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。     

巨大颅咽管瘤的立体定向内放射疗法

作者采用ＣＴ引导ＬＥＫＳＥＬＬ立体定向仪，通过注入放射性同位素Ｐ－３２和Ｙ－９０，治疗５０例直径＞５ｃｍ的颅咽管瘤，取得较为满意疗效。本组患者内放疗操作无致死及严重并发症发生。内放疗后１个月，有效率８２．０％。内放疗后随访２～７年（平均４．０年），内放疗有效率６２．０％。作者认为此方法治疗巨大颅咽管瘤较为理想，并就内放疗操作方法、如何减少并发症进行了讨论。     

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。     

颅咽管瘤放射治疗进展

颅咽管瘤是颅内最常见的先天性肿瘤,虽然在组织学上呈良性表现,但治疗的困难使之呈恶性结果。目前,大多数学者主张尽可能全切肿瘤,但高致残率、高死亡率以及术后激素水平低下,严重影响了患者的生存质量。术后放疗在一定程度能改善上述状况。放射治疗包括普通放疗、伽马刀与腔内近距离放疗,而后二者能够分别针对颅咽管瘤的实性和囊性部分进行治疗,可以取得较好效果。     

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。     

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。     

放射治疗颅咽管瘤22例

 本文报道我科1976～1989年间收治颅咽管瘤22例。均经病理证实。男性16例，女性6例。患者年龄4～45岁。术后放疗18例，术后复发单纯放疗2例，再切除后放疗2例。5、10年生存率分别为59.9％及28.6％。我区本病发生率及发病年龄较国内报道略低。年龄、病程及手术切除范围与预后有关。     

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。     

Therapeutic benefits of combination chemotherapy with vincristine,BCNU, and procarbazine on recurrent cystic craniopharyngioma

Summary The authors report a case of recurrent cystic craniopharyngioma managed with chemotherapy. The patient refused adamantly the alternative therapy methods, such as surgery and radiotherapy, initially offered. Eight courses of chemotherapy with vincristine (2 mg/M², i.v.) on day 1, 1,3-bis(2-chloroethyl)-1-nitrosourea (100 Mg/M², i.v.) on day 2, and procarbazine (50 mg, b.i.d., p.o.) on days 3 to 21 were administered at 6 week intervals. The effectiveness of this treatment modality has been evaluated by the unequivocal neurological improvement and by the decreases in size of the cyst using serial computerized tomography. Toxocities were mild and chiefly hematological.     

Long-term control of disseminated pleomorphic xanthoastrocytoma with anaplastic features by means of stereotactic irradiation

Pleomorphic xanthoastrocytoma (PXA) is a rare astrocytic neoplasm of the brain. Some PXAs are accompanied by anaplastic features and are difficult to manage because of frequent recurrences that lead to early death. No previous reports have demonstrated consistent efficacy of adjuvant radiotherapy or chemotherapy for this disease. We report a case of PXA with anaplastic features treated with stereotactic irradiation (STI) that resulted in long-term control of repeatedly recurring nodules throughout the neuraxis. A 47-year-old woman presented with an epileptic seizure due to a large tumor in the right frontal lobe. The tumor was resected and diagnosed as PXA with anaplastic features. Sixteen months later, a relapse at the primary site was noted and treated with stereotactic radiosurgery using Gamma Knife. Two years later, the patient developed a tumor nodule in the cervical spinal cord that histologically corresponded to a small-cell glioma with high cellularity and prominent MIB-1 (mindbomb homolog 1) labeling. In the following months, multiple nodular lesions appeared through-out the CNS, and STI was performed six times for eight intracranial lesions using Gamma Knife and twice using a linear accelerator, for three spinal cord lesions in total. All lesions treated with STI were well controlled, and the patient was free from symptomatic progression for 50 months. However, diffuse dissemination along the craniospinal axis eventually progressed, and she died 66 months after initial diagnosis. Autopsy showed that the nodules remained well demarcated from the surrounding nervous system tissue. STI may be an effective therapeutic tool for controlling nodular dissemination of PXA with anaplastic features.     

Intracystic bleomycin therapy for craniopharyngioma in children: the Canadian experience

BACKGROUND: Surgical removal and radiation therapy are associated with significant risk for morbidity in the pediatric population with craniopharyngioma. Intracystic therapies have been utilized in some centers to potentially decrease morbidity associated with cystic craniopharyngioma. The aim of the study was to review the Canadian experience with intracystic bleomycin therapy (ICB). METHODS: All centers in the Canadian Pediatric Brain Tumor Consortium (CPBTC) were invited to participate in a retrospective review of this treatment. A questionnaire was sent to each center. The data were analyzed at British Columbia's Children's Hospital. RESULTS: In all, 6 of 17 centers utilized ICB and submitted data. A total of 17 of 19 patients with the intention to treat received bleomycin. Twelve were treated at the time of diagnosis, and 5 at the time of recurrence. Five patients achieved a complete response, 6 achieved a partial response, and 5 achieved a minor response to bleomycin. One patient was stable for 2.8 years. At the time of last follow-up, 8 patients have not required further intervention. Complications included transient symptomatic peritumoral edema (2 patients), precocious puberty (1 patient) and panhypopituitarism (2 patients). The median follow-up was 4 years (range, 0.5-10.2 years). The median progression-free survival was 1.8 years (range, 0.3-6.1 years). One patient died of a massive infarct secondary to radiation-induced moyamoya syndrome. CONCLUSIONS: ICB was found to be well tolerated in this group of children. ICB may be a feasible and effective therapy for certain children with craniopharyngioma. Bleomycin may delay the need for aggressive surgery or radiation therapy for several years. Prospective multiinstitutional clinical trials are required to further evaluate the feasibility, effectiveness, and dose schedules of this treatment.     

局部进展期宫颈癌四野盒式照射联合ICBT融合剂量学研究

目的:分析局部进展期宫颈癌(locally advanced cervical cancer,LACC)四野盒式照射联合腔内近距离放疗(intracavitary brachytherapy,ICBT)靶区和危及器官(organs at risk,OARs)融合剂量学分布.方法:20例LACC患者,行MRI和模拟CT扫描,融合MRI/CT图像,勾画靶区和OARs.设置四野/ICBT计划,单独计算靶区和OARs剂量,相加为几何剂量;叠加四野与ICBT形成融合计划,计算靶区和OARs融合剂量.计算ICBT对靶区和OARs剂量贡献.结果:几何计算导致低估靶区剂量和高估OARs剂量.除GTV外,ICBT对CTV和PTV也有贡献.膀胱充盈及空虚比较,靶区几何剂量低于融合剂量(P<0.05),OARs几何剂量高于融合剂量(P<0.05).膀胱充盈有利于降低OARs剂量.结论:LACC四野联合ICBT放疗融合剂量学评估可能优于几何评估,但有待进一步临床观察.膀胱保持一定容量有利于降低OARs剂量.     

Cell kinetic investigations in brain tumors studied by serial stereotactic biopsy

Summary Between July 1983 and July 1986, 109 consecutive patients affected by brain tumors and selected for stereotactic biopsy underwentin vitro investigation of cell kinetics. The potential proliferative activity of these different neoplasms, evaluated asin vitro 3H-thymidine labeling index (LI), has been determined in 46 mature astrocytomas, 19 anaplasic astrocytomas, 25 glioblastomas, 5 cystic craniopharyngiomas, 6 metastatic tumors, 4 primary C.N.S. lymphomas, 3 pineal germinomas and one choroid plexus papilloma. The relevance of LI on prognosis has been evaluated in 35 patients affected by glial tumors with adequate follow-up longer than 2 years. This retrospective study allowed us to demonstrate the prognostic value of LI in mature astrocytoma and anaplasic, astrocytoma series. The feasibility of LI determination byin vitro procedure has been demonstrated also in non-neuroectodermal tumors. In craniopharyngioma the LI investigations allowed to demonstrate a peculiar topographic arrangement of cells in S phase.     

伽马刀FSRT颅内囊变型转移瘤的临床分析

目的 分析伽马刀FSRT在颅内囊变性转移瘤治疗中的作用。方法 对2013—2015年间治疗的 189例颅脑转移瘤373个病灶筛选出 40例伴有61个囊变性转移灶者。所有病灶均采用伽马刀FSRT,50%等剂量线定义为处方剂量线,处方剂量 40~48 Gy分 10~12次。Kaplan-Meier法计算生存率,Logrank法检验单因素分析。结果 中位随访21个月(6~39个月),中位生存期15.3个月,6个月、1、2年LC率分别为93%、82%,79%,1、2年生存率分别为63%、30%。单因素分析显示囊变体积、病灶体积与LC率均无关(P=0.17、0.48)。结论 采用伽玛刀治疗脑囊变性转移瘤具有与实体转移瘤相似的有效率,LC率与安全性值得临床借鉴与应用。     

高剂量率192铱后装机腔内加外照射治疗宫颈癌60例临床分析

目的:探讨高剂量率192铱后装腔内加体外照射治疗宫颈癌的疗效及副作用等。方法:2005年3月至2007年1月本院放疗中心共60例宫颈癌患者,采用8MV-X线直线加速器全盆照射,开始体外全盆腔照射,5次/周,2Gy/次,剂量25-40Gy;然后中间挡铅,4个野照射,5次/周,2Gy/次,宫旁剂量20-25Gy:同时腔内治疗,1次/周,6Gy/次,剂量为35-40Gy。腔内治疗采用ZL-HDR18铱高剂量率后装治疗机,全部病例均宫颈阴道同时进行。腔内治疗每周1次,A点剂量36-40GY/6-7F/6-7w,腔内治疗当日停体外照射,治疗时间56-77天。结果:CR+PR 100%,随访超过3年,随访率达95%,3年生存率Ⅱ期88.3%,Ⅲ期82.9%;早期放射性直肠反应发生率为12.4%,膀胱反应发生率5.2%;晚期放射性直肠炎发生率13.8%,膀胱炎3.8%。结论:高剂量率192铱后装机腔内加体外治疗宫颈癌的疗效满意,患者生存率较高,耐受好,并发症少。