CAJ | 학술논문

目的分析直径大于10 cm的巨大肾母细胞瘤术前三维适形放射治疗效果,探讨中晚期肾母细胞瘤更为有效的术前治疗方法.方法 32例患者均经影像学检查及穿刺活组织检查明确诊断,术前给予三维适形放射治疗,剂量分割方式:DT(150～200)cGy/次,5次/周,总剂量DT 800～2 000 cGy,中位剂量DT1 600 cGy.治疗中每周复查B型超声、CT测定肿瘤体积变化,患者一般情况好、肿瘤体积缩小1/3以上、肿瘤与毗邻重要脏器粘连缓解,及时请泌尿科会诊确定可以手术时,休息1周后行手术治疗.术中4例术中见有周围粘连者局部放置银夹标记,术后给予补充放疗DT1 000～2 000 cGy,中位剂量DT1 200 cGy.结果瘤体中位缩减率37.0％,术前放疗有效率100.0％,完整切除率87.5％,无手术相关死亡率,2年无瘤生存率达84.4％(27/32),5年无瘤生存率78.1％(25/32).结论巨大肾母细胞瘤术前三维适形放射治疗能缩小肿瘤,提高手术切除率,延长生存率.
목적 분석직경대우10 cm적거대신모세포류술전삼유괄형방사치료효과,탐토중만기신모세포류경위유효적술전치료방법.방법 32례환자균경영상학검사급천자활조직검사명학진단,술전급여삼유괄형방사치료,제량분할방식:DT(150～200)cGy/차,5차/주,총제량DT 800～2 000 cGy,중위제량DT1 600 cGy.치료중매주복사B형초성、CT측정종류체적변화,환자일반정황호、종류체적축소1/3이상、종류여비린중요장기점련완해,급시청비뇨과회진학정가이수술시,휴식1주후행수술치료.술중4례술중견유주위점련자국부방치은협표기,술후급여보충방료DT1 000～2 000 cGy,중위제량DT1 200 cGy.결과 류체중위축감솔37.0％,술전방료유효솔100.0％,완정절제솔87.5％,무수술상관사망솔,2년무류생존솔체84.4％(27/32),5년무류생존솔78.1％(25/32).결론 거대신모세포류술전삼유괄형방사치료능축소종류,제고수술절제솔,연장생존솔.
Objective To analyse the effectiveness of the preoperative 3-dimensional conformal radiotherapy for large nephroblastoma up to 10 centimeters in diameter,and to investigate more effective preoperative therapies for intermediate and advanced nephroblastoma.Methods 32 cases of nephroblastoma were treated with preoperative radiotherapy with a dose fractionation as follows:150-200 cGy/fraction,5 fraction/week,the total dose of 1 000-2 000cGy,the mean dose of 1 600 cGy.During the radiotherapy,the B ultrasonic examination and CT were performed weekly to measure the variation of tumor volumes.The time of operation were determined based on the overall health status of patients,the shrinkage of tumor,and adhesions between tumor and adjacent vital organs.Radiontherapy was terminated one week before operation.4 patients who were found tumor adhered to normal tissues around kidney during operation were placed silver clip,and were given postoperative radiotherapy with additional dose of 1 000-2 000 cGy and the mean dose of 1 200 cGy.Results The median tumor reduction rate was 37 ％.The effective rate of preoperative radiotherapy was 100 ％.The complete resection rate was 87.5 ％.2-years tumor-free survival rates was 84.4 ％ and 5-years was 78.1％.There was no surgery-related death.Conclusion Preoperative 3-dimensional conformal radiotherapy reduces tumor volume,and raises resection and survival rate.