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目的 探讨调强适形放射治疗脑肿瘤的近期疗效和副反应。方法 2 0 0 1年 8月～ 2 0 0 2年 7月收治经病理证实的脑肿瘤 15例 ,其中胶质瘤Ⅱ～Ⅳ级 8例 ,脑膜瘤 3例 ,胶质瘤合并脑膜肉瘤 1例 ,垂体瘤、颅咽管瘤及小脑血管母细胞瘤各 1例。照射靶区及敏感器官按ICRU 5 0号报告标准勾划 ,用美国NOMOS公司生产的孔雀系统进行计划设计 ,加速器 6MV -X线 ,MIMiC 1cm或 2cm模式作切片式断层共面或非共面旋转照射 ,每周 3次 ,每次 30 0～ 35 0cGy。 6例脑肿瘤全程IMRT治疗 45～ 5 4Gy ,7例常规外照射 30Gy后局部追加 2 1～ 2 8Gy。 结果 95 %等剂量曲线包绕CTV ,均匀度指数 (最大剂量 /处方剂量 )平均 1.2 2 ,脑干、脊髓、眼晶体等敏感器官最大剂量均低于其耐受剂量 (TD5 /5 )的 5 0 %以上。治疗期间未出现明显的头痛、呕吐等高颅压症状。治疗结束时 2例局部活检病人症状明显缓解 ,MRI复查肿瘤消失。其余病人放疗结束 1月后 ,复查头颅CT/MRI均呈放疗后改变 ,1例水肿范围明显增大。结论 调强适形放射治疗脑肿瘤其剂量分布的优势是其他方法难以比拟的 ,能很好地保护周围敏感器官 ,放疗反应小 ,对于提高肿瘤局控率、保护正常脑组织、改善病人生存质量均有重要意义
Objective To investigate the short-term curative effect and adverse reactions of intensity modulated conformal radiation therapy for brain tumors. Methods From August 2001 to July 2002, 15 cases of pathologically confirmed brain tumors were obtained, including 8 cases of grade Ⅱ ~ Ⅳ gliomas, 3 cases of meningioma, 1 case of glioma combined with meningioma , Pituitary tumor, craniopharyngioma and cerebellar hemangioblastoma in 1 case. Targets and sensitive organs were irradiated according to the report standard of ICRU 50 and planned by the peacock system produced by NOMOS Company in America. The 6MV-X line and MIMiC 1cm or 2cm accelerator were used for slice-slice coplanar or non-coplanar rotation Irradiation, 3 times a week, each 30 0 ~ 35 0cGy. 6 cases of brain tumor IMRT 45 ~ 5 4Gy full treatment, 7 cases of conventional external beam 30Gy local added 21 ~ 28Gy. Results The 95% isodose curves were wrapped around CTV. The evenness index (maximum dose / prescription dose) was 1.2 2. The maximum dose of sensitive organs such as brain stem, spinal cord and ocular lens was lower than the tolerable dose (TD5 / 5) 0% or more. During treatment there was no obvious headache, vomiting and other symptoms of high intracranial pressure. At the end of treatment, the symptoms of 2 cases of biopsy were significantly relieved and the tumor disappeared on MRI. The remaining patients after 1 month after the end of radiotherapy, review head CT / MRI were changed after radiotherapy, a case of edema was significantly increased. Conclusion The advantages of intensity-modulated conformal radiation therapy of brain tumor dose distribution are unmatched by other methods, which can well protect the surrounding sensitive organs and reduce the radiotherapy response. It is of great value in improving the tumor control rate, protecting the normal brain tissue and improving the quality of life of patients All have important meaning