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題名 | 成人低惡性度顱內星狀細胞瘤之術後放射治療=Posoperative Radiotherapy for Adult Intracranial Low Grade Astrocytoma |
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作者 | 張東杰; 容世明; 魏國珍; 曾振凎; 陳尚文; | 書刊名 | 放射治療與腫瘤學 |
卷期 | 5:4 1998.12[民87.12] |
頁次 | 頁269-276 |
分類號 | 416.291、416.291 |
關鍵詞 | 顱內星狀細胞瘤; 預後因子; 放射治療; 存活率; Intracranial low grade astrocytoma; Radiotherapy; Survial; |
語文 | 中文(Chinese) |
中文摘要 | 目的:低惡性度腦瘤的術後放射治療,尤其是星狀細胞瘤的處理是個爭議性的課 題,本研究探討低惡性度星狀細胞腦瘤的預後因子並對其治療做一個回顧與評估。材料與方 法:1979 年至 1988 年間, 共有 46 位低惡性度星狀細胞腦瘤的成人患者在林口長庚醫院 完成術後放射治療。他們年紀從 15 歲至 63 歲,中間值是 32 歲。有 25 位男性,21 位 女性。 根據 Kernohan 的病理分期標準,這些病人有 10 位患者屬第一級,36 位屬第二級 。其中 11 位病人接受腫瘤完全切除術,17 位接受部份切除術,而另 18 位只接受切片檢查 ,並沒有切除腫瘤。開刀後,46 位患者都有很好的行動指標 (Performance status)。每位 病人都接受 Co-60 或百萬電子伏特以上的光子射線治療。 治療劑量從 44-66 Gy 不等,劑 量的中間值是 60 Gy。沒有患者在一開始便接受化學治療。結果:五年的存活率是 49%,女 性比男性患者有較好的存活率 (54% vs. 24%, P=0.015); 年齡小於或等於 30 歲者比年紀 大的病人有較好的治療結果 (47% vs. 30%, P=0.035); 病理分期屬第一級者比第二級者預 後較好 (69% vs. 30%, P=0.04);開刀範圍的大小並不影嚮預後,但有開刀切除者比只做切 片者有較好的五年存活率 (44% vs. 32%, P=0.05);術後放射治療劑量的高低對預後並無實 質的影響。結論:根據我們治療的結果發現低惡性度星狀細胞瘤病人接受術後放射治療的結 果並不佳,其中更以 Kernohan 第二級病人的表現較差。因此尋求更積極有效的治療方式應 是優先考量的課題。 |
英文摘要 | Purpose:It got no consensus about the therapy of low grade glioma, especially for the low grade astrocytoma. We have retrospectively reviewed the results of radiotherapy for low grade astrocytoma, and define the role of postoperative radiotherapy in the treatment of low grade astrocytoma. Materials and Methods:From 1979 to 1988, 46 adult patients with low grade astrocytoma received postoperative radiotherapy in Chang Gung Memorial Hospital --Linkou Medical Center. The median age of these patients was 32 years old with the range from 15 to 63. There were 25 male and 21 female. According to the Kernohan's grading system, 10 patients' tumors belonged to grade 1 and the others belonged to grade 2. Eleven patients received total removal of tumors, 17 patients received subtotal excision of tumors, and 18 patients received biopsy only. All patients had good performance status (Karnofsky scale>70) after operation. For radiotherapy, the median total dose was 6000 cGy on each patient, ranging from 4400 to 6600 cGy. No patient received chemotherapy at the beginning. Result:The overall 5 year survival was 79%. Female had better survival than male (54% vs 24%, p=0.015). Younger patients had better results than older patients (47% vs 30%, p=0.04). Patients with grade Ⅰ tumors had better survival than patients with grade Ⅱ tumors (69% vs 30%. p=0.04). Patients received excision surgery had better survival rate (44% vs 32%, p=0.05), but the extent of surgery did not make the difference. Total radiation dose did not significantly change the survival result. Discussion:The low grade astrocytoma patients showed poor survival rate after radiotherapy, especially for patients with group Ⅱ tumor. To properly treat patients with low-grade astrocytoma is a more important issue than to consider the incidence of radiation complication. |
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