关键词：脑转移瘤；伽玛刀；放射外科
摘要 目的：回顾本院近3年来伽玛刀治疗脑转移瘤的情况，阐明其治疗的有效性，研究影响患者预后的相关因素。方法：回顾性调查1993年10月～1995年11月治疗的153例脑转移瘤患者(372个病灶)。平均年龄为57岁，平均卡氏评分67%，平均随访时间24个月。通过Cox多元回归分析影响生存时间的13个因素。统计学上有显著的差异P<0.05。结果：术后平均生存时间为8.5个月。多元统计分析原发肿瘤稳定，卡氏评分大于70%，病灶3个或更少以及全身化疗加原发肿瘤切除这四个因素能明显延长生存时间(P<0.05)，由此引入一个五级评分系统来预测患者的生存时间(每个因素为1分，分别为4，3，2，1，0分)。4分患者有12个月存活时间，3分10个月，2分6个月，1分3个月，0分1个月。结论：伽玛刀是一种安全有效适用于中、小体积，等级评分大于1分的脑转移瘤患者的治疗方法。
Effect of metastatic brain tumors treated by Gamma kinfe radiosurgery: retrospective analysis of 153 cases Xu Weimin, Yang Liqun, Pan Li, et al. Department of Neurosurgery, Shanghai Gamma Knife Hospital, Shanghai Medical University, Shanghai 200233
Abstract Objective: To review the treatment experience with Gamma kinfe for radiosurgery metastasis in our hospital for 3 years in order to improve the effectiveness of the treatment and to find the related factors which affect the prognoses. Methods:Retrospective analysis 153 patients (372 lesions) treated between October 1993 and December 1995. The study population had a median age of 57 years and a median Karnofsky Performance Score (KPS) of 67% before radiosurgery. Median follow-up period was 24 months. The Cox regression model was used to study the effects of multiple covariates (13 factors) on patients' suvival. Statistical significance was defined as P< 0.05. Results: Median overall survival time after gamma knife therapy was 8.5 months. Through the analysis of multiple covariates, the adsence of active systemic disease, KPS more than 70%, three or fewer lesions and chemotherapy plus the resection of the primary tumor were significantly associated with increased survival time (P< 0.05). These four factors were used to develop a grading system (grades I～ V). Patients categorized in grade V had a 12 months median survival time, whereas the median survival time of patients in grades IV, III, II and I was 10, 6, 3 and 1 month, respectively. Conclusion: The results show that Gamma knife radiosurgery is an effective, minimally invasive treatment option for smaller intracranial metastases of patients who are categorized in higer than grade I.
Key words Gamma knife Brain metastases Radiosurgery
脑转移瘤是指颅外其他组织、器官的原发性癌肿转移至颅内者(1) ......
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