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目的评价解放军总医院使用螺旋断层(helical tomotherapy,HT)全中枢放疗(craniospinal irradiation,CSI)23例颅内生殖细胞瘤患者的近期治疗效果。方法 2008年1月-2012年7月收治23例经螺旋断层全中枢放疗的颅内生殖细胞瘤患者,平均年龄20岁。全中枢放疗剂量:27~36 Gy/15~20 F(1.5~2.0 Gy/F),局部剂量46~60 Gy/30~50 F,女性行全中枢照射的患者均从腰5以下采用三维适形放疗,左右对穿野照射以保护卵巢功能,DT 30~36 Gy/15~20 F,单次剂量1.8~2 Gy。中位随访时间30.9(5~67)个月。总生存率采用SPSS19.0软件Kaplan-Meier法。结果中位随访30.9(5~67)个月,在17例可评价原发肿瘤的患者中,治疗结束后复查9例(52.9%)完全缓解(CR),7例(41.2%)部分缓解(PR),1例(5.9%)疾病稳定(SD)。血液学毒性是放疗过程中最严重的不良反应,本组病人中白细胞减少1~4级比例分别为8.7%、30.4%、34.8%、21.7%,;血小板减少1~4级比例分别为8.7%、30.4%、21.7%、8.7%;血红蛋白减少1~4级比例分别为26.1%、13.0%、8.7%、0。全组病例3年无复发生存率、3年无转移生存率、3年总生存率分别为95.2%、100%、91.3%。结论对于原发于颅内的生殖细胞瘤,使用HT进行CSI既简化放疗程序、增加了放疗精确性,又能更好地保护周围危及器官、保证治疗效果,所产生的急性及晚期毒性可以接受,是临床上首选的放疗模式。
Objective To evaluate the short-term therapeutic effect of 23 patients with intracranial germinoma treated with craniospinal irradiation (HT) in Chinese PLA General Hospital. Methods From January 2008 to July 2012, 23 patients with intracranial germinoma treated with helical CT were included in this study. The mean age was 20 years. The total central radiotherapy dose was 27-36 Gy / 15-20 F (1.5-2.0 Gy / F) and the local dose was 46-60 Gy / 30-50 F Radiotherapy, left and right field exposure to protect ovarian function, DT 30 ~ 36 Gy / 15 ~ 20 F, a single dose of 1.8 ~ 2 Gy. The median follow-up time was 30.9 (5-67) months. The overall survival rate using SPSS19.0 software Kaplan-Meier method. Results After a median follow-up of 30.9 months (range, 5-67 months), of the 17 patients with evaluable primary tumors, 9 (52.9%) had complete remission (CR) and 7 (41.2%) had partial remission PR), 1 case (5.9%) stable disease (SD). Hematologic toxicity is the most serious adverse reaction in the course of radiotherapy. The ratio of leukopenia grade 1 to grade 4 in this group of patients was 8.7%, 30.4%, 34.8% and 21.7%, respectively; the thrombocytopenia grade 1 to 4 grade were 8.7% , 30.4%, 21.7% and 8.7%, respectively. The proportion of hemoglobin decreasing from 1 to 4 were 26.1%, 13.0% and 8.7%, respectively. The 3-year recurrence-free survival rate and 3-year overall survival rate were 95.2%, 100% and 91.3% respectively in all cases. Conclusions For patients with primary intracranial germinomas, the use of HT for CSI not only simplifies the radiotherapy program, increases the accuracy of radiotherapy but also protects the surrounding organs from compromising the therapeutic efficacy and the resulting acute and late toxicity are acceptable , Is the clinical choice of radiation therapy mode.