颅内肿瘤伽玛刀治疗后并发症原因分析

（目的）探讨伽玛刀治疗对颅内肿瘤产生并发症的原因,（方法）回顾性分析受伽玛刀治疗后出现并发症的１８例患者的临床资料。（结果）颅内肿瘤伽玛刀治疗后并发症的发生率为６％（１８／３００）。１２例患者表现为颅压增高和神经功能缺失,４例出现新的神经功能缺失,２例脑疝：肿瘤最大直径均大于３．０ｃｍ,且多位于中线结构及主要回流静脉附近１１例保守治疗,７例行手术治疗,无一例死亡,（结论）颅内肿瘤伽玛刀治疗后并发症     

对“脑肿瘤伽玛刀治疗后再开颅切除原因分析”一文的不同看法

中华放射肿瘤学杂志编辑部：读贵刊今年第２期上述文章，产生如下不同看法：上文作者所列医院从１９９５年７月，至１９９６年５月十个月中就有１９例伽玛刀治疗后再手术，值得深思。据文中所列附表：“肿瘤大小及照射剂量”可见，在诊治的病例中无论病变的性质如何，随着...     

伽玛刀治疗脑转移瘤38例疗效观察

伽玛刀治疗脑转移瘤３８例疗效观察隋邦森，高南平，孙启银，陈鹏，孙永文，王学锋从１９９３年１０月～１９９４年６月，我们对３８例脑转移瘤进行了伽玛刀治疗。３８例中，男性３０例，女性８例。年龄３１～６２岁，平均５２．３岁。原发灶为肺癌者２２例，肝癌、肾癌、...     

颅内肿瘤伽玛刀治疗后并发症原因分析

[目的]探讨伽玛刀治疗颅内肿瘤产生井发症的原因。（方法）回顾性分析接受价玛刀治疗后出现并发症的18例患者的临床资料。［结果］颅内肿瘤伽玛刀治疗后并发症的发生率为6％（18/300）。12例患者表现为颅内压增高和神经功能缺失,4例出现新的神经功能缺失,2例脑疝;肿瘤最大直径均大于3．0cm,且多位于中线结构及主要回流静脉附近;11例保守治疗,7例行手术治疗,无一例死亡。[结论]颅内肿瘤伽玛刀治疗后并发症的发生主要与颅内肿瘤的大小、形态及部位等因素有关。选择合理的治疗剂量和剂量曲线可能降低伽玛刀治疗后并发症的发生。     

胸颅一期手术治疗肺癌合并脑转移

作者报告１０例肺癌合并脑转移，一期剖胸开颅切除肺癌原发病灶和脑转移灶，无一例手术死亡，亦未发生其它严重并发症。经随访已死亡的４例，平均生存期８．２５个月，目前仍存活６例，最短８个月，最长近３年，平均存活１年４个月。作者认为，对于周边型肺癌合并脑转移估计肺癌原发病灶能切除，脑转移为单发性转移且全身情况良好者应积极争取胸颅一期根治性切除手术，术后辅以化疗等，可延长生命提高疗效。     

伽玛刀治疗垂体瘤116例临床分析

背景与目的：垂体瘤是颅内常见的良性肿瘤，以往治疗多为手术加放疗和药物治疗。近年来，越来越多的垂体瘤患者接受了伽玛刀治疗，并取得了良好的临床效果。本文探讨伽玛刀治疗不同类型垂体瘤的方法和疗效。方法：采用OUR旋转式伽玛刀治疗垂体瘤116例，50％等剂量曲线包绕肿瘤，周边剂量12～24Gy，平均16．8Gy，中心剂量24-46Gy，平均34．7Gy，根据肿瘤体积大小和内分泌类型分组，总结各组疗效。结果：随访时间6-36月，临床 影像学随访116例，激素水平测定复查86例，症状消失／改善74例(63．8％)，无变化34例(29．3％)，加重8例(6．9％)，肿瘤消失／缩小93例(80．2％)，无变化19例(16．3％)，增大4例(3．5％)，3例视力减退分别于伽玛刀治疗后4月、7月行手术视神经减压，垂体低功能5例，无早期临床死亡，肿瘤控制率96．5％。结论：伽玛刀治疗垂体瘤安全、有效，不同类型的垂体瘤应制定相应合理的治疗规划。     

脑肿瘤放疗后脑损伤的治疗

 目的　探讨治疗放射性脑损伤的意义。方法　 37例放射性脑损伤患者采用脱水药、扩血管药物、神经营养药物、立体定向或和开颅手术等治疗。结果　 6 0 %的病人症状改善 ,2 0 %部分改善 ,2 0 %无效。结论　对脑组织放射性损伤进行再治疗及采取积极的处理措施 ,将会使放射性脑损伤减少到最小程度 ,越早期治疗越好且有望症状改善或部分恢复 ,有手术指征者应及时采取正确的手术治疗。此外正确有效的预防措施在防止放射性脑损伤时也具有十分重要的意义。     

旋转式伽玛刀治疗55例听神经瘤分析

目的;分析伽玛刀（γ刀）治疗听神经瘤的疗效及适应证,并发症发生的原因及预防,方法：采用OUR－XGD旋转式伽玛刀治疗听神经瘤55例,肿瘤平均直径2．9cm,平均肿瘤边缘剂量14Gy,中心剂量33．6Gy,平均采用 等剂量曲线为48．7％,平均等中心点为4．7个,随访12－35个月,结果：肿瘤缩小41．8％,肿瘤稳定无增大50．9％,合计肿瘤生长控制率92．7％,肿瘤增大7．3％,听神经保护率40％,面神经保护率89．8％,无死亡病例,结论：γ刀治疗听神经瘤具有较高的肿瘤生长控制率,死亡纺极小,且可保护颅神经功能,是一种有效的治疗方法。     

全脑放疗联合伽玛刀治疗脑转移瘤

[目的]评价全脑放疗联合伽玛刀治疗脑转移瘤的价值.[方法]将60例脑转移瘤病人随机分为两组:全脑放疗联合伽玛刀治疗组(A组)及单纯伽玛刀治疗组(B组).A组先全脑放疗40Gy/20F/4W后,复查颅脑MRI或CT,如果有残留,则继以伽玛刀治疗,周边剂量8Gy～26Gy,一次照射:B组单纯伽玛刀治疗,肿瘤周边剂量16Gy～32Gy,一次照射.分别对两组不同病灶数患者的近期疗效及生存率进行统计学分析.[结果]两组患者近期疗效及生存率差异无显著性;分层研究显示:单个病灶者两组生存率差异无显著性,而两个以上病灶者全脑放疗联合伽玛刀治疗的生存率高于单纯伽玛刀治疗,差异有显著性.[结论]对于单个病灶的脑转移瘤可单纯行伽玛刀治疗:而多发病灶的脑转移瘤,建议全脑放疗联合伽玛刀治疗.     

Microsurgery plus whole brain irradiation versus Gamma Knife surgery alone for treatment of single metastases to the brain: a randomized controlled multicentre phase III trial

Journal of Neuro-Oncology - Background Is Gamma Knife surgery alone as effective as surgery plus whole brain irradiation (WBRT) for patients with a single, small-sized brain metastasis? Methods...     

Gamma Knife radiosurgery after radiation therapy as an adjunctive treatment for glioblastoma

Despite a randomized trial showing no benefit of stereotactic radiosurgery (SRS) prior to radiation therapy (RT), the benefits of SRS after RT and at the time of progression require further characterization. We retrospectively reviewed 48 patients with histopathological diagnoses of glioblastoma (GBM) that were treated with SRS over a 16-year period (1991–2007). Twenty-two were treated as part of their initial treatment paradigm and 26 were treated at the time of progression. The primary endpoints studied were overall survival (OS), survival after SRS and time-to-progression (TTP). Patients treated at the time of progression had significantly longer OS than those treated on initial presentation (17.4 vs. 15.1 months, P = 0.003). On multivariate analysis, Radiation Therapy Oncology Group (RTOG) class III patients, those with more extensive resections, and those who were not on steroids at the time of SRS had significantly improved OS. SRS margin dose was a significant prognostic factor for TTP on multivariate analysis (HR = 0.78, 95% CI: 0.62–0.98). In the subgroup of patients treated with GKS as part of their initial treatment, an increasing number of weeks between surgical resection and GKS was a poor prognostic factor on multivariate analysis (HR = 1.11, 95% CI: 1.01–1.23). In patients who were treated with SRS at the time of progression, chemotherapy was associated with a longer TTP (P = 0.028). Our results suggest that SRS provides a survival advantage when delivered after RT. This benefit may be best appreciated in RTOG class III patients. Moreover, SRS may be a viable alternative to open surgery for aggressive management of GBM at the time of recurrence. Prospective studies of SRS for GBM should focus on these two groups of patients. Portions of this work were presented as proceedings at the Annual Meeting of the Neurosurgical Society of the Virginias, Hot Springs, Virginia, January 2006.     

脑转移瘤伽玛刀配合全脑放疗的临床研究

目的探讨脑转移瘤伽玛刀治疗配合全脑放疗的疗效。方法自2002年3月至2006年3月收治脑转移瘤患者79例。原发灶控制稳定,脑转移患者中,44例采用伽玛刀配合全脑放疗,35例单纯给予伽玛刀治疗。伽玛刀治疗处方等剂量线采用45%～75%等剂量包绕计划靶区,边缘剂量15～20 Gy,中心30～45 Gy;全脑放疗每次分割剂量为2～3 Gy,1次/d,每周照射5次,总剂量25～30 Gy。结果伽玛刀治疗开始后3个月,复查MRI,影像学结果显示总的有效率为83.5%（66/79）。伽玛刀配合全脑放疗组的1年生存率为29.5%,2年生存率9.1%;单纯伽玛刀组患者的1年生存率为17.1%,2年生存率2.9%。随访期内未见严重放射性并发症。结论对脑转移瘤采用伽玛刀配合全脑放疗是较有效的局部治疗方式,副反应轻,均能耐受治疗。     

伽玛刀照射猫脑组织引起的病理学变化

目的研究伽玛刀照射猫脑组织在不同时期产生的病理学变化。材料与方法３３只家猫分成１１组，１０个实验组分别用１０，２０，３０，４０，５０，７０，１００，１６０，１８０，２００Ｇｙ的剂量照射其大脑皮质，照射后３月、半年和１年（≥１６０Ｇｙ在１月、３月和半年）光镜观察组织学变化。结果（１）≥１６０Ｇｙ均引起局限性脑组织坏死灶，半年时坏死灶缩小；（２）１００Ｇｙ和７０Ｇｙ３月时未见坏死灶，１年时神经细胞坏死消失，残留者固缩；（３）５０Ｇｙ３月无变化，半年和１年引起神经元变性和固缩。４０Ｇｙ半年无变化，１年时神经元变性；（４）３０Ｇｙ１年时仅局部细胞数减少，２０和１０Ｇｙ无变化。结论（１）≥１６０Ｇｙ引起局限性脑坏死，２００Ｇｙ产生的坏死灶较大；（２）１００Ｇｙ和７０Ｇｙ引起早期迟发放射反应和严重的晚期反应；（３）４０Ｇｙ和５０Ｇｙ引起晚期迟发放射反应。     

Gamma Knife radiosurgery for brainstem metastases: the UCSF experience

Purpose: To assess clinical and imaging outcomes in patients treated with Gamma Knife stereotactic radiosurgery (SRS) for brainstem metastases. Materials and methods: We reviewed all patients with brain metastases treated with SRS at the University of California, San Francisco from 1991–2005 to identify patients who had SRS to a brainstem metastasis. Survival time and freedom from progression (FFP) were calculated from date of SRS using the Kaplan–Meier method. Prognostic factors were evaluated using the log-rank test and Cox proportional hazards model. Results: From 1991 through 2005, 42 consecutive patients with brainstem metastases had SRS to 44 lesions (seven midbrain, 31 pontine, and six medullary) in 42 sessions. Primary diagnoses included 14 cases of lung cancer (one small-cell), 10 melanoma, 12 breast cancer, five renal cell, and one unknown. The median age was 55 years (range, 25–79). The median survival time was 9 months after SRS. Longer survival time was associated with single metastasis, non-melanoma histology, and extracranial disease control. The median target volume was 0.26 ml (0.015–2.8 ml) and the median prescribed dose was 16.0 Gy (10.0–19.8 Gy). Brainstem lesion FFP was 90% at 6 months and 77% at 1 year. Four patients had brainstem complications following treatment. Poor brainstem outcome was associated with melanoma and renal cell histology as well as brainstem lesion volume ≥1 ml. Conclusions: In this series, SRS using a median dose of 16 Gy provided excellent local control with relatively low morbidity in patients with brainstem metastases less than 1 ml or non-melanoma, non-renal cell histology.     

Gamma knife radiosurgery for patients with nonfunctioning pituitary adenomas: results from a 15-year experience

PURPOSE: To evaluate the efficacy and complications of stereotactic radiosurgery for patients with nonfunctioning pituitary adenomas (NFA). METHODS AND MATERIALS: This was a retrospective review of 62 patients with NFA undergoing radiosurgery between 1992 and 2004, of whom 59 (95%) underwent prior tumor resection. The median treatment volume was 4.0 cm(3) (range, 0.8-12.9). The median treatment dose to the tumor margin was 16 Gy (range, 11-20). The median maximum point dose to the optic apparatus was 9.5 Gy (range, 5.0-12.6). The median follow-up period after radiosurgery was 64 months (range, 23-161). RESULTS: Tumor size decreased for 37 patients (60%) and remained unchanged for 23 patients (37%). Two patients (3%) had tumor growth outside the prescribed treatment volume and required additional treatment (fractionated radiation therapy, n = 1; repeat radiosurgery, n = 1). Tumor growth control was 95% at 3 and 7 years after radiosurgery. Eleven (27%) of 41 patients with normal (n = 30) or partial (n = 11) anterior pituitary function before radiosurgery developed new deficits at a median of 24 months after radiosurgery. The risk of developing new anterior pituitary deficits at 5 years was 32%. The 5-year risk of developing new anterior pituitary deficits was 18% for patients with a tumor volume of < or = 4.0 cm(3) compared with 58% for patients with a tumor volume >4.0 cm(3) (risk ratio = 4.5; 95% confidence interval = 1.3-14.9, p = 0.02). No patient had a decline in visual function. CONCLUSIONS: Stereotactic radiosurgery is effective in the management of patients with residual or recurrent NFA, although longer follow-up is needed to evaluate long-term outcomes. The primary complication is hypopituitarism, and the risk of developing new anterior pituitary deficits correlates with the size of the irradiated tumor.     

Analysis of dose distribution in gamma knife radiosurgery for multiple targets

Purpose: The aim of this study is to evaluate the actual effect of irradiation for other targets in dose planning for the treatment of multiple metastases with Gamma Knife.

Methods and Materials: We analyzed dose distributions for 51 targets in 10 patients with metastatic brain tumors who underwent radiosurgery with Gamma Knife for the treatment of more than one target in one session. We made dose plans with every attempt to include as many targets as possible and calculate dose distributions separately for each dose matrix. We also calculated the composite dose distribution by including the effect of all shots used. We compared these noncomposite and composite dose distributions.

Results: The differences in the mean target dose between the noncomposite dose distribution and the composite one ranged from 0.0 to 4.5 Gy with a mean of 1.5 Gy and was more than 2 Gy in 12 (24%) targets. The difference tended to be larger when targets were small in volume and/or the number of targets was large.

Conclusions: The effect of irradiation from the shots for other targets was not negligible in some cases. This difference of dose distribution should be considered in the analysis of clinical outcomes of cases with multiple targets treated in one session.     

Gamma knife radiosurgery for treatment resistant choroid plexus papillomas

Objective To report the results of gamma knife radiosurgery (GKR) for treatment resistant choroid plexus papillomas. Methods Six patients (median age 55 years; range 29-75) with residual (n = 2) or recurrent (n = 4) choroid plexus papillomas underwent GKR. All failed prior surgery and one failed prior proton beam radiation therapy. These six patients had a total of 11 locally or distant recurrent intracranial tumors. The median and mean tumor volumes were 2.7 and 3.9 cc (range, 0.23-21.1). A median margin dose of 12.0 Gy (range, 11.5-15) was prescribed to the tumor margin. Results The progression-free periods varied from 7 to 108 months (mean: 36.9). Four tumors were stable after GKR but seven showed progression. Four recurrent tumors in two patients were managed with repeat radiosurgery and three were observed. At the second GKR, the tumor volume varied from 1.3 to 12.4 cc, and the marginal radiation dose varied from 11 to 14 Gy. The overall survival after the first GKR varied from 15 to 120 months. Four patients were alive at the end of the study period. Conclusions Radiosurgery represents an additional management strategy for patients who progress despite surgical removal. It may especially be useful for patients with small deep seated residual choroid plexus papillomas, and for tumors that recur at a site distant from their origin.