脑干胶质瘤三维适形放疗36例临床分析

目的分析接受三维适形放疗（3DCRT）脑干胶质瘤患者的生存时间及影响生存时间的相关因素。方法2004年10月至2008年12月36例明确诊断为脑干胶质瘤的患者，均给予局部病灶3DCRT，剂量50～54Gy，25～30次，5～6周。放疗期间观察并记录患者症状、体征及放疗不良反应，评价疗效，随访至诊断后3年，采用Kaplan—Meire法进行生存分析。结果儿童组（23例）中位生存时间9个月，成年人组（13例）中位生存时间15个月。儿童组及成年人组1、2、3年生存率分别为43．5％（10／23）与76．9％（10／13）、26．1％（6／23）与46．2％（6／13）、8．7％（2／23）与38．5％（5／13）。入院时Kamofsky评分（χ^2=20．059，P=0．000）、病变累及桥脑与否（χ^2=17．585，P=0．000）、影像学分型（χ^2=21．247，P=0．000）是影响患者生存的因素。结论3DCRT是脑干胶质瘤有效的治疗方法，儿童发病、病变侵袭桥脑、弥散型以及Kamofsky评分〈80分是预后不良的危险因素。

Clinical analysis of 3DCRT on brain stem glioma in 36 cases

Objective To analyse the survival time and related factors of patients with brain stem glioma who received 3DCRT. Methods Thirty-six patients with brain stem tumor were admitted from October 2004 to December 2008 and all received 3D-CRT with the dosage （50-54 Gy, 25-30 f, 5-6 weeks）. During treatment, the patients outcomes were analyzed by observing the changes of symptoms, signs and adverse radiotherapy reaction and all of them were followed-up in the next 3 years. The survival data were analyzed by Kaplan-Meire method. Results The median survival time was 9 months in the 23 pediatric patients and 15 months in 13 adult patients. One-, two- and three-year survival rates between pediatric group and the adult group were 43.5 % （10/13） vs 76.9 % （10/13）, 26.1% （6/23） vs 46.2 % （6/13）, 8.7 % （2/23） vs 38.5 % （5/13）. Karnofsky performance scale score at admission （χ^2 = 20.059, P = 0.000）, tumor site （χ^2= 17.585, P = 0.000）, growth pattern （χ^2= 21.247,P = 0.000） were associate with survival time. Conclusion 3DCRT is an effective therapy to brain stem glioma, childhood onset, pontine glioma, diffusion style and Karnofsky performance scale less than 80 are risk factors of poor prognosis.