摘要
目的采用调强适形放疗后结合伽玛刀推量治疗颅内高级别胶质瘤术后残留,分析其疗效并探讨其影响预后的因素。方法脑胶质瘤（Ⅲ~Ⅳ）患者采用调强适形放后结合伽玛刀推量的方法。2010-2013年间27名胶质瘤患者采用调强适形放疗后1~3个月内复查提示病灶仍有活性、KPS评分基本稳定且未口服过替莫唑胺化疗的患者,其中15名患者入组本次补量观察。调强放疗处方剂量：PGTVtb 64.2Gy/2.14Gy/30f,PTV1：60Gy/2.0Gy/30f,PTV2：54Gy/1.8Gy/30f。伽玛刀主要为GTV追加剂量,分上下午两次给予,以40%~60%等剂量曲线覆盖肿瘤周边剂量6~9Gy。Kaplan-Meier法计算总生存率,log-rank法比较生存率差异。结果推量后影像复查有效率为73.3%,较推量前局控率明显提高（P=0.009〈0.05）。1、2、3年生存率两组相比χ2=0.244,P=0.621〉0.05,说明两组处理对生存曲线影响无意义。推量后KPS评分较补量前明显改善（t=7.897,P=0.00〈0.05）,与同期拒绝组73±6相比提高明显（t=2.1,P=0.046〈0.05）。结论调强适形放疗结合伽玛刀2次分割补量发挥了放射物理剂量优势,又符合放射生物学原则,明显提高了病灶局部控制率及改善了患者的生存质量（KPS）,提高了生存机会。
Objective using intensity-modulated radiation therapy（IMRT） combined with gamma knife integrated boost technique to treat of postoperative residual of intracranial high-grade gliomas,analyses the initial clinical effects and explore its prognostic factors. Methods The glioma（Ⅲ~Ⅳ） were treated with intensity-modulated radiation therapy combined with gamma knife integrated boost technique. 27 glioma patients treated by IMRT review lesions prompted to be still active within 1 to 3 months during 2010-2013, their KPS score keep basically stable and without chemotherapy by oral temozolomide, 15 patients of them were enrolled into the integrated boost observetion. Prescription dose： PGTVtb 64.2Gy/2.14Gy/30 f, PTV1： 60Gy/2.0Gy/30 f, PTV2： 54Gy/1.8Gy/30 f. Gamma Knife primarily add dose for the GTV, gived in the Morning and afternoon as twice, with the 40% to 60% isodose curve to Covering the tumor margin dose by 6~9Gy. Kaplan-Meier method to calculate overall survival, using the log-rank test to compare survival rates. Results the patient with Gamma Knife integrated boost with the effecience rate of 73.3%, the local control rate was significantly improved by contrast to the Gamma Knife treatment with the effecience rate of 20% by the chi-square test P=0.0090.05. The treatment of two groups had any Meaning to do with the survival curve byχ2= 0.244, P=0 6210.05. KPS is improved Obvious by compared with the refused-group. Conclusion IMRT with Gamma Knife twice split integrated boost get the the advantages of radiation physics dose, and it is consist with the principles of radiobiology,it improves local control rate and improve the quality of the survival patients（KPS）, and the chances of survival for the patients.
出处
《疾病监测与控制》
2014年第11期681-683,共3页
Journal of Diseases Monitor and Control
关键词
脑胶质瘤
调强适形
伽玛刀
推量
Glioma
intensity-modulated radiation therapy
Gamma Knife
integrated boost
