中华放射医学与防护杂志
中華放射醫學與防護雜誌
중화방사의학여방호잡지
Chinese Journal of Radiological Medicine and Protection
2010年
6期
721-724
,共4页
严丹方%严森祥%杨劲松%孙晓丽%陆中杰
嚴丹方%嚴森祥%楊勁鬆%孫曉麗%陸中傑
엄단방%엄삼상%양경송%손효려%륙중걸
神经胶质瘤%调强放射疗法%生存质量%认知功能%记忆下降
神經膠質瘤%調彊放射療法%生存質量%認知功能%記憶下降
신경효질류%조강방사요법%생존질량%인지공능%기억하강
Glioma%Intensity-modulated radiotherapy%Quality of life%Cognitive function%Memory disorder
目的 评价调强放疗(IMRT)对术后脑神经胶质瘤患者的初步疗效及生存质量影响.方法 回顾分析2007-2009年本院初治、病理确诊的神经胶质瘤患者37例,全部行显微镜下肿瘤切除术.术后2~4周行IMRT,2.0 Gy/次,5次/周,至40~50 Gy后适当缩野并加量至50~60 Gy.参考欧洲肿瘤研究与治疗组织建议勾画靶区:大体肿瘤靶区(GTV):低级别神经胶质瘤为术前T2加权(T2WI)磁共振成像(MRI)上高信号区范围及术后瘤腔,高级别神经胶质瘤为术前T1加权(T1WI)增强MRI上异常强化区及术后瘤腔;临床靶区(CTV):低级别神经胶质瘤为GTV+1.5 cm,高级别为GTV+2.5 cm;计划靶区(PTV):CTV+0.4 cm.观察半年生存率、1年生存率及无进展生存时间.比较所有患者治疗前后的卡氏评分与量化后的乏力症状以及头痛、嗜睡、认知障碍、记忆力下降、个性行为、言语障碍、癫痫发作、感觉神经异常、运动神经异常等脑功能改变情况,探讨影响生存质量的相关因素.结果 中位随访时间13个月,半年生存率100%,1年生存率79.2%,中位无进展生存时间10个月,半年无进展生存率87.5%,1年无进展生存率82.4%.生存质量改变以疲乏感、轻度记忆下降及认知功能障碍为主,影响记忆改变的主要因素是放射剂量,而疲乏感只与年龄有关.结论 IMRT对脑神经胶质瘤有较好的局控率,同时有利于改善患者的生存质量.
目的 評價調彊放療(IMRT)對術後腦神經膠質瘤患者的初步療效及生存質量影響.方法 迴顧分析2007-2009年本院初治、病理確診的神經膠質瘤患者37例,全部行顯微鏡下腫瘤切除術.術後2~4週行IMRT,2.0 Gy/次,5次/週,至40~50 Gy後適噹縮野併加量至50~60 Gy.參攷歐洲腫瘤研究與治療組織建議勾畫靶區:大體腫瘤靶區(GTV):低級彆神經膠質瘤為術前T2加權(T2WI)磁共振成像(MRI)上高信號區範圍及術後瘤腔,高級彆神經膠質瘤為術前T1加權(T1WI)增彊MRI上異常彊化區及術後瘤腔;臨床靶區(CTV):低級彆神經膠質瘤為GTV+1.5 cm,高級彆為GTV+2.5 cm;計劃靶區(PTV):CTV+0.4 cm.觀察半年生存率、1年生存率及無進展生存時間.比較所有患者治療前後的卡氏評分與量化後的乏力癥狀以及頭痛、嗜睡、認知障礙、記憶力下降、箇性行為、言語障礙、癲癇髮作、感覺神經異常、運動神經異常等腦功能改變情況,探討影響生存質量的相關因素.結果 中位隨訪時間13箇月,半年生存率100%,1年生存率79.2%,中位無進展生存時間10箇月,半年無進展生存率87.5%,1年無進展生存率82.4%.生存質量改變以疲乏感、輕度記憶下降及認知功能障礙為主,影響記憶改變的主要因素是放射劑量,而疲乏感隻與年齡有關.結論 IMRT對腦神經膠質瘤有較好的跼控率,同時有利于改善患者的生存質量.
목적 평개조강방료(IMRT)대술후뇌신경효질류환자적초보료효급생존질량영향.방법 회고분석2007-2009년본원초치、병리학진적신경효질류환자37례,전부행현미경하종류절제술.술후2~4주행IMRT,2.0 Gy/차,5차/주,지40~50 Gy후괄당축야병가량지50~60 Gy.삼고구주종류연구여치료조직건의구화파구:대체종류파구(GTV):저급별신경효질류위술전T2가권(T2WI)자공진성상(MRI)상고신호구범위급술후류강,고급별신경효질류위술전T1가권(T1WI)증강MRI상이상강화구급술후류강;림상파구(CTV):저급별신경효질류위GTV+1.5 cm,고급별위GTV+2.5 cm;계화파구(PTV):CTV+0.4 cm.관찰반년생존솔、1년생존솔급무진전생존시간.비교소유환자치료전후적잡씨평분여양화후적핍력증상이급두통、기수、인지장애、기억력하강、개성행위、언어장애、전간발작、감각신경이상、운동신경이상등뇌공능개변정황,탐토영향생존질량적상관인소.결과 중위수방시간13개월,반년생존솔100%,1년생존솔79.2%,중위무진전생존시간10개월,반년무진전생존솔87.5%,1년무진전생존솔82.4%.생존질량개변이피핍감、경도기억하강급인지공능장애위주,영향기억개변적주요인소시방사제량,이피핍감지여년령유관.결론 IMRT대뇌신경효질류유교호적국공솔,동시유리우개선환자적생존질량.
Objective To evaluate treatment outcomes and quality of life (QOL) in glioma patients treated with postoperative intensity-modulated radiotherapy (IMRT), and to explore the possible clinical factors of affecting QOL. Methods From 2007 to 2009, 37 patients with low or high grade glioma were analyzed retrospectively. All patients were operated by tumor resection below microscopy. IMRT began at 2-4 week postoperstion with 2.0 Gy/fractior, 5 fractions/week and to shrink portal and to add dose to 50-60 Gy/25-30 fractions after 40-50 Gy. The gross tumor volume (GTV) was defined as preoperation T2WI MRI high sign area and postoperation tumor cavity for low grade glioma, and with preoperation T1WI MRI enhanced abnormity area and postoperation tumor cavity for high grade glioma. The clinical target volume ( CTV ) was defined as GTV with a margin of 1.5 cm for low grade glioma and a margin of 2.5 cm for high grade ghoma, the planning target volume (PTV) with CTV plus 0.4 cm margin for setup errors according to the European Organization for Research and Treatment of Cancer ( EORTC ).The treatment outcomes and QOL were assessed. Results The half-year and one-year survival rates for all the patients were 100% and 79.2%, respectively. The median progression-free survival time was 10 months. The main side-responses after postoperative IMRT were fatigue and mild memory decline or cognitive disabilities, which were radiation dose-dependent. Conclusions Postoperative IMRT is an effective and safe modality of therapy for glioma patients.