实用癌症杂志
實用癌癥雜誌
실용암증잡지
The Practical Journal of Cancer
2015年
10期
1443-1448
,共6页
陈志萍%溝脇尚志%小倉健%宇藤惠%平岡眞寛
陳誌萍%溝脇尚誌%小倉健%宇籐惠%平岡眞寛
진지평%구협상지%소창건%우등혜%평강진관
听神经瘤%立体定向技术%放射治疗%分割模式
聽神經瘤%立體定嚮技術%放射治療%分割模式
은신경류%입체정향기술%방사치료%분할모식
Acoustic neuroma%Stereotaxic techniques%Radiotherapy%Dose fractionation
目的:评价大剂量分割立体定向放疗(hypo-FSRT)治疗听神经瘤患者在肿瘤局部控制及有效听力保存等方面的临床价值。方法回顾性分析47例单侧听神经瘤患者,中位年龄61岁,放疗前19例患者持有有效听力,肿瘤最大径中位值20 mm,处方剂量:等中心总剂量25 Gy,5次分割,每日1次,80%剂量曲线包绕计划靶区( PTV)边缘。采用实体瘤消退评价标准( RECIST)改良版1.1评估肿瘤消退情况。采用Gardner-Robertson Class 评估听力保存情况。 SPSS 18.0软件进行统计分析。结果中位随访及听力随访时间分别为61及52个月,30例(63.8%)、13例(27.67%)及4例(8.5%)患者分别出现肿瘤部分缩退(PR)、稳定(SD)、进展(PD),根据Kaplan-Meier生存分析,5年肿瘤局部控制率为90.4%,放疗前肿瘤是否合并囊变成分在肿瘤控制方面存在显著性差异(P=0.015),合并囊变的肿瘤预示放疗后出现肿瘤进展的可能性大。放疗后14例(29.8%)患者出现肿瘤暂时性增大。1、3、5年患者有效听力保存率分别为68.4%,62.1%及35.5%。有效听力保存与未保存患者在肿瘤消退情况方面存在明显差异(P=0.017)。1例(2.1%)患者行挽救性手术,2例(4.3%)患者行VP-脑室分流术,2例(4.3%)患者新出现三叉神经轻度麻痹。结论 Hypo-FSRT (25 Gy/5次)治疗单侧听神经瘤可有效控制肿瘤,放疗后并发症发生率低。影像定期随访中观察到肿瘤暂时性增大及逐渐缩退过程。放疗前肿瘤合并囊变预示患者放疗后出现肿瘤进展的机率更高。
目的:評價大劑量分割立體定嚮放療(hypo-FSRT)治療聽神經瘤患者在腫瘤跼部控製及有效聽力保存等方麵的臨床價值。方法迴顧性分析47例單側聽神經瘤患者,中位年齡61歲,放療前19例患者持有有效聽力,腫瘤最大徑中位值20 mm,處方劑量:等中心總劑量25 Gy,5次分割,每日1次,80%劑量麯線包繞計劃靶區( PTV)邊緣。採用實體瘤消退評價標準( RECIST)改良版1.1評估腫瘤消退情況。採用Gardner-Robertson Class 評估聽力保存情況。 SPSS 18.0軟件進行統計分析。結果中位隨訪及聽力隨訪時間分彆為61及52箇月,30例(63.8%)、13例(27.67%)及4例(8.5%)患者分彆齣現腫瘤部分縮退(PR)、穩定(SD)、進展(PD),根據Kaplan-Meier生存分析,5年腫瘤跼部控製率為90.4%,放療前腫瘤是否閤併囊變成分在腫瘤控製方麵存在顯著性差異(P=0.015),閤併囊變的腫瘤預示放療後齣現腫瘤進展的可能性大。放療後14例(29.8%)患者齣現腫瘤暫時性增大。1、3、5年患者有效聽力保存率分彆為68.4%,62.1%及35.5%。有效聽力保存與未保存患者在腫瘤消退情況方麵存在明顯差異(P=0.017)。1例(2.1%)患者行輓救性手術,2例(4.3%)患者行VP-腦室分流術,2例(4.3%)患者新齣現三扠神經輕度痳痺。結論 Hypo-FSRT (25 Gy/5次)治療單側聽神經瘤可有效控製腫瘤,放療後併髮癥髮生率低。影像定期隨訪中觀察到腫瘤暫時性增大及逐漸縮退過程。放療前腫瘤閤併囊變預示患者放療後齣現腫瘤進展的機率更高。
목적:평개대제량분할입체정향방료(hypo-FSRT)치료은신경류환자재종류국부공제급유효은력보존등방면적림상개치。방법회고성분석47례단측은신경류환자,중위년령61세,방료전19례환자지유유효은력,종류최대경중위치20 mm,처방제량:등중심총제량25 Gy,5차분할,매일1차,80%제량곡선포요계화파구( PTV)변연。채용실체류소퇴평개표준( RECIST)개량판1.1평고종류소퇴정황。채용Gardner-Robertson Class 평고은력보존정황。 SPSS 18.0연건진행통계분석。결과중위수방급은력수방시간분별위61급52개월,30례(63.8%)、13례(27.67%)급4례(8.5%)환자분별출현종류부분축퇴(PR)、은정(SD)、진전(PD),근거Kaplan-Meier생존분석,5년종류국부공제솔위90.4%,방료전종류시부합병낭변성분재종류공제방면존재현저성차이(P=0.015),합병낭변적종류예시방료후출현종류진전적가능성대。방료후14례(29.8%)환자출현종류잠시성증대。1、3、5년환자유효은력보존솔분별위68.4%,62.1%급35.5%。유효은력보존여미보존환자재종류소퇴정황방면존재명현차이(P=0.017)。1례(2.1%)환자행만구성수술,2례(4.3%)환자행VP-뇌실분류술,2례(4.3%)환자신출현삼차신경경도마비。결론 Hypo-FSRT (25 Gy/5차)치료단측은신경류가유효공제종류,방료후병발증발생솔저。영상정기수방중관찰도종류잠시성증대급축점축퇴과정。방료전종류합병낭변예시환자방료후출현종류진전적궤솔경고。
Objective To study the clinical outcomes of hypofractionated stereotactic radiotherapy ( hypo-FSRT) for a-coustic neuromas (ANs).Methods 47 patients with unilateral acoustic neuroma were treated consecutively with hypo -FSRT. The median age was 61 years old.19 patients kept serviceable hearing status prior to hypo-FSRT.The median value of the maxi-mum diameter was 20 mm.25 Gy in 5 fractions in a week was prescribed at the isocenter and the planning target volume ( PTV) was covered by the 80%isodose line.Statistical analyses were performed with IBM SPSS statistics version 18 (sig.P<0.05). Results The median follow-up and audiometric follow-up were 61 and 52 months,respectively.Estimated local progression-free probability at 5 years were 90.4%.Existence of cystic component before hypo-FSRT had a significantly worse impact on local control (P=0.015).Temporary expansion of tumors was observed in 14 patients (29.8%).Estimated hearing preservation prob-ability at 1,3 and 5 years was 68.4%,62.1% and 35.5%,respectively.Hearing preservation was significantly related to tumor response (better in PR cases,P=0.017).Salvage surgery and VP-shunt surgery was required in one and two cases ,respectively. 2(4.3%) patients experienced newly mild symptom in trigeminal nerve function .Conclusion Hypo-FSRT in 5 fractions for uni-lateral acoustic neuroma can achieve excellent tumor local control with no severe facial and trigeminal complications .Tumor ex-pansion during the imaging follow-up is observed while majority is temporary .Cystic ANs has higher risk of tumor progression .