伽玛刀治疗视网膜母细胞瘤的疗效观察

为观察伽玛刀治疗视网膜母细胞瘤的临床效果 ,我院自1993年从确诊为视网膜母细胞瘤的患儿中选择两组年龄相近、瘤体大小相似 ,都处于眼内期且已丧失视力的患儿分别进行伽玛刀治疗及眼球摘除术 ,结果表明 ,用伽玛刀治疗能延缓肿瘤的复发时间 ,从而延长患儿的生命 ,Ｐ <0 .0 5 ,可在临床上应用。临床资料 :伽玛刀治疗组 :16例 ( 18只眼 ) ,单右眼 9例 ,单左眼 5例 ,双眼 2例。年龄 8个月～ 2岁 10个月 ,平均 1.5岁 ,瘤体 0 .3× 0 .2 5ｃｍ～ 1.1× 0 .9ｃｍ。眼球摘除术组 :16例 ( 18只眼 ) ,单右眼 8例 ,单左眼 6例 ,双眼 2例。年龄 7个月～…     

脑胶质母细胞瘤放化疗疗效观察

目的观察并比较脑胶质母细胞瘤放疗加化疗与不加化疗的疗效。方法试验组28例患者放射治疗20～40Gy后,加用化疗药洛莫司汀(CCNU)或卡莫司汀(BCNU);对照组28例单纯放射治疗20～40Gy,不加化疗药。结果经随访,试验组和对照组1,3,5年生存率分别为57.1%,22.5%,15.0%和17.9%,7.1%,3.6%,中位生存期分别为29.7±7.0个月和9.7±3.5个月,P＜0.001,差异有极显著性。显示试验组疗效优于对照组。结论脑瘤放疗20～40Gy后,血脑屏障开放,是化疗最佳时机,这期间加化疗,可显著提高生存率。     

全身伽玛刀治疗纵隔转移瘤65例近期疗效观察

目的观察全身伽玛刀治疗纵隔转移瘤的近期疗效与放射反应。方法应用全身伽玛刀治疗纵隔转移瘤65例,肿瘤组织照射剂量单次3-4Gy,总量60—65Gy,13—16次完成。治疗结束后2个月采用CT复查纵隔转移瘤情况。结果病灶完全缓解（CR）51例,部分缓解（PR）10例,无变化（NC）4例,无进展病例。急性放射性气管炎发生率Ⅰ级24．6％（16／65）,无Ⅱ-Ⅳ级发生;急性放射性食管炎发生率Ⅰ级13．8％（9／65）,无Ⅱ-Ⅳ级发生。结论全身伽玛刀治疗纵隔转移瘤近期疗效显著,是一种安全、可靠的治疗方法,远期反应有待随访观查。     

原发性肺癌全身伽玛刀治疗后近期疗效观察(附78例报告)

目的 :观察全身伽玛刀治疗原发性肺癌的近期疗效。方法 :78例原发性肺癌接受伽玛刀治疗 ,用 5 0 %～ 70 %的等剂量曲线包绕肿瘤边缘 ,并外扩 10～ 15mm ,周边剂量 5 0 0～ 10 0 0cGy ,总剂量 36 0 0～ 4 2 0 0cGy,分 8～ 4次 ,隔日治疗。结果 :1～ 3个月后复查 ,最长达 6个月 ,78例获得随访 ,其中 6 2例获得影像学复查。肿块消失率 2 3 3% ,局部控制率 95 1% ,症状缓解率 90 9%。结论 :全身伽玛刀为原发性肺癌患者提供一种安全、有效的治疗方法     

体部伽玛刀联合GP方案治疗中晚期胰腺癌33例近期疗效观察

目的:探讨体部伽玛刀联合GP方案化疗治疗中晚期胰腺癌的近期疗效.方法:对33例中晚期胰腺癌患者采用伽玛刀联合GP方案化疗.根据病灶的三维形状、大小及患者身体状况,确定靶点数目、治疗次数及分次剂量,取55%-65%的等剂量曲线覆盖95%的靶体积,单次剂量260-400cGy,每日治疗1次,每周5次,治疗10-16次.化疗:泽菲1000mg/m2,第1、8天静脉滴注;顺铂40mg,第1-3天,静脉滴注.间隔4周重复.以2005年6月至2006年5月单纯伽玛刀治疗的胰腺癌19例作为对照组,进行比较.结果:治疗结束后止痛有效率90.9%,黄疸消退10例 (71.43%),3月复查CT或MR, 肿瘤消失5例(18.18%),缩小19例(57.25%),无变化8例(24.24%),增大1例(3.03%),治疗3个月后在治疗部位复发者1例,腹腔淋巴结、肝脏、肺、多发性骨转移各1例.对照组19例患者治疗后3月复查CT或MRI,肿瘤消失2例(10.53%),缩小10例(52.63%),无变化5例(26.32%),增大2例(10.53%),治疗3个月后在治疗部位复发者1例,腹腔淋巴结转移2例、肝脏转移1例.治疗组不良反应较对照组明显增加,但均不太严重,经对症治疗后不影响治疗.结论:体部伽玛刀联合GP方案化疗治疗中晚期胰腺癌近期疗效显著,值得进一步观察.     

甘氨双唑钠辅助伽玛刀治疗颅内转移瘤的近期疗效及安全性

目的探讨甘氨双唑钠辅助伽玛刀治疗颅内转移瘤的近期疗效及安全性。方法依据随机数字表法将116例颅内转移瘤患者分为观察组和对照组,每组58例。观察组患者采取甘氨双唑钠辅助伽玛刀治疗,对照组患者仅采取伽玛刀治疗。比较两组患者的近期疗效及不良反应发生情况。结果观察组患者的总有效率为86.21%,高于对照组的70.69%,差异有统计学意义(P﹤0.05)。治疗期间,两组患者皮肤反应、消化道反应、神经系统反应、血液系统反应、肝功能不全、肾功能不全的发生率比较,差异均无统计学意义(P﹥0.05)。结论甘氨双唑钠辅助伽玛刀治疗颅内转移瘤的近期疗效较好,安全性较高,建议在临床中推广。     

体部伽玛刀治疗202例肺癌临床疗效观察

目的：探讨体部伽玛刀治疗肺癌的近期疗效。方法：采用OUR—QGD型体部伽玛刀治疗肺部肿瘤202例，根据病灶的三维形状及病人的身体状况确定靶点数目、治疗次数及分次剂量。P1v覆盖95％以上CTV，等剂量曲线50％-85％，中位值61．81％，Ⅲ周边照射总剂量2800eGy-5500eGy，分割处方剂量350eGy-800eGy，重复治疗4—12次。结果：治疗后随诊3至15个月，胸痛症状止痛有效率为94．93％。189例病人进行疗效评价，CR29例（15．34％），PR113例（59．79％），NC36例（19．05％），PD11例（5．82％），稳定率为94．18％。病理类型以小细胞未分化癌疗效最佳。肿瘤体积≤30cm^3者较肿瘤体积〉30cm^3者治疗效果明显为好。肿瘤分期早期病人治疗效果较好，中晚期病人经过放射治疗可以减轻临床症状。治疗中与治疗后发生的副反应及放射性损伤均较小。结论：体部伽玛刀治疗肺癌可以使肿瘤局部得到准确的高剂量照射，近期疗效显著，安全可行。     

肿瘤电场治疗胶质母细胞瘤1例

患者女性,31岁.因"间歇性头痛头晕伴呕吐1个月余"2018年3月于中南大学湘雅二医院就诊.术前MRI示:左侧顶叶及侧脑室巨大占位性病变,考虑脑胶质瘤可能(图1A).于2018年4月行肿瘤部分切除术,术后病理示:(左顶枕叶占位)组织多块,共7 cm×7 cm×3 cm.镜下见:肿瘤细胞密度高,核异型有多形性.微血管增生...     

贝伐珠单抗治疗复发胶质母细胞瘤疗效和预后分析

  目的   探讨贝伐珠单抗治疗复发胶质母细胞瘤的疗效及预后因素。  方法  回顾性分析2011年12月至2020年7月中山大学肿瘤防治中心接受贝伐珠单抗治疗的81例成人复发胶质母细胞瘤患者的临床资料,评价其疗效和不良反应,以总生存期为预后指标进行单因素和Cox比例风险模型多因素分析。  结果  81例患者的客观有效率为62.9%,疾病控制率为80.2%,90.1%的患者生存质量状况（KPS）评分和神经症状有改善。中位无进展生存期（median progression-free survival,mPFS）和中位总生存期（median overall survival,mOS）分别为4.4个月（95%CI:4.0～4.8）和7.8个月（95%CI:6.8～8.8）。单因素分析显示用药时机（首次或≥2次复发时用药）、剂量（5 mg/kg,6～9 mg/kg,10 mg/kg）和是否联合化疗对mOS无影响,多因素分析显示KPS评分和MGMT启动子甲基化状态是影响mOS的独立预后因素。不良事件主要为1～2级。  结论  贝伐珠单抗可以改善成人复发胶质母细胞瘤患者的生存质量,治疗耐受性好。KPS评分和MGMT启动子甲基化状态是影响mOS的独立预后因素,贝伐珠单抗在复发后的用药时机、剂量、是否联合化疗对mOS无影响。      

伽玛刀治疗大肠癌肝转移近期疗效观察

目的:评价伽玛刀治疗大肠癌肝转移的近期疗效。方法:采用伽玛刀治疗大肠癌肝转移患者30例,根据病变大小和部位选用不同大小的准直器,50%-70%等剂量曲线覆盖整个靶区,单次周边剂量给予3-6Gy,周边总剂量35-50Gy,分割6-12次,每周3-5次。结果:血清CEA由治疗前80.4±10.3ng/L至治疗结束后四周下降为38.4±11.5ng/L(P<0.05),CR 8例,PR 14例,总有效率(CR+PR)为73.3%,肿瘤病灶小于3cm的患者局部控制率较好。随访3个月、6个月、12个月、18个月,生存率分别为96.7%、83.3%、66.7%、43.3%。结论:伽玛刀治疗大肠癌肝转移安全有效,可作为大肠癌肝转移新的治疗手段。     

Prognostic Factor Analysis for Multiple Brain Metastases After Gamma Knife Radiosurgery: Results in 97 Patients

Stereotactic radiosurgery (SR) is being used with increasing frequency in the treatment of brain metastases. This study provides data from a clinical experience with radiosurgery in the treatment of cases with multiple metastases and identifies parameters that may be useful in the proper selection and therapy of these patients. From January 1993 to April 1997, 97 patients (43 women and 54 men; median age 58 years) suffering from multiple brain metastases (median 3; range 2–4) in MRI scans, received SR with the Gamma Knife. The median dose at the tumor margin was 20Gy (range 17–30Gy). Median tumor volume was 3900cmm (range 100–10000). Different forms of hemiparesis, focal and generalized seizures, cognitive deficit, headache, dizziness and ataxia had been the predominant neurological symptoms. Major histologies included lung carcinoma (44%), breast cancer (21%), renal cell carcinoma (10%), colorectal cancer (8%), and melanoma (7%).The median survival time was 6 months after SR. The actual one-year survival rate was 26%. In univariate and multivariate analysis, a higher Karnofsky performance rating and absence of extracranial metastases had a significantly positive effect on survival. Local tumor control was achieved in 94% of the patients. Complications included the onset of peritumoral edema (n=5) and necrosis (n=1).SR induces a significant tumor remission accompanied by neurological improvement and, therefore, provides the opportunity for prolonged high quality survival. We conclude that radiosurgical treatment of multiple brain metastases leads to an equivalent rate of survival when compared to the historic experience of patients treated with whole brain radiotherapy. Patients presenting initially with a higher Karnofsky performance rating and without extracranial metastases had a median survival time of nine months. Each such case should therefore be evaluated based on these factors to determine an optimal treatment regimen.     

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。     

Outcomes of Gamma Knife surgery for craniopharyngiomas

Gamma Knife surgery (GKS) has emerged as a valuable adjuvant treatment modality for recurrent or residual craniopharyngioma. However, prognostic factors pertaining to progression-free survival (PFS) remain poorly understood. A study was conducted to address this issue. A total of 37 consecutive patients undergoing 39 sessions of GKS procedures targeting the solid portions of the tumors at our institution between 1989 and 2005 were analyzed. Twenty-one male and 16 female patients comprised this study. Median age at GKS was 36 years (range, 4–78). Median tumor volume was 1.6 cm³ (range, 0.1–18.6), median marginal dose was 14.5 Gy (range, 6–25), and median maximal dose was 30 Gy (range, 15.6–60). Median follow-up was 50 months (range, 8–212). Univariate and multivariate analyses using Cox proportional hazards model were employed to identify the potential prognostic factors including tumor volume, marginal dose, gender, age at GKS, and status of visual field defect (VFD) in terms of in-field PFS. The actuarial 3- and 5-year in-field PFS were 84.8 and 67.0%, respectively. On univariate analysis, absence of VFD at GKS was a favorable prognostic factor (hazard ratio: 0.279; 95% CI, 0.085–0.913, P = 0.035), whereas on multivariate analysis, absence of VFD at GKS, tumor volume ≤1.6 cm³, and marginal dose >14.5 Gy related to a longer in-field PFS. GKS may offer reasonable control of recurrent or residual craniopharyngiomas. There was a consistent correlation between absence of VFD at the time of GKS and in-field PFS.     

伽玛刀治疗垂体微腺瘤远期对垂体功能的影响

背景与目的：立体定向伽玛刀治疗垂体瘤在临床已经广泛开展，但治疗垂体微腺瘤的报道仍较少，而且伽玛刀治疗远期对垂体功能的影响至今尚不明确，尤其引起垂体功能损害的情况仍令人担忧。回顾性分析伽玛刀治疗垂体微腺瘤的远期对垂体功能的影响，尤其是引起垂体功能低下的情况。方法：随访应用Leksell伽玛刀治疗的垂体微腺瘤患者，获得完整资料109例，进行回顾性分析。所有随访时间超过5年，平均89.40个月。结果：33例在术前存在不同程度垂体功能低下，治疗后28例恢复正常（84．8％）；本组有8例目前存在垂体激素水平低下，但只有1例与本次治疗有明确关系，5名目前无自诉症状，有症状而且需要激素替代治疗有3例（2．7％）。结论：伽玛刀治疗垂体微腺瘤远期引起垂体功能低下的发生率极低，而对改善垂体功能低下有明确的效果。     

Gamma Knife stereotactic radiosurgery for intracranial hemangiopericytomas

The purpose of this study is to determine the efficacy of Gamma Knife stereotactic radiosurgery (GK SRS) for intracranial hemangiopericytomas, and to investigate the optimal dose for successful tumor control without adverse effects. We evaluated 17 hemangiopericytomas of nine patients treated with GK SRS between 1999 and 2008. The mean tumor volume was 2.2 cm³ (range 0.2–9.9 cm³), and the mean and median marginal doses were 18.1 and 20 Gy (range 11–22 Gy), respectively, at the 50% isodose line. Mean clinical and radiological follow-up periods were 49 and 34 months, respectively. Successful tumor control was achieved in 14 of 17 lesions (82.4%) at time of last follow-up after GK SRS. Actuarial local tumor control rates at 1, 2, and 5 years after GK SRS were 100%, 84.6%, and 67.7%, respectively. No adverse effects, such as radiation necrosis or marked peritumoral edema, were observed in any patient. Marginal dose (≥17 Gy) was the only statistically significant factor for local tumor control on univariate analysis. Extended analysis using lesion data available from previous studies revealed that higher marginal dose (≥17 Gy) was also significant (P = 0.028). GK SRS provides an effective and safe adjuvant management option for patients with recurrent or residual hemangiopericytomas. Our results suggest that doses higher than previously used (around 15 Gy) are desirable to achieve better local tumor control of hemangiopericytomas. Close radiological follow-up is also necessary for early detection of small recurrent lesions.     

伽玛刀放射外科治疗垂体大腺瘤临床研究

背景与目的:垂体大腺瘤多数以手术治疗为主,但有部分患者不接受手术,是否可行伽玛刀治疗?本文回顾性分析96例垂体大腺瘤的伽玛刀放射外科临床资料,探讨其治疗策略。方法:1997年到2003年,本院行伽玛刀治疗的垂体瘤302例,其中96例为垂体大腺瘤,50%等剂量曲线包绕肿瘤体积1/2或2/3,肿瘤基底部周边剂量14～27Gy,中心剂量30～40Gy,视通路控制在8～10Gy以下。结果:伽玛刀放射外科治疗后随访平均34个月,临床症状、MRI检查肿瘤大小及形态的改变、内分泌检查相关激素的变化、视力视野均得到显著改善。结论:伽玛刀放射外科采用剂量-体积分割治疗垂体大腺瘤是一个可以选择的治疗手段。     

Gamma Knife radiosurgery for occipital condyle metastasis

We present a 45 year old female with right occipital condylar metastases who was treated at William Beaumont Hospital in the Gamma Knife Unit. Clinical results at 17 months follow-up and MRI are exposed.