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。     

囊性颅咽管瘤立体定向囊腔内放疗的临床研究

目的　探讨囊性颅咽管瘤囊腔内放疗的有效性和安全性。方法　对 5 6例囊性颅咽管瘤行CT引导立体定向囊腔内放疗 ,根据个体化剂量设计分别置入 1～ 3次、2 .4～ 14 .8MBq不等胶体磷酸铬 (Cr3 2 Po4) ,并进行临床随访观察。结果　 5 6例患者术后神经功能均很快出现不同程度的改善。随访 6个月至 9年 ,49例视力、视野障碍中 ,45例获得逐渐改善 ,4例恶化 ,偏瘫 3例恢复正常 ,所有内分泌功能障碍者均获得稳定或不同程度好转 ,复查CT或MR示 :5例瘤实质增大 (9% ) ,2例新的囊腔形成 ,1例导管在脑室内囊腔略缩小 ,囊腔完全消失 2 4例 (4 3 % ) ,囊腔明显缩小 (>80 % )2 4例 (86% )。无手术死亡及严重并发症。结论　立体定向囊腔内放疗是一种治疗囊性颅咽管瘤的安全而有效方法 ,放射剂量设计的个体化是提高治疗有效率的关键。     

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...     

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。     

32P胶体体外诱导颅咽管瘤细胞凋亡

  目的   探讨32P胶体对颅咽管瘤（craniopharyngioma,CP）体外培养细胞诱导凋亡作用及剂量效应和时间效应关系。   方法   通过原代细胞培养获得CP有限传代细胞系,经不同浓度32P胶体处理不同时间后,应用MTT比色法绘制细胞存活率曲线。流式细胞仪定量检测细胞凋亡率。Hoechst 33342荧光染色检测凋亡细胞形态。TUNEL荧光染色检测DNA特征改变。透射电子显微镜（TEM）检测细胞超微结构。   结果   Hoechst 33342荧光染色、TUNEL荧光染色、TEM均证实32P胶体确能引起CP细胞产生凋亡。随着32P胶体处理浓度（0~14.80 MBq/mL）及时间（1~14 d）的增加,CP细胞存活率减少、凋亡率增高。   结论   32P胶体能明显抑制CP体外培养细胞生长并诱导凋亡,剂量越大及处理时间越长其杀伤作用越强。      

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。     

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。     

颅咽管瘤的影像学分析

目的 探讨颅咽管瘤的影像学表现及其诊断价值,提高影像诊断率。方法 利用CT和MRI检查方法,分析了9例经手术病理证实为颅咽管瘤的影像学表现,讨论了颅咽管瘤的病理及分型,临床及预后,CT和MRI对本病的诊断及鉴别诊断。结果 囊性者6例,CT为边清低密度影,伴钙化,呈环形或岛状强化。实性者1例,为混杂密度影。囊实混合者2例。MRI见 T_1WI呈低、等或高信号,T_2WI呈混杂高信号。结论 CT及MRI对颅咽管瘤的定位诊断率达100％,定性诊断率89％,为临床准确提供手术方式。     

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.     

Tumor irradiation followed by intratumoral cytokine gene therapy for murine renal adenocarcinoma

To circumvent the toxicity caused by systemic injection of cytokines, cytokine cDNA genes encoding the human interleukin IL-2 cDNA (Ad-IL-2) and murine interferon IFN-gamma gene (Ad- IFN-gamma) were inserted into adenoviral vectors. These constructs were used for intratumoral gene therapy of murine renal adenocarcinoma Renca tumors. Treatment with three doses of Ad-IL-2 or Ad- IFN-gamma, given a day apart, was more effective than single-dose gene therapy. We found that tumor irradiation enhanced the therapeutic efficacy of Ad-IL-2 and Ad-IFN-gamma intratumoral gene therapy. Tumor irradiation, administered 1 day prior to three doses of Ad-IL-2 treatment, was more effective than radiation or Ad-IL-2 alone, resulting in tumor growth arrest in all mice, increased survival and a consistent increase in complete tumor regression response rate. Complete responders rejected Renca tumor challenge and demonstrated specific cytotoxic T-cell activity, indicative of specific tumor immunity. The effect of radiation combined with three doses of Ad-IFN-gamma was less pronounced and did not lead to tumor immunity. Histological observations showed that irradiation of the tumor prior to gene therapy increased tumor destruction and inflammatory infiltrates in the tumor nodules. These findings demonstrate that tumor irradiation improves the efficacy of Ad-IL-2 gene therapy for induction of antitumor immune response.     

立体定向穿刺引流联合32P囊内注射治疗囊性脑转移瘤

目的 观察立体定向穿刺引流联合32P囊内注射治疗囊性脑转移瘤的疗效.方法 研究设3个组:A组25例,采用立体定向穿刺引流联合32P囊内注射治疗;B组21例,采用立体定向穿刺引流联合X刀治疗;C组26例,单纯采用X刀治疗.结果 A组、B组和C组总有效率分别为76.0%、66.7%和7.7%,A组和B组总有效率显著高于C组(χ2＝24.163,P＝0.000).1年、2年生存率A组分别为52.0%、16.0%,B组为42.8%、14.3%,C组为19.2%、0,A组和B组1年生存率显著高于C组(χ2＝6.116,P＝0.047).A组1例患者出现癫痫小发作,B组2例患者出现头痛、1例患者出现脑水肿,C组3例患者出现脑水肿.未见其他严重并发症.结论 立体定向穿刺引流联合32P囊内注射治疗囊性脑转移瘤有较好的临床疗效.     

Complete tumor response following intratumoral 32P BioSilicon on human hepatocellular and pancreatic carcinoma xenografts in nude mice.

PURPOSE: 32P BioSilicon is a new, implantable, radiological medical device that comprises particles of highly pure silicon encapsulating 32phosphorus (32P) for the treatment of unresectable solid tumors. Prior to administration, the device particles are suspended in a formulant which provides an even suspension of the intended dose for implantation. The primary objective of this animal trial study was to investigate the effects of intratumoral injection of 32)P BioSilicon on human hepatocellular (HepG2) and pancreatic carcinoma (2119) xenografts implanted in nude mice (BALB/c). A secondary objective was the histopathologic examination of the tumor foci and surrounding tissue during the study. METHODS: Cultured human carcinoma cells (HepG2 and 2119) were injected s.c. into the gluteal region of nude mice. When the implanted tumors were approximately 1 cm in diameter, 32P BioSilicon (0.5, 1.0, and 2.0 MBq) or formulant was injected into the tumors. Implanted tumor size was measured once a week for 10 weeks. At study termination, the tumor and surrounding normal tissue were collected and fixed in 10% formalin and processed for histopathologic analysis. RESULTS: 32P BioSilicon produced a reduction in HepG2 tumor volume when compared with formulant control, and complete response was observed among tumors in the 1.0 and 2.0 MBq treatment groups after week 8. There was also significant reduction in 2119 tumor volume in all treated groups, with the complete response rate of 67% in the 2.0 MBq group. CONCLUSION: 32P BioSilicon suppressed the growth of both human hepatocellular and pancreatic carcinoma xenografts implanted in nude mice and complete responses were also observed in tumors at higher radiation doses.     

Comparison of 32P therapy and sequential hemibody irradiation (HBI) for bony metastases as methods of whole body irradiation

We report a retrospective study of 15 patients with prostate carcinoma and diffuse bone metastases treated with sodium 32P for palliation of pain at Downstate Medical Center and Kings County Hospital from 1973 to 1978. The response rates, duration of response, and toxicities are compared with those of other series of patients treated with 32P and with sequential hemibody irradiation. The response rates and duration of response are similar with both modalities ranging from 58 to 95% with a duration of 3.3 to 6 months with 32P and from 75 to 86% with a median duration of 5.5 months with hemibody irradiation. There are significant differences in the patterns of response and in the toxicities of the two treatment methods. Both methods cause significant bone marrow depression. Acute radiation syndrome, radiation pneumonitis, and alopecia are seen with sequential hemibody irradiation and not with 32P, but their incidence can be reduced by careful treatment planning. Hemibody irradiation can provide pain relief within 24 to 48 h, while 32P may produce an initial exacerbation of pain. Lower hemibody irradiation alone is less toxic than either upper hemibody irradiation or 32P treatment.     

婴幼儿皮肤血管瘤P-32放射治疗的临床观察

目的：探讨P-32放射治疗婴幼儿皮肤血管瘤的临床效果及不良反应。方法：观察38例婴幼儿P-32放射治疗后的治疗效果及不良反应。结果：P-32放射治疗婴幼儿血管瘤一次治愈率76.3%,有效率100%。治疗中要及时注意皮肤局部损伤情况。结论：P-32放射治疗婴幼儿皮肤血管瘤方法有效,不良反应。     

婴幼儿皮肤血管瘤P-32放射治疗的临床观察

目的:探讨P-32放射治疗婴幼儿皮肤血管瘤的临床效果及不良反应.方法:观察38例婴幼儿P-32放射治疗后的治疗效果及不良反应.结果:P-32放射治疗婴幼儿血管瘤一次治愈率76.3%,有效率100%.治疗中要及时注意皮肤局部损伤情况.结论:P-32放射治疗婴幼儿皮肤血管瘤方法有效,不良反应.