惡性腦部星細胞瘤的放射治療近況

Recent Approachs of Radiotherapy in Malignant Astrocytoma

許文林(Wen Lin Hsu)

《放射治療與腫瘤學》 1卷1期 (1994/03) Pp. 27-32

https://doi.org/10.6316/TRO/199401(1)27

摘要

惡性腦部星細胞瘤，包括anaplastic astrocytoma(AAF)及glioblastoma multiforme (GBM)，是所有惡性腦瘤中最常見也最難處理的癌病。傳統的治療皆是先手術切除再合併用術後放射線治療，以三總為例，在過去10年中，一共有56例，其中AAF佔了36例，而GBM為20例，所有病人皆先接受手術全部或部份切除再加上5,000-6500cGy/5-7wk導的光子射束治療。AAF的平均存活期約30個月，中值存活期為20個月，5年存活率為30%，而GBM的平均存活期為9個月，中值存活期為8個月，存活超過2年的只有3位，其年齡分別為6歲、17歲及48歲，結果非常不理想。分析其失敗的原因，大部份皆因局部復發而死亡，也就是腫瘤中的缺氧細胞影響光子射束的治療效果。目前國外有許多對缺氧細胞所提出的改善辨法來對付AAF及GBM等兩種惡性腦癌，包括高壓氧合併放射治療，放射致療劑合併放射治療，化學藥物合併放射治療，每日多次放射治療，重粒子放射治療(heavy particle)，組織插種放射治療或合併高熟治療及硼中子捕獲治療等，將—分別在文中計論。

並列摘要

Malignant astrocytoma, including Anaplastic astrocytoma(AAF) and Glioblastma Multiforme(GBM), are the most common primary intracranial tumor with high mortality. Conventionally, malignant astrocytoma are treated with surgical resection and postoperative radiotherapy. In past ten years, fifty-six cases of malignant astrocytoma including 36 cases of AAF and 20 cases of GBM were treated with complete or incomplete resection first then followed by postoperative cranial irradiation at Tri-Service General Hospital. The mean and medial survival for AAF were 30 and 20 months, with 30% of 5-y-s-r. For GEM, the mean and median survival were 9 and 8 months, only three cases survived over 2 years. The treatment result was not good. Most of the causes of failure were local recurrence and the attempts to improve disease control with irradiation have focused on the known hypoxic regions of malignant astrocytoma. Several new approaches to improving the efficacy of irradiation on the hypoxic cells of AAF and GBM have been utilized in other countries, it included hyperbaric oxygen, radiosensitizers, hyperfractionation, heavy particle radiotherapy, interstitial brachytherapy, hyperthermia and boron neutron capture therapy. I will discuss the above approaches in this paper.