupying lesion.     

Initial clinical results of stereotactic radiotherapy for the treatment of craniopharyngiomas

The efficacy and toxicity of stereotactic radiotherapy (SRT) for the treatment of craniopharyngioma has been retrospectively evaluated in 16 patients. The median tumor diameter was 2.8 cm (range 1.5-6.1) and the median tumor volume was 7.7 cc (range 0.7-62.8). SRT was delivered to a single isocenter using a dedicated 6 MV linear accelerator to patients immobilized with a relocatable stereotactic head frame. The three-year actuarial overall survival was 93% and the rate of survival free of any imaging evidence of progressive disease was 75%. The three-year actuarial survival rates free of solid tumor growth or cyst enlargement were 94% and 81% respectively. Our results suggest that SRT is a safe and effective treatment approach for patients with craniopharyngioma. Long-term follow-up is required to determine whether the normal tissue-sparing inherent with SRT results in reduction of the neurocognitive effects of conventional radiotherapy for craniopharyngioma. SRT can be delivered to craniopharyngioma that may be difficult to treat with stereotactic radiosurgery due to proximity of the optic chiasm. Further clinical experience is necessary to determine the clinical utility of beam shaping in the setting of SRT.     

Dose distribution outside of a sphere of P-32 chromic phosphorous colloid

PURPOSE: To evaluate the dose distribution outside of a cyst instilled with phosphorous-32 (P-32, an electron emitter with a short effective range of 2-8 mm and average energy of 0.69 MeV, used to treat cystic craniopharyngioma) as a function of cyst size with and without plating (migration and adhesion of P-32 to the cyst surface). METHODS AND MATERIALS: A cystic craniopharyngioma treated with instillation of P-32 was approximated by a sphere of uniformly distributed and plated chromic P-32 colloid. The percent depth dose was calculated along a radial position vector exterior to the sphere with a three-dimensional convolution integral and a dose point kernel. RESULTS: The percent depth dose variation of surface or volume source external to a family of spheres was plotted. Complex cyst geometry is amenable to evaluation by approximation with simple spheres. Error estimates are calculated for the dose outside of truncated sphere segments. Plating might occur and raise the dose outside the cyst by more than a factor of 5.0. This has the potential to cause damage to adjacent tissues, including the optic chiasm. CONCLUSION: Clinicians are faced with a number of treatment options for cystic craniopharyngioma, including intracystic instillation of colloid P-32. Unfortunately, plating might occur and potentially damage adjacent normal tissues. It is recommended that the propensity for a craniopharyngioma to plate be evaluated before full treatment, especially after previous treatment.     

High precision conformal radiotherapy employing conservative margins in childhood benign and low-grade brain tumours.

BACKGROUND AND PURPOSE: To report local control and follow up outcome data of high precision conformal radiotherapy in childhood brain tumours. MATERIALS AND METHODS: Between December 1999 and December 2002, 26 children (17 boys and 9 girls, median age 11.5 years) with incompletely excised or recurrent benign and low-grade brain tumours [13 craniopharyngiomas, 11 low-grade gliomas (LGG) and 2 others] were treated with three-dimensional (3D) conformal radiotherapy (CRT) (12 patients) and stereotactic conformal radiotherapy (SCRT) (14 patients). Gross tumour volume (GTV) included neuro-imaging based visible tumour and/or resected tumour bed. Clinical target volume (CTV) consisted of GTV+ 5 mm margin and planning target volume (PTV) consisted of additional 5 mm margin for CRT and 2 mm for SCRT. Treatment was delivered with 3-9 conformal fixed fields to a median dose of 54 Gy/30 fractions. RESULTS: The actuarial 2 and 3 year disease free and overall survival was 96 and 100%, respectively (median follow up: 25 months, range 12-47 months). Radiological follow up available in 25 patients revealed complete response in 1, partial regression in 10, stable disease in 13 and progression in 1 patient (within the CTV). One patient with craniopharyngioma on a routine imaging revealed a mild asymptomatic cyst enlargement, which resolved with conservative management. A patient with chiasmatic glioma developed cystic degeneration and hydrocephalus 9 months after SCRT requiring cyst drainage and placement of a ventriculoperitoneal shunt. CONCLUSION: High-precision conformal techniques delivering irradiation to a computer generated target volume employing 7-10 mm 3D margins beyond the visible tumour and/or resected tumour bed appear to be safe in children with incompletely resected or recurrent benign and low-grade brain tumours, based on these data.     

卵巢囊性病变蒂扭转的MSCT表现与诊断价值

目的:探讨卵巢囊性病变蒂扭转的MSCT表现与诊断价值。方法:回顾分析10例经手术病理证实的卵巢囊性病变蒂扭转的CT资料。结果:10例CT平扫均出现盆腔内囊实性双肿块,实性肿块与一侧子宫角或输卵管相连;囊壁均匀或不均匀增厚,合并囊内出血2例;卵巢明显肿大2例;6例子宫偏向扭转侧;2例合并腹盆腔积液,其中1例为血性渗液。结论:卵巢囊性病变蒂扭转的CT表现具有一定特征性,MSCT扫描作为超声检查的一种补充检查方法,对卵巢囊性病变蒂扭转的诊断及鉴别诊断具有重要的临床价值。     

Fractionated stereotactic conformal radiotherapy following conservative surgery in the control of craniopharyngiomas.

PURPOSE: To describe the technique and results of stereotactically guided conformal radiotherapy (SCRT) in patients with craniopharyngioma after conservative surgery. METHODS AND MATERIALS: Thirty-nine patients with craniopharyngioma aged 3-68 years (median age 18 years) were treated with SCRT between June 1994 and January 2003. All patients were referred for radiotherapy after undergoing one or more surgical procedures. Treatment was delivered in 30-33 daily fractions over 6-6.5 weeks to a total dose of 50 Gy using 6 MV photons. Outcome was assessed prospectively. RESULTS: At a median follow-up of 40 months (range 3-88 months) the 3- and 5-year progression-free survival (PFS) was 97% and 92%, and 3- and 5-year survival 100%. Two patients required further debulking surgery for progressive disease 8 and 41 months after radiotherapy. Twelve patients (30%) had acute clinical deterioration due to cystic enlargement of craniopharyngioma following SCRT and required cyst aspiration. One patient with severe visual impairment prior to radiotherapy had visual deterioration following SCRT. Seven out of 10 patients with a normal pituitary function before SCRT had no endocrine deficits following treatment. CONCLUSION: SCRT as a high-precision technique of localized RT is suitable for the treatment of incompletely excised craniopharyngioma. The local control, toxicity and survival outcomes are comparable to results reported following conventional external beam RT. Longer follow-up is required to assess long-term efficacy and toxicity, particularly in terms of potential reduction in treatment related late toxicity.     

Radiation therapy of esophageal cancer: role of high dose rate brachytherapy.

Fifty untreated cases of squamous cell carcinoma arising from the middle one-third of the esophagus, with no apparent extraesophageal spread on a computed tomography (CT) scan and with a Karnofsky performance status of over 70, were treated by external beam irradiation to a dose of 3500 cGy/15 fractions/3 weeks. Twenty-five patients (Group A) received treatment with further external beam irradiation to a dose of 2000 cGy/10 fractions/2 weeks. Another group of 25 patients (Group B) received treatment with high dose rate intracavitary irradiation to a dose of 1200 cGy delivered in two sessions of 600 cGy each a week apart. All patients were assessed symptomatically, endoscopically, and radiologically every 3 months. There was marked difference at the end of 1 year in relief of dysphagia (37.5% in Group A vs. 70.6% in Group B), local control (25% in group A vs. 70.6% in group B) although the results were statistically insignificant (p greater than 0.05) and actuarial survival (44% in group A vs. 78% in group B) which was, however, significant statistically (z = 2.83). The cumulative radiation effect (CRE) by external beam irradiation was 1729 reu and by external beam and intracavitary irradiation 1741 reu, but the biological dose effect was better with external beam and intracavitary irradiation. Eight percent of patients treated by external beam and intracavitary irradiation had strictures in contrast to 4% treated by external beam irradiation alone. Moderate doses of external beam and intracavitary irradiation can give a better local response than external beam irradiation alone for the same biological dose in the treatment of esophageal carcinoma.     

Phosphorus-32 therapy for cystic craniopharyngiomas

Background and purpose

To examine control rates for predominantly cystic craniopharyngiomas treated with intracavitary phosphorus-32 (P-32).

Material and methods

22 patients with predominantly cystic craniopharyngiomas were treated at Indiana University between October 1997 and December 2006. Nineteen patients with follow-up of at least 6 months were evaluated. The median patient age was 11 years, median cyst volume was 9 ml, a median dose of 300 Gy was prescribed to the cyst wall, and median follow-up was 62 months.

Results

Overall cyst control rate after the initial P-32 treatment was 67%. Complete tumor control after P-32 was 42%. Kaplan-Meier 1-, 3-, and 5-year initial freedom-from-progression rates were 68%, 49%, and 31%, respectively. Following salvage therapy, the Kaplan-Meier 1-, 3-, and 5-year ultimate freedom-from-progression rates were 95%, 95%, and 86%, respectively. All patients were alive at the last follow-up. Visual function was stable or improved in 81% when compared prior to P-32 therapy. Pituitary function remained stable in 74% of patients following P-32 therapy.

Conclusions

Intracystic P-32 can be an effective and tolerable treatment for controlling cystic components of craniopharyngiomas as a primary treatment or after prior therapies, but frequently allows for progression of solid tumor components. Disease progression in the form of solid tumor progression, re-accumulation of cystic fluid, or development of new cysts may require further radiotherapy or surgical intervention for optimal long-term disease control.