CAJ | 학술논문

目的评价伽玛刀联合立体定向囊内间质内放疗治疗囊实体混合性颅咽管瘤的远期疗效.方法回顾性分析1996年10月至2005年12月接受伽玛刀联合立体定向囊内间质内放疗治疗并至少生存5年的67例囊实体混合性颅咽管瘤患者资料.男性39例,女性28例;年龄3～ 70岁,平均31.5岁.随访内容包括临床评估(神经检查、神经眼科和神经内分泌学检查)、综合生活质量评价、神经影像学检查、生存率和生存期分析.采用x2检验,Kaplan-Meier法计算生存率.结果随访时间60～168个月,平均114个月,伽玛刀联合立体定向囊内间质内放疗治疗对大实体小囊性、大囊性小实体颅咽管瘤以及总体有效控制率分别为10/12、90.9％和89.6％.本组患者的平均生存时间为(110±9)个月.大实体小囊性和大囊性小实体肿瘤患者的平均生存时间为(97±12)和(120±14)个月,10年实际生存率分别为7/12和69.1％.两组患者的肿瘤控制率和10年生存率间差异无统计学意义(x2 =0.114和1.541,P ＞0.05).5～10年的实际生存率分别为90.5％、85.7％、83.3％、76.4％、69.4％和60.0％.视力受损者术后6个月和长期随访的改善率分别为68.3％和70.0％.67例患者末次随访时综合生活质量评价28例(41.8％)优,19例(28.4％)良,17例(25.4％)可,3例(4.5％)差.治疗后6 ～12个月4例视力下降,4例出现新的丘脑下部功能受损表现,1例于术后5年出现一侧动眼神经不全麻痹,并发症发生率为13.4％.结论伽玛刀联合立体定向间质内放疗为囊实混合性颅咽管瘤提供了良好的肿瘤控制率和理想的远期生存率,是一种安全有效的治疗选择.
목적 평개가마도연합입체정향낭내간질내방료치료낭실체혼합성로인관류적원기료효.방법 회고성분석1996년10월지2005년12월접수가마도연합입체정향낭내간질내방료치료병지소생존5년적67례낭실체혼합성로인관류환자자료.남성39례,녀성28례;년령3～ 70세,평균31.5세.수방내용포괄림상평고(신경검사、신경안과화신경내분비학검사)、종합생활질량평개、신경영상학검사、생존솔화생존기분석.채용x2검험,Kaplan-Meier법계산생존솔.결과 수방시간60～168개월,평균114개월,가마도연합입체정향낭내간질내방료치료대대실체소낭성、대낭성소실체로인관류이급총체유효공제솔분별위10/12、90.9％화89.6％.본조환자적평균생존시간위(110±9)개월.대실체소낭성화대낭성소실체종류환자적평균생존시간위(97±12)화(120±14)개월,10년실제생존솔분별위7/12화69.1％.량조환자적종류공제솔화10년생존솔간차이무통계학의의(x2 =0.114화1.541,P ＞0.05).5～10년적실제생존솔분별위90.5％、85.7％、83.3％、76.4％、69.4％화60.0％.시력수손자술후6개월화장기수방적개선솔분별위68.3％화70.0％.67례환자말차수방시종합생활질량평개28례(41.8％)우,19례(28.4％)량,17례(25.4％)가,3례(4.5％)차.치료후6 ～12개월4례시력하강,4례출현신적구뇌하부공능수손표현,1례우술후5년출현일측동안신경불전마비,병발증발생솔위13.4％.결론 가마도연합입체정향간질내방료위낭실혼합성로인관류제공료량호적종류공제솔화이상적원기생존솔,시일충안전유효적치료선택.
Objective To evaluate the long-term results of combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy for mixed cystic and solid craniopharyngiomas.Methods Sixty-seven consecutive patients with mixed cystic and solid craniopharyngioma treated by Gamma Knife radiosurgery combined with stereotactic brachytherapy from October 1996 to December 2005 were selected for retrospective analysis.The inclusion criterion was the patients who survived for at least 5 years after combined treatment.There were 39 male and 28 female patients and the mean age was 31.5 years (ranged from 3 to 70 years).The clinical evaluations including neurological,neuro-ophthalmological,and neuro-endocrinological examinations,assessment of comprehensive quality of life and neuroimaging examinations were performed periodically.The actuarial survival rates and the mean survival time were calculated by using Kaplan-Meier product limit method.The rates were compared using the x2 test.Results Follow-up period varied from 60 to 168 months,with an average of 114 months.The tumor response rate gained from combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy for predominantly solid and cystic craniopharyngiomas were 10/12 and 90.9％ respectively,and 89.6％ in all.Mean survival after combination treatment was (110 ± 9) months.The mean survival of patients with predominantly solid and cystic craniopharyngioma were(97 ± 12) months and (120 ± 14) months and the actuarial 10-year survival rates were 7/12 and 69.1％.There was no statistics difference in tumor response rate and 10-year survival arate between 2 groups of patients with predominantly solid and cystic craniopharyngioma.The actuarial 5-,6-,7-,8-,9-and 10-year survival rates were 90.5％,85.7％,83.3％,76.4％,69.4％ and 60.0％respectively.The decreased visual acuity had improved in 68.3％ at 6 months postoperatively and in 70.0％in long term results.Comprehensive quality of life in long term follow-up of 67 patients was excellent in 28 cases(41.8％),good in 19 cases(28.4％),fair in 17 cases(25.4％) and poor in 3 cases(4.5％),respectively.The side effects that occurred 6 to 12 months after treatment were worsening of visual acuity (4 patients),dysfunction of hypothalam (4 patients) and third nerve palsy was found in 1 patents 5 years after treatment.The rate of complications was 13.4％.Conclusion Combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy is highly effective and safety in the treatment of mixed cystic and solid craniopharyngiomas.