伽玛刀治疗中晚期贲门癌的临床观察

目的：探讨立体定向伽玛刀放射治疗中晚期贲门癌的近期疗效及可行性。方法：对2005年1月至2008年1月我院收治的43例中晚期贲门癌患者，进行立体定向伽玛刀放射治疗。患者均以仰卧位用负压袋固定、经CT扫描定位，将定位图像输入γ-TPS系统，由医师确定精确的靶区，由物理师设计靶点，调整剂量分布，尽量避开肝脏和胰腺、肾脏等正常组织，以50％-85％的剂量曲线包绕靶区，肿瘤边缘剂量DT2．5—3．2Gy／f，3f／W，总量DT20—32Gy／8—10f。CT定位及每次治疗前，患者均定量充盈胃腔。比较患者放疗前、后的钡餐及CT片中病灶的大小、临床症状，统计生存率并观察放疗反应。结果：伽玛刀放射治疗后，43例患者均有不同程度的症状改善（上腹疼痛不适减轻23例，呕血黑便停止2例，进食改善17例，体重增加20例）；3月时复查钡餐或CT，总有效率为72．09％，其中病灶完全缓解4．65％（2／43），部分缓解67．44％（29／43），无变化27．91％（12／43），恶化0。治疗后1年、2年总体生存率分别为51．16％（22／43），25．58％（11／43），中位生存期为18．2月。放疗反应：腹痛腹胀55．8％（15例出现，9例加重，24／43），骨髓抑制18．6％（8／43），放射性胃炎4．7％（2／43）。全部患者配合对症支持治疗后，放疗反应逐渐恢复，肝肾功能基本正常，并均按计划完成放疗。结论：伽玛刀治疗中晚期贲门癌有显著的近期疗效，放疗反应较轻，是中晚期贲门癌姑息治疗的可行方案之一。

clinical observation of Gamma knife treatment for advanced cardiac cancer

Objective： To investigate the short - term efficacy and feasibility of Gamma knife stereotactic radiother apy for advanced cardiac cancer. Methods ： From January 2005 to January 2008,43 patients with advanced gastric car dia cancer in our hospital were treated by Gamma knife stereotactic radiotherapy. First, patients were fixed by vacuum bag in supine position and scanned by CT. The positioning images were inputted into β-TPS. Second, the precise tar get were determined by the doctors and the radiation therapy planning were designd by physicians, adjusting the dose distribution as far as possible to avoid the liver and pancreas, kidneys and other norms] tissues,50% -85% of the dose curve enveloping the target,tumor margins] dose DT 2.5 - 3.2Gy/f,3tVW,the total DT 20 - 32Gy/8 - 10f. Pa tients were quantitative gastric cavity filling beforo CT positioning and treatment each time. The barium meal, size of tumors, clinics] symptoms, survival rate and side -- effcets were compared before and after Gamma knife treatment. Results：Mter Gamma knife treatment, symptoms of 43 patients improved in varying degrees（ Epigastric pain reduced in 23 cases, hematemesis stopped in 2 cases, taking food improved in 17 eases and weight gain in 20 cases）. Reviewed with barium or CT after three months, the total effective rate was 72.09%, of which 4.65% complete remissed （2/ 43 ） ,67.44% partial remissed （29/43） ,27.91% （12/43） didnt change. The overall survival rates of 1 year and 2 -year after treatment were 51.16% （22/43） ,25.58% （11/43） respectively. The median survival time was 18.2 months. The side - effects of treatment maily were： abdominal distension 55.8% （24/43,15 eases of the emergence, nine cases of aggravated）, myelo - suppression 18.6% （ 8/43 ）, radiation gastritis of 4.7 % （ 2/43 ）. With symptomatic support therapy, radiotherapy side - effects restorated gradually, liver and renal function were normal, and radiation therapy course finished in all patients. Conclusion：Gamma knife treatment for advanced gastric cardia cancer is sig nificantly effective in short - tenn with less radiation reaction. It is one of palliative therapy for advanced cardiac caneor.