目的评估伽玛刀治疗（gamma knife surgery,GKS）颅内多发血管母细胞瘤（hemangioblastoma，HB）的疗效，探讨治疗适应证。方法回顾性分析2000年1月至2013年3月间本院采用GKS治疗的24例患者的临床资料，散发性患者4例，VHL综合征（von hippel-lindau综合征的简称，即中枢神经系统HB合并肾脏或胰腺囊肿、嗜铬细胞瘤、肾癌以及外皮囊腺瘤等疾病）患者20例。共治疗肿瘤103个，肿瘤体积0.005～9.8cm3，平均（0.67±1.49）cm3，周边剂量10.5～20.0Gy（中位15Gy），中心剂量20～33.3Gy（中位28Gy）。结果平均随访81个月，103个肿瘤中33个（32%）缩小，59个（57%）无改变，11个（11%）肿瘤增大，GKS治疗后5年和10年的肿瘤实际控制率分别为90%和79%。最后随访时，7例患者因治疗肿瘤复发再次手术，所有患者均未发现放射相关并发症。结论 GKS治疗中小型实性HB安全、有效，可以用于治疗有生长趋势的HB。临床随访需注意散发HB术后是否播散，早期发现的小瘤灶可选择GKS。%0bjecfive To evaluate the efficacy of gamma knife surgery(GKS) for intracranial multiple hemangioblastomas and discuss the clinical indications for GKS.MethodRetrospective analysis of clinical data of 24 patients treated with gamma knife in our hospital from January 2000 to March 2013.4 patients had sporadic hemangioblastomas and 20 had VHL-related hemangioblastomas .The tumor volume ranged from 0.005 to 9.8cm3 [mean volume (0.67±1.49)cm3]. The median margin dose was 15Gy (range,10.5 to 20 Gy). The median central dose was 28Gy (range,20 to 33.3Gy).ResultThe mean follow-up duration was 81 months. Of the 103 tumors, 11 tumors increased in size (11%), 33 decreased (32%), and 59 were stable (57%). The control local tumor rate was 90% at 5 years, and 79% at 10 years. At the last clinical follow-up,7 patients with tumor progression had surgery following GKS and all patients didn’t develop adverse radiation effects.ConclusionGKS is an effective and safe treatment for small or medium, solid hemangioblastomas.GKS can be applied for treatment of growing tumors.Clinical follow-up needs to pay attention to the dissemination of sporadic hemangioblastomas.Small disseminated focis which are detected early should actively choose gamma knife treatment.
展开▼
