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目的 评价伽玛刀对脑内胶质细胞瘤的治疗效果。方法 自 1996年 11月至 1999年 12月对 5 7例病理诊断明确的脑胶质瘤患者进行了伽玛刀治疗 ,其中男 35例 ,女 2 2例 ,年龄 7～ 6 8岁 ,平均 30 8岁。病变位于大脑半球 2 7例 ,丘脑及基底节区 2 2例 ,脑干 2例 ,小脑 2例。病理诊断 :星形细胞瘤Ⅰ级 7例 ,Ⅱ级 5例 ,Ⅰ～Ⅱ 18例 ,少枝胶质瘤 4例 ,室管膜瘤 2例 ,星形细胞瘤Ⅲ级 2例 ,Ⅳ级 2例 ,Ⅲ～Ⅳ级 13例 ,胶质母细胞瘤 4例。周边剂量为 12～ 2 2Gy ,平均为 16 5Gy。结果 随访时间为 6至 4 2个月 ,平均为 2 3个月。 36例低恶度胶质瘤的影像学复查结果 :显效 6例 ;有效 14例 ;微效 5例 ;无变化 6例 ;恶化 5例。有效率为 5 5 6 %。 2 1例高恶度胶质瘤中 2～ 3个月及远期影像有效率分别为 6 6 7%和 2 3 8%。 6 ,12 ,2 4 ,36个月的存活率分别为 :95 2 % (2 0 / 2 1) ;81 0 % (17/ 2 1) ;4 7 1% 9(8/ 17)和 33 3% (3/ 9)。 15例病人 (2 6 3% )于治疗后 12个月内出现放射性水肿。结论 伽玛刀对体积较小 ,边界相对较清的低恶度胶质瘤的治疗是有效的 ,对高恶度胶质瘤在短期内可有效地杀死靶区内肿瘤细胞并延缓肿瘤的生长 ,但并不能有效地控制周边肿瘤细胞生长和复发。
Objective To evaluate the therapeutic effect of gamma knife on glioma in the brain. Methods Fifty-seven patients with pathologically diagnosed gliomas underwent gamma knife treatment from November 1996 to December 1999. There were 35 males and 22 females, aged 7 to 68 years, with an average of 30 8 year-old. Lesions in the cerebral hemisphere 2 7 cases, thalamus and basal ganglia 2 2 cases, 2 cases of brain stem, 2 cases of cerebellum. Pathological diagnosis: astrocytoma grade Ⅰ in 7 cases, grade Ⅱ in 5 cases, Ⅰ ~ Ⅱ 18 cases, 4 cases of juvenile glioma, 2 cases of ependymoma, astrocytoma Ⅲ grade in 2 cases, Ⅳ grade 2 Cases, Ⅲ ~ Ⅳ grade 13 cases, glioblastoma in 4 cases. Peripheral dose of 12 ~ 2 2Gy, with an average of 16 5Gy. Results The follow-up time was 6 to 42 months with an average of 23 months. 36 cases of low-grade glioma imaging review results: 6 cases markedly effective; effective in 14 cases; 5 cases of micro-effect; no change in 6 cases; 5 cases of deterioration. The effective rate is 556%. The effective rates of 2 ~ 3 months and long-term imaging in 21 high-grade gliomas were 66.7% and 23.8%, respectively. Survival rates at 6, 12, 24, and 36 months were 95 2% (20/1), 81 0% (17/2 1), 471% 9 (8/17) and 33 3 % (3/9). Fifteen patients (26.3%) developed edema within 12 months of treatment. Conclusions Gamma knife is effective in treating low-grade gliomas with relatively small volume and relatively clear border. In the short-term, high-grade gliomas can effectively kill tumor cells in the target area and delay tumor Growth, but it can not effectively control the surrounding tumor cell growth and recurrence.