成人低惡性度顱內星狀細胞瘤之術後放射治療

Posoperative Radiotherapy for Adult Intracranial Low Grade Astrocytoma

張東杰(Tung-Chieh Cjamg) ； 容世明(shih-Ming Jung) ； 魏國珍(Kuo-Chen Wei) ； 曾振凎(Chen-Kan Tseng) ； 陳尚文(Shang-Wen Chen)

《放射治療與腫瘤學》 5卷4期 (1998/12) Pp. 269-276

https://doi.org/10.6316/TRO/199805(4)269

摘要

目的：低惡性度腦瘤的術後放射治療，尤其是星狀細胞瘤的處理是個爭議性的課題，本研究探討低惡性度星狀細胞腦瘤的預後因子並對其治療做一個回顧與評估。
材料與方法：1979年至1988年間，共有46位低惡性度星狀細用包腦瘤的成人患者在林口長庚醫院完成術後放射治療。他們年紀從15歲至63歲，中間值是32歲。有25位男性，21位女性。根據Kernohan的病理分期標準，這些病人有10位患者屬第一級，36位屬第二級。其中11位病人接受腫瘤完全切除術，17位接受部份切除術，而另18位只接受切片檢查，並沒有切除腫瘤。開刀後，46位患者都有很好的行動指標(Performance status)。每位病人都接受Co-60或百萬電子伏特以上的光子射線治療。治療劑量從44-66Gy不等，劑量的中間值是60Gy。沒有患者在一開始便接受化學治療。
結果：五年的存活率是49%，女性比男性患者有較好的存活率(54% vs. 24%, P=0.015)；年齡小於或等於30歲者比年紀大的病人有較好的治療結果(47% vs. 30%, P=0.035)；病理分期屬第一級者比第二級者預後較好(69% vs. 30%, P=0.04)；開刀範圍的大小並不影響預後，但有開刀切除者比只做切片者有較好的五年存活率(44% vs. 32%, P=0.05) ；術後放射治療劑量的高低對預後並無實質的影響。
結論：根據我們治療的結果發現低惡性度星狀細胞瘤病人接受術後放射治療的結果並不佳，其中更以Kemohan第二級病人的表現較差。因此尋求更積極有效的治療方式應是優先考量的課題。

關鍵字

顱內星狀組胞瘤 ； 預後因子 ； 放射治療 ； 存活率

並列摘要

Purpose: It got no consensus about the therapy of low grade glioma, especially for the low grade astrocytoma. We have retrospectively reviewed the results of radiotherapy for low grade astrocytoma, and define the role of postoperative radiotherapy in the treatment of low grade astrocytoma. Materials and Methods: From 1979 to 1988, 46 adult patients with low grade astrocytoma received postoperative radiotherapy in Chang Gung Memorial Hospital-Linkou Medical Center. The median age of these patients was 32 years old with the range from 15 to 63. There were 25 male and 21 female. According to the Kernohan's grading system, 10 patients' tumors belonged to grade 1 and the others belonged to grade 2. Eleven patients received total removal of tumors, 17 patients received subtotal excision of tumors, and 18 patients received biopsy only. All patients had good performance status (Karnofsky scale ＞ 70) after operation. For radiotherapy, the median total dose was 6000 cGy on each patient, ranging from 4400 to 6600 cGy. No patient received chemotherapy at the beginning.
Result: The overall 5 year survival was 49%. Female had better survival than male (54% vs 24%, p=O.O15). Younger patients had better results than older patients (47% vs 30%, p0.04). Patients with grade I tumors had better survival than patients with grade Ii tumors (69% vs 30%, p=O.O4). Patients received excision surgery had better survival rate (44% vs 32 %, p=0.05), but the extent of surgery did not make the difference. Total radiation dose did not significantly change the survival result.
Discussion: The low grade astrocytoma patients showed poor survival rate after radiotherapy, especially for patients with grade II tumor. To properly treat patients with low-grade astrocytorma is a more important issue than to consider the incidence of radiation complications.

並列關鍵字

Intracranial low grade astrocytoma ； Radiotherapy ； Survival