36例髓母细胞瘤临床治疗及回顾性分析.doc

36例髓母细胞瘤临床治疗及回顾性分析 　【摘要】 目的 分析髓母细胞瘤临床治疗效果及预后影响因素。方法 回顾性分析接受手术、放疗及化疗的髓母细胞瘤36例。按照Changs M分期，M0期23例，≥M1期13例。所有病例均接受了原发肿瘤的全切或次全切除手术。6例全切术切除范围为肉眼肿瘤外延1.5cm者（下称根治术），CSI(craniospinal irradiation, CSI)24Gy，再局限于小脑加量24Gy。其余病例放疗先给予CSI 30 Gy,然后缩野至后颅窝局部加量20～25 Gy,中位分次剂量为1.8Gy。所有M1期患者接受化疗。结果 所有病例均完成了放疗及化疗,全组3 、5 年总生存率分别为72. 2%和69. 4 % ,其中6例根治手术加全脑全脊髓低剂量预防照射患者3、5年生存率为83.3%、83.3%；M0期全切或次全切手术加全脑全脊髓足量放射治疗患者3、5年生存率为66.7%、60.0%；≥M1期患者61.5%、53.5%。手术与放疗间隔时间≤21d、＞21d的3年生存率分别为80.0%、55.6%(Plt;0.05)，无病生存率为72.2%、44.4%。辅助化疗对提高高危组的生存率有一定意义。放疗中最常见的副反应主要为白细胞下降, 86.1%的病例在治疗中出现了白细胞下降(lt;4.0×109 /dl) ,其中2 ～3 级的血液系统毒性占58.3%；放疗后甲状腺功能改变发生率为52.8%。结论 髓母细胞瘤通过手术与放、化疗结合能取得较好疗效。手术与放疗间隔时间对生存率及复发率有一定影响，放疗中最常见的副反应为血液毒性和甲状腺功能改变，辅助化疗可以改善高危组的生存率。　　【关键词】 髓母细胞瘤；放射疗法;化学疗法;预后 　　A prognostic analysis of the clinic treatment of 36 patients with medulloblastomas 　　　【Abstract】 Objective To analyze the treatment effects and prognostic factors of the 36 patients with medulloblastoma. Methods 36 patients with medulloblastoma, by Chang’s staging system M0 and ≥M1 were admitted in our prognostic analysis. All patients received operation entirely or largely portion tumour resection,6 patients received the radical cure operation in which tumour and 1.5cm tissue around it were resected.The patients who receive the radical cure operation were irradiated with the technique: 24Gy delivered to the whole craniospinal axis followed by a 24Gy boost to the posterior fossa , with a median fraction dose of 1.8Gy.All others patients were irradiated with the technique: 30Gy delivered to the whole craniospinal axis followed by a 20～25Gy boost to the posterior fossa , with a median fraction dose of 1.8Gy. All ≥M1 patients received chemotherapy. Results All patients had finished the radiotherapy and/or chemotherapy. The overall 3 and 5 year survival rates were 72.2% and 69.4% respectively.The 6 patients who received the radical cure operation and CSI 24Gy followed by a 24 Gy boost to the posterior fossa，of which 3 and 5 year survival rates were