颅内肿瘤的立体定向放射治疗79例分析

目的探讨颅内肿瘤立体定向放射治疗（ＳＲＴ）的方法、效果及适应证。方法总结７９例颅内肿瘤ＳＴＲ治疗及随访资料。结果７９例颅内肿瘤分别采用ＢＲＷ分次、ＧＴＣ低分次、多分次、高分次治疗。平均随访１４．３６个月，１年生存率７２．３４％，生存期１９．５７个月；实际肿瘤控制率８７．５％。结论ＳＲＴ疗效确切，优于单次治疗，且并发症低于后。ＳＲＴ治疗需严格掌握适应证，并根据病变部位、体积、性质、一般情况及放疗病     

松果体区肿瘤的伽玛刀治疗

使用立体定向伽玛刀治疗松果体区肿瘤３３例，肿瘤直径（Ｘ＋Ｙ＋Ｚ／３）１０．０～４５．５ｍｍ；平均２３．５ｍｍ；体积０．４～３５．４ｃｍ３，平均１２．１ｃｍ３；肿瘤边缘剂量１４～２０Ｇｙ，平均１５．２±１．７Ｇｙ；中心剂量２５．０～４２．８Ｇｙ，平均３７．３±６．９Ｇｙ；影像定位仪为１．５ＴＭＲ。随访３～１２个月。初步结果表明：病人的临床症状体证明显好转，９个月后肿瘤生长控制率，即治疗有效率为９６．２％，显效率９２．３％，无严重并发症发生。提示γ－刀可作为松果体区肿瘤的有效治疗方法。     

颅内肿瘤立体定向放射治疗后MR变化及意义

目的：探讨颅内肿瘤立体定向放射治疗（ＳＲＴ）后的ＭＲ变化及意义。方法：收集资料完整的３８例颅内肿瘤的ＭＲ影像资料，其中胶质肿瘤１３例，脑膜瘤７例，转移瘤６例，听神经瘤５例，生殖细胞瘤４例，垂体瘤２例，三叉神经瘤１例。病例均采用１．０Ｔ超导型ＭＲ扫描仪检查。结果：颅内肿瘤立体定向放射后ＭＲ发生以下变化，（１）肿瘤中央长ＴＩＷ、Ｔ２Ｗ信号改变，周边强化；（２）瘤体失强化或囊变；（３）瘤灶变化可分为完全消失、明显缩小、轻度缩小或基本不变和增大；（４）瘤周不同程度水肿。结论：立体定向放射治疗后，肿瘤信号、病灶大小及瘤周可发生一系列生物学变化，ＭＲ能准确客观反映其变化特征，为临床确认颅内肿瘤性质，能否ＳＲＴ治疗或其他治疗提供可靠依据。     

立体定向放射外科治疗脑转移瘤

目的：探讨脑转移瘤的立体定向放射治疗的方法,临床结果。方法：采用单纯ＳＲＳ治疗颅内转移瘤３３例,ＳＲＳ＋ＷＢＲＴ治疗４２例,３１例行单纯全脑放疗。单纯ＳＲＳ治疗的剂量为１４～２２Ｇｙ／单次,ＳＲＳ＋ＷＢＲＴ则在单次ＳＲＳ后在行全脑放疗３０～４０（ｙ）３～４周,单纯ＷＢＲＴ治疗剂量４０～５０Ｇｙ／４～５周。结果：经２～３年随访,ＳＲＳ组３３例ＰＲ＋ＣＲ局部控制率８７．８％,一年生存率７５．８％,两年生存率４５．５％;ＳＲＳ＋ＷＢＲＴ组４１例,ＣＲ＋ＰＲ９２．９％,一年生存率８８．１％,两年生存率４７．６％;两组对照无显著差异（Ｐ〉０．１０）,但无对照有显著差异（Ｐ〈０．０５）,ＷＢＲＴ组３１例,ＣＲ＋ＰＲ８７．１％,两年生存率２５．８％,与ＳＲＳ＋ＷＢＲＴ组对照无显著差异（Ｐ〉０．１０）,瘤生存率分别为４８．４％     

X刀治疗颅内占位性病变

目的探讨立体定向放射外科治疗颅内占位性病变的疗效。方法采用立体定向等中心直线加速器治疗颅内不同的病变１２７例，等中心照射剂量为１５～３５Ｇｙ（平均２４５Ｇｙ），良性肿瘤周边剂量选取８０％等剂量线，恶性肿瘤选取９０％以上的等剂量线。结果８８例（６９３％）随访１个月至２年，其中病变消失３１例（３５２％），缩小３１例（３５２％），无变化２０例（２２７％），增大６例（６８％）。结论该技术治疗脑转移瘤效果最为满意，脑转移瘤在Ｘ刀治疗后结合全脑照射，肿瘤有效控制率达９２５％。     

伽玛刀治疗颅内疾病3094例临床报告

目的： 探讨立体定向放射手术（伽玛刀） 对颅内疾病的疗效。方法： 用１．５Ｔｅｓｌａ 磁共振仪和γ－ ｐｌａｎ 计算机联网定位, γ－ ｐｌａｎ４．０ 版剂量规划系统作治疗方案设计, 剂量规划, 对３０９４ 例不同类型的颅内疾病包括肿瘤、血管畸形及功能性疾病等实施立体定向放射外科治疗, 病种达２０ 余种,年龄１．１～８６ 岁,周边剂量９～７５Ｇｙ,中心剂量１８～１５０Ｇｙ,等剂量曲线３０％ ～９０％ ,靶点数１～１２ 个。结果： 随访１０～４７ 个月, 统计结果表明： 伽玛刀疗效是确切的。对脑动静脉畸形, 随防一年半以上, 完全闭塞率可达４４．６％ , 体积越小, 周边照射剂量越大, 闭塞率越高。对颅内肿瘤的生长控制率, 良性肿瘤≥８０．０％ , 恶性肿瘤≥６６．７％ ,对功能性疾病的治疗有效率, 帕金森病为８５．２％ , 三叉神经痛为７６．９％ 。结论： 伽玛刀是治疗颅内疾病又一种可选择方法。治疗技术良好, 指征掌握严格, 可提高疗效, 降低并发症。     

立体定向适形放射治疗脊柱转移瘤12例报告

脊柱转移瘤是常见的骨转移疾病,如不及时治疗,约５％～１４％脊柱转移会出现并发症,并可最终导致括约肌功能障碍和瘫痪［１］,严重影响病人生存质量和时间。自１９９８年１月～１９９９年１０月间,我院应用立体定向适形放射治疗脊柱转移瘤１２例,取得满意的疗效,现报告如下：１对象和方法１．１一般资料１２例病人,男９例,女３例。年龄５０～７６岁,病史１０天～６个月。原发灶：肺癌４例,乳腺癌２例,消化道肿瘤２例,泌尿系肿瘤３例,来源不详１例。全部病人均以疼痛为首发症状及就诊原因,合并肢体麻木３例,括约肌功能障碍和…     

CT立体定向囊腔内放疗治疗囊性颅咽管瘤

目的：研究治疗囊性颅咽管瘤最佳治疗方法。方法：对３４例囊性颅咽管瘤进行ＣＴ立体定向囊腔内胶体磷酸铬内放疗。结果：全部病例经手术排除囊液后临床症状迅速改善，经囊腔内放疗后１２～６６个月随访，ＣＴ扫描显示２８例（８２．５％）瘤腔持续消失，３例（８．８％）瘤腔显著缩小，症状持续改善。３例（８．８％）分别于１９、２５、３６个月后因瘤实质部分增大，症状恶化而相继死亡。无手术死亡率和严重并发症。结论：ＣＴ立体定向囊腔内放疗治疗囊性颅咽管瘤十分安全、有效，应作为治疗囊性颅咽管瘤首选的方法。     

颅内肿瘤立体定向放射后被迫手术的原因及影响

颅内肿瘤立体定向放射后被迫手术的原因及影响漆松涛方陆雄彭林冯文峰任文德立体定向放射外科（ＳＲＳ）治疗颅内肿瘤已日益为人们接受。从１９９４年４月至１９９６年５月，我院收治了２８例接受γ－刀或Ｘ－刀治疗后被迫再作者单位：５１０５１５广州南方医院神经外科常...     

CT-引导下颅咽管瘤内置入放射性核素治疗的研究

自１９８８年１月至１９９６年１月采用ＣＴ引导立体定向技术对３００例颅咽管瘤进行了３８５次瘤内置入放射性核素的治疗。其中男１８０例，女１２０例，年龄３～７４岁，平均３０．５岁。全部病例均有视路受损症状。ＣＴ或ＭＲＩ检查显示：囊性肿瘤１７５例，实体性肿瘤４０例，实体与囊腔并存８５例，无，手术死亡及严重并发症。结果：术后２５０例随访６个月至８年，平均４年：肿瘤消失１８０例（７２％）；肿瘤显著缩小（＞８０％）３０例（１２％）；肿瘤缩小５０％左右２０例（８％）；肿瘤增大（主要为实体性）１６例（６．４％）；死亡４例（１．６％）。所使用的Ｐ－３２和Ｙ－９０是纯Ｂｅｔａ射线源，因其穿透能力短易于运送与保存、保护、对使用囊壁的治疗量为２００Ｇｙ（２００００ｒｄ）为好，可杀死瘤细胞而对周围组织无损害。提示立体定向瘤内放射性核素行间质内照射是治疗颅咽管瘤的一种有效方法。     

颅内肿瘤的立体定向放射治疗(附79例报告)

目的　探讨立体定向放射治疗颅内肿瘤的方法和疗效。方法　对 79例胶质瘤等 6种颅内肿瘤采用 5～ 10个非共面弧共治疗 3～ 10次 ,3～ 10Gy/次 ,3次 /周 ,总剂量 2 0～ 5 0Gy。术后随访 6～ 2 4个月 ,以CT/MR示肿瘤平均直径变化为主的指标评定疗效。结果　立体定向放射治疗 (SRT)组 79例 ,有效 6 6例 (83 5 % ) ,立体定向放射外科 (SRS)组 73例 ,有效 6 3例 (86 3% ) ,两组比较无显著差异 (P >0 0 5 ) ;术后放疗 (S RT)组 5 7例 ,有效 36例 (6 3 2 % ) ,与SRT组比较有显著差异 (P <0 0 1) ;SRT组无效 13例 (16 5 % ) ,出现并发症 4例 (5 % ) ;SRS对照组并发症 2 1例 (2 8 8% )与SRT组有显著差异 (P<0 0 1) ;S RT组并发症 6例 (10 5 % ) ,与SRT组比较无显著差异 (P >0 0 5 )。结论　SRT可治疗体积较大和位于重要器官的肿瘤。它与外放疗比较 ,可缩短治疗时间 ,提高个别颅内肿瘤的疗效 ;与SRS比较 ,可减少并发症发生率 ;与S RT比较可提高治疗效果     

Image-guided helical Tomotherapy for treatment of spine tumors

OBJECTIVES: One of the most common indications for radiotherapy is treatment of the spine. The vast majority of cases are related to metastatic disease with primary tumors of the spine being rare. Conventional radiation therapy often plays an important role in the management of spine tumors although at times with significant side effects and disadvantages. Furthermore, retreatment of spine tumors is a challenge due to concerns over spinal cord toxicity. In this series, we examine the efficacy of using image-guided helical Tomotherapy and the possible advantages offered by this new technology. PATIENTS AND METHODS: Eight patients at Hoag Memorial Hospital Presbyterian were treated between November 2005 and November 2006. The median age was 66 years. Of the eight patients, seven had metastatic disease with one patient having a primary neuroendocrine tumor of the spine. Five patients were previously treated to the spine with conventional radiation planning. Two patients received single fraction stereotactic radiosurgery (15 Gy) while the remaining patients received hypofractionated stereotactic radiotherapy to a median total dose of 2,500 cGy in 500 cGy fractions. RESULTS: At the time of last follow-up, radiographic control was seen in all eight patients with a median local control rate of 2.5 months (range of 1-5.8 months). Four of the eight patients are still alive with median overall survival of 5.1 months (range 1.4-6.9 months). Acute toxicity ranged from Radiation Therapy Oncology Group (RTOG) score 0-2 and no patients experienced late complications of radiation myelitis. CONCLUSIONS: The TomoTherapy Hi-ART system can be an alternative treatment option for upfront or retreatment of spine tumors. Minimal acute and late toxicity were seen in patients treated with Tomotherapy. Intensity-modulated radiation delivery combined with megavoltage CT image guidance offered by the TomoTherapy Hi-ART system allows for set-up and delivery accuracy that is required for stereotactic treatment of spine tumors and eliminates the need for any internal or external fiducial marker placement.     

隐匿性脑血管畸形的诊断和微侵袭治疗

目的：报告DSA未能显示的隐匿性脑血管畸形11例,并探讨其发生机理,误诊原因和诊治原则,方法：详细分析11例病人的临床资料。结果：该病变发生机理主要是病变输入运输太细,病灶内血栓形成,出血和血肿破坏了畸形血管以及出血后血管痉挛,其被误诊原因是一些病人的临床特点,CT表现与某些胶质瘤酷似,结论：MR对隐匿性脑血管畸形的诊断有重要意义,MRA可帮助确诊。该病变不宜行血管内治疗,应以显微手术和立体定向放射治疗为主。     

胶质瘤X-刀治疗后放射性坏死貌似肿瘤复发

目的 探讨X-刀治疗胶质瘤后放射性坏死貌似肿瘤复发的临床表现与影像学特点。方法回顾性分析7例因胶质瘤而首选X-刀治疗后疑似肿瘤复发再行手术治疗，病理结果证实为放射性坏死病人的临床表现与影像学特点。结果7例病人均在X-刀治疗后半年内．平均4．3个月，出现颅内压增高症状或原有症状的加重，影像学(CT、MRI)特征表现为病灶范围扩大，病灶无明显增强及占位表现；手术切除病灶后病理报告为坏死组织，未发现肿瘤细胞。结论X-刀治疗半年内出现的颅内压(ICP)增高症状或原有症状加重可能为延迟性放射性坏死，极易与胶质瘤复发混淆，应根据影像学特点加以鉴别，鉴别困难时，应先行保守治疗．无效时方可手术治疗，以减少病人不必要的神经损害和经济负担。     

Technique for stereotactic body radiotherapy for spinal metastases

Stereotactic body radiotherapy (SBRT) is an emerging technique for spinal tumours that is a natural succession to brain radiosurgery. The spine is an ideal site for SBRT due to its relative immobility and the potential clinical benefits of high dose delivery, particularly to optimise local control and avoid disease progression that can result in spinal cord compression. However, the proximity of the tumour to the spinal cord, with the potential for radiation myelopathy if the dose is delivered inaccurately or if the spinal cord dose limit is set too high, demands technical accuracy with radiation myelopathy a feared complication. Spine SBRT has been delivered with either a robotic-based linac system such as the Cyberknife, or with linac-based systems equipped with a multileaf collimator and image guidance system. Regardless of the technology, spine SBRT demands sophisticated treatment planning and delivery. This case-based technical review outlines the SBRT apparatus, planning and treatment delivery in use at the University of Toronto, Toronto, Canada.     

三维适形放疗联合立体定向放射外科推量治疗颅内血管周细胞瘤

目的 探讨三维适形放疗(3D-CRT)联合立体定向放射外科(SRS)推量治疗手术切除后颅内血管周细胞瘤(HPC)的疗效. 方法 广东三九脑科医院肿瘤综合治疗中心自2008年10月1日至2011年11月30日应用3D-CRT联合SRS推量治疗6例手术切除术后的颅内HPC患者,回顾性分析患者的临床表现、病理学特征、影像学表现和疗效. 结果 HPC患者的发病年龄在33～55岁之间,中位年龄46.5岁.临床表现主要为颅内压增高症状和肿瘤压迫、破坏周围组织所导致的局灶性症状；病理染色显示瘤细胞密集,呈纺锤形或多角形,胞膜不清,胞质略嗜酸性,可见核异型及核分裂;所有患者术后接受3D-CRT联合SRS推量治疗,随访14-44个月,2例完全缓解,4例部分缓解. 结论 HPC预后不良,易复发,偶有全身转移,手术切除是最佳治疗手段.对部分切除术后的患者,3D-CRT联合SRS推量可能进一步提高疗效.     

Treatment of recurrent high grade gliomas with hypofractionated stereotactic image-guided helical tomotherapy

Objective

Salvage treatment of high grade gliomas that progress after standard therapy of resection and adjuvant chemoradiation therapy includes repeat surgical resection, second line chemotherapy, re-irradiation, or often a combination of the above. We present a series on patients treated with hypofractionated stereotactic image-guided helical tomotherapy and discuss the efficacy of this new technology in the treatment of high grade gliomas.

Materials and methods

Between June 2005 and August of 2008, eight patients with recurrent high grade gliomas were treated with salvage radiation therapy using hypofractionated stereotactic image-guided helical tomotherapy after image documentation of disease progression. Median age was 48.5 years with 4 females and 4 males. Median KPS at time of treatment was 65. All patients had either Grade III or IV gliomas at time of treatment with previous history of involved field fractionated radiotherapy. Median total dose given was 2500 cGy in 500 cGy fractions.

Results

The median planning target volume was 69.5 cm³. Five of the eight patients were alive at the time of last follow-up with a median survival of 7.6 months. Radiographic documented control was seen in six of the eight patients with median local control of 4.6 months. Acute Radiation Therapy Oncology Group (RTOG) toxicity scores measured zero in all patients with only one patient requiring a reoperation following treatment.

Conclusions

Hypofractionated stereotactic image-guided helical tomotherapy provides an alternative to other stereotactic radiation therapy and radiosurgery options for treatment of recurrent high grade gliomas.     

立体定向放射外科结合化学治疗原发性颅内淋巴瘤(附42例临床分析)

目的评价立体定向放射治疗结合化学治疗原发性颅内淋巴瘤(primary intracranial lymphoma,PIL)的临床疗效。方法分析1997~2002年42例经过病理证实的PIL,均给予立体定向放射治疗,再给予全脑外照射20~30Gy,最后接受以甲氨蝶呤(MTX)大剂量化疗为基础的联合化疗4~6疗程。结果随访9~42个月,卡氏评分平均提高20分,即期疗效完全缓解39例,部分缓解3例,无肿瘤增大者。42例患者死亡31例,存活11例;平均生存期28.4±4.1个月;1、2、3年局部控制率为92.9%,73.8%和52.3%;1、2、3年生存率分别为85.7%,76.2%和57.1%;无明显毒副作用。结论立体定向放射治疗结合以大剂量MTX化学治疗是治疗PIL的有效,安全的方法。     

Linear accelerator radiosurgery for arteriovenous malformations: Updated literature review

Arteriovenous malformations (AVMs) are the leading causing of intra-cerebral haemorrhage. Stereotactic radiosurgery (SRS) is an established treatment for arteriovenous malformations (AVM) and commonly delivered using Gamma Knife within dedicated radiosurgery units. Linear accelerator (LINAC) SRS is increasingly available however debate remains over whether it offers an equivalent outcome. The aim of this project is to evaluate the outcomes using LINAC SRS for AVMs used within a UK neurosciences unit and review the literature to aid decision making across various SRS platforms. Results have shown comparability across platforms and strongly supports that an adapted LINAC based SRS facility within a dynamic regional neuro-oncology department delivers similar outcomes (in terms of obliteration and toxicity) to any other dedicated radio-surgical platform. Locally available facilities can facilitate discussion between options however throughput will inevitably be lower than centrally based dedicated national radiosurgery units.