分次伽玛刀联合替莫唑胺化疗治疗成人幕上高级别胶质瘤的分析-外科学专业论文.docxVIP

PAGE PAGE 10 周边剂量平均为 16Gy(10-22Gy). 伽玛刀分次伴化疗治疗组与单次伽 玛刀伴化疗治疗组疗效比较与治疗后不良反应发生几率比较都具有 统计学意义（X2 =5.223，P=0.022＜0.05）。而对于周边剂量而言，周 边剂量越大，肿瘤的控制率就越好（X2 =5.822，P=0.016＜0.05）。而 在 Cox 回归模型中，6 个候选因素中，性别、年龄、术后肿瘤残留大 小、级别、肿瘤发生部位、手术后症状与患者预后没有相关性，而周 边剂量大小与肿瘤的局部控制和患者预后密切相关(P=0.03＜0.05)。 结论：手术后伽玛刀分次治疗伴化疗比单次伽玛刀治疗伴化疗的肿瘤 局部控制要好，更能改善患者预后，改善生存质量，提高生存率，降 低不良反应和并发症的发生率。伽玛刀联合替莫唑胺能够起协同作 用，增强对肿瘤进展的局部控制。伽玛刀治疗术后高级别胶质瘤是可 行的一种安全有效的方法。本研究样本病例偏少，所得的结论还需经 过以后长期临床的大量不断检验。 关键词： 伽玛刀 替莫唑胺 高级别胶质瘤 立体定向放射外科 Fractionated gamma knife and synchronous chemotherapy in the treatment of adult supratent- orial high-grade glioma Postgraduate: Yang Jian-bo Tutor:Prof.Lei jin Abstract Background and Purpose: Glioma , the majority of which is high-grade gliomas, glioblastoma (GBM) mainly, represent the most common form of intracranial primary tumor. Since the aggressive growth character of high-grade gliomas, it is hard to be complete resected and easy to relapse. Surgical resection followed by radiotherapy and chemotherapy in the treatment of glioma is vrey important. However, the tolerance dose of normal brain as well as the functional areas of brain to radiotherapy limits the increase of radiation therapy dose, and the overall efficacy of radiotherapy is unsatisfactory, and expand the range of irradiation or change the dose fractionation can not significantly improve the quality of life andsurvival rate. This, stereotactic radiosurgery (SRS) is a safe and effective treatment of postoperative residual tumor or unresectable tumor lesions, such as Gamma Knife, CyberKnife, proton knife, which has accumulated a wealth of clinical experience in the treatment of benign intracranial tumor. The treatment effect and low adverse reaction of SRS has been fully affirmed, at the same time,because of it’s non-invasive, non-pain characteristics, the range of applications SRS as postoperative adjuvant or alternative treatment of brain tumors is wider and wider. For example, the Gamma Knife can effectively inhibit the multiplication