神經管胚細胞瘤的放射治療

Radiotherapy for Medulloblastoma

劉文山(Wen-Shan Liu)；吳永平(Yung-Ping Wu)；顏上惠(Sang-Hue Yen)；陳光耀(Kuang-York Chen)

腦部腫瘤 ； 腦部放射治療 ； brain, neoplasm ； therapeutic radiology, brain

中華放射線醫學雜誌

16卷4期（1991 / 12 / 01）

369 - 376

繁體中文

台北榮民總醫院癌病治療中心自1970年1月至1988年12月，共有37位神經管胚細胞瘤的病例接受手術加術後放射治療。所有病例均經病理醫師證實。病患年齡1至63歲，中值年齡為8歲，3至18歲者占68%。男女之比為1.3比1。追蹤期範圍為陰18至222月，中值數84月，追蹤率達95%。放射治療部分是以遠距鈷60治療機完成。全部病例5年與10年存活率及未復發存活率分別為52%與33%; 45%與33%。分析年齡、性別、腫瘤大小、手術徹底程度、及後顱腔放射劑量等因素和預後之關係；發現手術徹底程度和後顱腔劑量對存活期有顯著影響。巨觀完全切除者16例，部分切除者21例，其5年與10年存活率分別為67%與42%; 41%與25% (p=0.035)。後顱腔放射劑量大於50Gy者21例，小於50Gy者16例，其5年與10年存活率分別為63%與48%；38%與23% (p=0.025)。10例治療失敗者，後顱腔復發占9例；其中3例僅有後顱腔復發，3例併有脊椎管復發，2例合併有大腦天幕上復發，1例合併有多處骨骼轉移。僅有脊椎管復發者1例。智力測驗80-100分者有2例，低於80分者有3例，此3例在17例長期存活病例中占18%。

Thirty-seven patients with posterior cranial fossa medulloblastoma who received surgery plus radiotherapy from January 1970 to December 1988 at Veterans General Hospital-Taipei were reviewed. All cases had histological diagnosis of medulloblastoma after craniotomy with tumor resection. The age of patients ranged from 1 to 63 years, with a median of 8 years and 68% to be 3 to 18 years of age. The male to female ratio was 1.3: 1.The median time of follow-up was 84 months (ranged from 18 to 222 months) and the follow-up rate was 94.5%. Radiotherapy was given by Cobalt-60 teletherapeutic machines. The 5-and 10-year actuarial survival rates and disease-free survival rates were 52% and 33%, and 45% and 33%, respectively. Prognostic factors with statistical significance included completeness of surgical resection and radiation dosage to the posterior cranial fossa. The 5-and 10-year actuarial survival rates for patients with complete resection (16 cases) and partial resection (21 cases) were 66% and 42%, and 41% and 25%, respectively (P=0.035). The 5-and 10-year actuarial survival rates for those with posterior cranial fossa dosage greater (21 cases) and less (16 cases) than 50Gy were 63% and 48%, and 38% and 23%, respectively (P=0.025). The posterior cranial fossa was the predominant site of recurrence, which encountered 9 of 10 recognized treatment failures. Among them, 3 cases were posterior cranial fossa failure alone, 3 cases had combined spinal canal recurrence, 2 had combined supra-tentorial failure and 1 had combined multiple bony metastases. Only 1 case had spinal canal failure alone. Two cases had IQ tests between 80-100, and 3 cases below 80. The ratio of 3 low-IQ cases among all the 17 long-term survivors was 18%.