顱咽管瘤之放射治療

於1979至1989年間，總計45位經病理報告證實為顱咽管瘤的患者在長庚醫院接受放射治療。其中共有27位男性及18位女性。年齡範圍由4至67歲（中值為27歲）。最常見的症狀為頭痛（佔78%）和視力障礙（佔71%）。有39位患者於接受非根除性手術後加上放射線治療；其中38位完成治療過程1但有1人並未完成而沒列入日後分析。放射線是經由10MV光子或鈷六十射線，每週照射五次，每次給予150至200cGy總腫瘤劑量為4000至6400cGy（中值為5600cGy）。另有6位病人以放射治療來處理手術後復發之腫瘤。全部追蹤時間由2至13年（平均5.7年）。手術後放射治療之五年整體存活率為92%，無復發存活率為89%（其中18歲以下者為100%，以上者為81%）。全部共有3例死亡，其中2位因腫瘤壓迫，另1位因腦血管梗塞。其餘存活者有1位於治療後28個月查覺有局部囊狀腫瘤復發，但經放置腦室腹腔引流後至今一年情況良好。有1位於12個月後因頭痛接受電腦斷層攝影懷疑有右側顯葉梗塞。6位因復發而治療的病人裹，1位在37個月後因不詳原因死亡其餘5位情況正常。利用Cox regression model來分析預後因子，發現年齡差異具統計學上意義(P=0.012)。接受劑量不高於5600cGy者有較好預後，但不顯著。我們建議對於顱咽管瘤的治療，以手術再加放射治療可得到較佳效果。

關鍵字

腦部腫瘤；顱咽管瘤；腦部腫瘤，放射治療學

並列摘要

Between 1979 and 1989, 45 patients with pathologically proved craniopharyngioma received radiation therapy at Chang Gung Memorial Hospital. There were 27 males and 18 females in the age range of 4-67 years, with a median age of 27 years. Headache (78%) and visual disturbance (71%) were the most common symptoms. Thirty-nine patients had incomplete resection and radiation therapy as primary treatment, among which 38 cases completed the whole course of treatment. The irradiation was delivered with 10-MV photon or Co-60 gamma ray 5 days per week at 180 to 200cGy per fraction. The total tumor dose ranged from 4000cGy to 6400cGy with a median of 5600cGy. Six patients were irradiated for the recurrent tumor after previous operation. Follow-up period ranged from 2 to 13 years with a mean of 5.7 years. The overall 5-year survival rate was 92% and relapse-free survival rate was 89%.The relapse-free survival rate for those younger than 18 years of age was 100% and for the older ones, 81%. Three patients died during follow-up period, two for uncontrolled disease and the other one for CVA. Of the survivors, one patient was found to have local recurrence 28 months after treatment and was successfully salvaged by V-P shunt. One case experienced headache 12 months later and CT scan showed possible right temporal lobe infarct. Among 6 cases who were treated for recurrence, one died 37 months later with unknown cause and the remaining 5 cases were still doing well until 35 to 90 months after radiotherapy. Using the Cox regression model, age is the independent prognostic factor (p=0.012).Doses of not higher than 5600cGy appeared to give better results, but of no statistical significance. We recommend adequate surgery and postoperative radiation therapy for management of craniopharyngioma.

並列關鍵字

Brain, neoplasm ； Craniopharyngioma ； Brain, neoplasms, therapeutic radiology

國際替代計量

顱咽管瘤之放射治療

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