伽玛刀治疗眶尖部海绵状血管瘤的临床观察

摘要

目的：探讨伽玛刀治疗眶尖部海绵状血管瘤的疗效及安全性。方法2005年3月至2013年6月我院收治16例眶尖部海绵状血管瘤患者，行伽玛刀分次立体定向放射治疗，2�3～5 Gy／次，分6～20次完成，中位剂量40 Gy（24～46 Gy）。治疗前及治疗后每6个月左右检查视力、视野、眼球突出度及眼眶MRI。采用RECIST 1�0版标准评价疗效。结果治疗后患者的肿瘤病灶不同程度缩小，获CR 5例，PR 7例，SD 4例，有效率为75�0％，疾病控制率为100�0％；其中视力提高10例，稳定1例，轻微下降2例，视力保存率为81�3％（13／16），其余3例为治疗前视力为手动或光感者消失；视野改善率81�3％，突眼改善率100�0％；复视、眼眶疼痛及头晕均消失；治疗期间3例轻度急性反应。患者治疗前后视力及突眼度分别为0�310±0�324和0�625±0�477、（15�500±2�066）mm和（14�875±1�708）mm，差异均有统计学意义（P＝0�001、0�007）。结论伽玛刀立体定向放射治疗眶尖部海绵状血管瘤安全有效，能改善视功能及眼球突出。%Objective To analyze the efficacy and side effects of gamma knife for orbit apex cavernous hemangioma. Methods From Mar. 2005 to Jun. 2013 in our hospital, 16 cases of orbital apex cavernous hemangioma were treated with gamma knife to perform fractionated stereotactic radiotherapy. A total dose was prescribed to the targets in 6⁃20 fractions of 2�3⁃5 Gy each. Visual a⁃cuity, visual field, the degree of exophthalmos and orbital MRI should be tested before treatment and at about each 6 months post⁃treat⁃ment. The median followed⁃up time was 21months(12⁃111 months) and ended in July 2014. Results All the tumors shrank in differ⁃ent degrees,including 5 cases of CR, 7 cases of PR and 4 cases of SD. The tumor response rate was 75�0%, and tumor control rate was 100�0%. The preservation rate of vision acuity was 81�3 %(10 cases increased, 1 case kept stable and 2 cases decreased mildly). Three cases with a visual acuity of hand movements or light perception disappeared. The improvement rate of vision field and exophthal⁃mos were 81�3% and 100�0%, respectively. All the symptoms including ambiopa, orbital ache and dizziness were disappeared. During the treatment, 3 cases showed mild acute reaction. The differences of the local efficacy and visual acuity change in all the dose groups were not significant(P>0�05). Before and after treatment, visual acuity(0�310±0�324 vs. 0�625±0�477)and exophthalmos(15�500± 2�066 mm vs. 14�875±1�708 mm) improved and there were statistical significance(P=0�001,P=0�007),respectively. Conclusion Gamma knife⁃stereotactic radiotherapy treatment for orbital apex cavernous hemangioma is safe and effective with the effect of impro⁃ving visual function and exophthalmos.