Postoperative Radiotherapy of Intracranial Ependymoma

顱內室管膜瘤的手術後放射治療

張東杰(Joseph T. Chang) ； 史麗珠(Lai-Chu See) ； 陳麗惠(Li-Hui Chen) ； 湯國政(Simon G. Tang) ； 梁爲民(Wei-Manb Leung) ； 孫立民(Li-Min Sun)

《中華放射線醫學雜誌》 20卷1期 (1995/03) Pp. 43-51

摘要

顱內室管膜瘤是一種少見但卻對放射線敏感的腫瘤。術後放射治療的劑量及範圍一直尚未有定論，尤其是脊椎的預防照射。在本研究中，我們針對本院的病例做分析，評估此腫瘤對放射治療的反應。
從1981到1991，共有28位顱內室管膜瘤的患者在本院完成計畫的術後放。13例是天幕上的腫瘤（5個是高惡性度，8個是低惡性度）；15例是天幕下的腫瘤（9個是高惡性度，6個是低惡性度）。17個病患接受頭顱脊髓照射；劑量是腦脊髓軸：30至40葛雷，腫瘤區域：26至50葛雷。9個病人接受全腦照射，劑量是：全腦26至50葛雷，腫瘤區域：40至60葛雷。有二個病人只接受局部照射。
五年的存活率是63.4%，其中低惡性是83%，高惡性是41%。病理的惡性度是影響存活率的最重要指標。原發部位的控制失敗是最重要的死因，在死亡的8個病人中，有6個是原發部位復發。經過統計分析，預防性的頭顱及脊髓照射非但沒有增加，反而降低存活率。
此研究顯示，局部的復發是此疾病失敗的最重要因素。對於是否有腦脊髓液轉移，應盡可能做詳細的檢查，尤其是對高惡性度天幕下的腫瘤，預防性的頭顱及脊髓照射應再做前瞻性的研究計畫來評估。

關鍵字

室管膜瘤 ； 放射線治療 ； 術後

並列摘要

Ependymoma is a rare but radiosensitive brain tumor. The volume and dose of postoperative radiotherapy (RT) are still controversial, especially where the role of prophylactic spinal irradiation is concerned. This study attempted retrospectively to evaluate the efficacy of radiotherapy and evaluate the failure pattern of intracranial ependymoma of patients who were treated at Chang Gung Memorial Hospital from 1981 to 1991.
During this period, 28 cases of intracranial ependymoma completed the planned postoperative RT at our institution. Thirteen were supratentorial lesions (5 high grade, 8 low grade) and 15 were infratentorial lesions (9 high grade, 6 low grade). Seventeen patients received craniospinal irradiation (3000-4000 cGy to the neuroaxis, 4000-5600 cGy to the tumor bed). Nine patients received whole brain irradiation (2600-5000 cGy), followed by a boost to the lesion site (4600-6000 Gy); local irradiation was given to two patients.
The 5-year survival rate was 63.4% (83% for low grade lesion and 41% for high grade lesion). Pathological grading was the most significant factor affecting survival. Primary failure was the major cause of death (6 in 8 patients). Prophylactic craniospinal irradiation did not improve, but decreased the survival rate.
The present analysis suggests that local relapse remains the most significant component of treatment failure for ependymoma. A thorough study for CSF seeding is being considered for managing ependymoma, especially high grade infratentorial lesions. The role of prophylactic craniospinal irradiation should be re-evaluated.

並列關鍵字

Ependymoma ； therapeutic radiology, postoperative