Treatment in Patients with Malignant Glial Neoplasms: A Retrospective Analysis of Clinical Parameters, Therapy, and Outcome

惡性腦神經膠質瘤之處置經驗

鄭聖于(Sheng-Yu Cheng) ； 張丞圭(Cheng-Kuei Chang) ； 蔡承嘉(Cheng-Chia Tsai)

《中華民國癌症醫學會雜誌》 25卷1期 (2009/02) Pp. 28-37

https://doi.org/10.6588/JCOS.2009.25.1.4

摘要

腦瘤的治療發展已有近百年的歷史，但是針對高惡性度神經膠質瘤(Malignantglial neoplasms)迄今尚無治癒的方法，雖然各種療法包括手術及放射化療都在不斷努力研究突破中，目前尚無法治癒此類腫瘤。因此，治療的目的與目標是在建立組織學上的診斷，延長病人的生命，解除病人的痛苦，改善病人的神經機能障礙與生活品質。影響此類病患存活時間的因素牽涉較廣，其中包含年齡、臨床症狀表現（有無癲癇或神經缺損併發），腫瘤位置，細胞型態及惡性度，和手術減壓根除程度，或放射治療的劑量等臨床因素。目前對於惡性神經膠質瘤的治療方法，大多數病例採手術切除，再加上術後放射線治療，有時再加上化學治療。我們總結本院從1996至2006年間收治113個惡性腦神經膠質瘤病例的臨床資料，針對診斷和治療的經驗作回朔性的比較與分析，分手術治療與保守立體定位切片診斷加放射治療等觀察群組，同時合併文獻回顧，總結惡性腦神經膠質瘤當前時效的診斷與治療。結果69 例(60.83%)採保守立體定位切片檢查(stereotactic biopsy)合併放射治療，44 例(39.1%)行開顱手術治療(craniotomy with tumor resection)並加上放射治療，立體定位切片組有六例在術後一個月內死亡，三例神經功能惡化，而開顱切除組除了七例因腦瘤合併症無改善外，無死亡案例發生。結論：根據本院回朔性的案例分析顯示；手術後加上放射線治療之成效（存活時間）比單用手術或僅作立體定位切片加放射治療來的好，在病患狀況穩定前提下，應盡早掌握治療時機，進行手術及放射線治療。

關鍵字

腦腫瘤 ； 惡性神經膠質瘤 ； 預後因素 ； 立體定位切片

並列摘要

Objective: The purpose of this study was to evaluate the therapeutic impact of tumor resection in the treatment of malignant glial neoplasms and delineate the outcomes after a combined therapy. Materials and Methods: A retrospective study was conducted (Jul 1996- Jun 2006) to compare the treatment results of stereotactic biopsy plus radiation therapy (69 patients) with those of surgical resection plus radiation therapy (44 patients). The clinical records were reviewed and analyzed regarding patient demographics, and treatment of choice, including surgery, radiotherapy, or a combination of both. Surgical indications and pretreatment performance status scores were also recorded. The treatment outcomes were analyzed in terms of survival time and performance status score. Results: The resection group and the biopsy group did not differ in terms of age, pretreatment Karnofsky performance status (KPS), gender, duration of symptoms, presenting symptoms, tumor location, tumor size, and frequency of midline shift. Transient perioperative morbidity and mortality rates were 4.34% and 8.69%, respectively, in the biopsy group and 20.3% and 0%, respectively, in the resection group (P＞0.05). This multivariate model identified age as the strongest pretreatment prognostic factor, and the KPS correlated significantly with age. The study indicates that patients with malignant gliomas who complete radiation therapy (doses ＞ 50 Gy) after resection of tumor tissue mass survived longer than those who received biopsy alone, even after adjustment for the effects of clinical prognostic factors. Conclusions: Surgical excision for maximum cytoreduction affords increased quality and duration of survival. In selected malignant gliomas, resection of the tumor mass followed by radiation therapy is associated with longer survival times than radiation therapy after biopsy alone.

並列關鍵字

brain neoplasm ； malignant glioma ； prognostic factor ； stereotactic biopsy