Hasegawa Toshinori, Kondziolka Douglas, Hadjipanayis Costas G, Lunsford L Dade
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Neurosurgery. 2004 Apr;54(4):813-20; discussion 820-2. doi: 10.1227/01.neu.0000114262.30035.af.
The efficacy of stereotactic intracavitary irradiation with phosphorus-32 ((32)P) for patients with cystic craniopharyngiomas was assessed on the basis of patient survival, tumor control, and visual and endocrinological function before and after treatment. Limited data are available regarding long-term outcomes.
Forty-nine patients were treated with stereotactic (32)P intracavitary irradiation. Of these, 25 had had no prior treatment as the primary treatment, and 24 were treated for residual or recurrent tumor cysts. At the time of (32)P intracavitary irradiation, 34 of the patients were adults, and 15 were children younger than 16 years of age. The mean cyst volume was 13 ml. The radiation dose varied from 189 to 250 Gy to the cyst wall during five half-lives of the isotope (mean, 224 Gy). The mean follow-up periods were 7 years after diagnosis and 4 years after (32)P treatment.
The actuarial survival rates were 90% at 5 years after the diagnosis and 80% at 10 years. The actuarial tumor cyst control rates were 76% at 5 years and 70% at 10 years after the diagnosis. After treatment, 9 (23%) of 40 patients who underwent preoperative and postoperative visual testing were found to have delayed worsening in visual function, 6 as a result of tumor progression and 3 attributed to irradiation. Nineteen patients (48%) had improved visual function. Of 17 patients who had normal preoperative pituitary function or stalk effect, 12 (71%) had preserved and 5 (29%) had worsened visual function. No complications other than visual or endocrinological deterioration occurred in these patients.
For patients with cystic craniopharyngiomas, (32)P intracavitary irradiation proved effective, with a low risk of complications, for the control of tumor cysts but not of solid tumor components.
基于患者生存率、肿瘤控制情况以及治疗前后的视觉和内分泌功能，评估立体定向腔内 32P 照射治疗囊性颅咽管瘤患者的疗效。关于长期疗效的数据有限。
49 例患者接受了立体定向 32P 腔内照射。其中，25 例作为初始治疗未接受过先前治疗，24 例针对残留或复发肿瘤囊肿进行治疗。在进行 32P 腔内照射时，34 例患者为成年人，15 例为 16 岁以下儿童。囊肿平均体积为 13 毫升。在同位素的五个半衰期内，囊肿壁的辐射剂量从 189 至 250 Gy 不等（平均 224 Gy）。诊断后的平均随访期为 7 年，32P 治疗后的平均随访期为 4 年。
诊断后 5 年的精算生存率为 90%，10 年为 80%。诊断后 5 年的精算肿瘤囊肿控制率为 76%，10 年为 70%。治疗后，40 例接受术前和术后视觉测试的患者中有 9 例（23%）出现视觉功能延迟恶化，其中 6 例因肿瘤进展，3 例归因于照射。19 例患者（48%）视觉功能改善。17 例术前垂体功能或垂体柄效应正常的患者中，12 例（71%）视觉功能得以保留，5 例（29%）视觉功能恶化。这些患者除视觉或内分泌功能恶化外未发生其他并发症。
对于囊性颅咽管瘤患者，32P 腔内照射被证明对控制肿瘤囊肿有效且并发症风险低，但对实体肿瘤成分无效。
