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目的分析髓母细胞瘤放疗疗效及预后影响因素,观察最常见的放疗副反应。方法回顾性分析接受放疗的髓母细胞瘤64例,年龄均≥4岁。术前中枢神经系统MRI检查无蛛网膜下腔播散迹象,属Chang’sM分期M0～M1期。所有病例均在外院接受了原发肿瘤的全切或次全切除手术。放疗先予全脑全脊髓照射30Gy,然后缩野至后颅窝局部加量20～25Gy,中位分次剂量为180cGy。结果所有病例均完成了放疗,全组3、5年总生存率分别为68.8%和55.7%,无病生存率分别为57.8%和51.4%,27例(42.2%)在3年内复发。通过分析年龄、性别、原发肿瘤大小、手术与放疗间隔时间对生存率影响发现,只有手术与放疗间隔时间有一定影响,手术与放疗间隔时间≤25、>25d的3年总生存率分别为81.5%、59.5%(P=0.110),3年无病生存率分别为74.1%、46.0%(P=0.030)。放疗中最常见的副反应主要为白细胞下降,92.2%的病例在治疗中出现了白细胞下降(<4.0×109/dl),其中2～3级的血液系统毒性占64.0%。结论髓母细胞瘤通过手术与放疗结合能取得较好疗效,但治疗失败率较高。手术与放疗间隔延长对总生存率和无病生存率均有影响,年龄、性别、原发肿瘤大小不是明显预后因素,放疗中最常见的副反应为血液毒性。
Objective To analyze the radiotherapy efficacy and prognostic factors of medulloblastoma and to observe the most common side effects of radiotherapy. Methods Retrospective analysis of 64 cases of medulloblastoma receiving radiotherapy, all were ≥ 4 years old. Preoperative central nervous system MRI without signs of subarachnoid dissemination, is Chang’sM staging M0 ~ M1 period. All cases were received in the outer hospital of the total tumor or subtotal resection of the tumor. Radiation therapy to the whole brain irradiation of the whole spinal cord 30Gy, and then shrink to the posterior cranial foci local dosage 20 ~ 25Gy, median dose of 180cGy. Results The radiotherapy was completed in all cases. The overall 3 and 5-year overall survival rates were 68.8% and 55.7% respectively. The disease-free survival rates were 57.8% and 51.4% respectively, and 27 cases (42.2%) relapsed within 3 years. By analyzing the age, sex, primary tumor size, the impact of surgery and radiotherapy interval on survival rate, only the operation and radiotherapy interval time have some influence, the operation and radiotherapy interval time≤25,> 25d three-year overall survival rates were 81.5% and 59.5% respectively (P = 0.110). The 3-year disease-free survival rates were 74.1% and 46.0% respectively (P = 0.030). The most common side effects of radiotherapy were leukopenia, with 92.2% of cases having leukopenia (<4.0 × 109 / dl), of which, grade 2 to 3 hematologic toxicity was 64.0%. Conclusions Medulloblastoma can achieve good effect through the combination of surgery and radiotherapy, but the treatment failure rate is higher. Prolonged operation and radiotherapy interval have an impact on the overall survival and disease-free survival rate, age, gender, primary tumor size is not a significant prognostic factor, the most common side effects of radiotherapy is hematotoxicity.