Kong Doo-Sik, Nam Do-Hyun, Lee Jung-Il, Park Kwan, Kim Jong Hyun
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea.
J Neurosurg. 2006 Dec;105 Suppl:139-43. doi: 10.3171/sup.2006.105.7.139.
The authors conducted a retrospective study to evaluate the efficacy of Gamma Knife surgery (GKS) followed by radiotherapy for the treatment of unresectable glioblastomas multiforme (GBMs) on patient survival and quality of life.
A total of 19 patients with unresectable GBMs located in eloquent areas of the brain were eligible for this study. Beginning in January 2002, 10 patients underwent GKS followed by fractionated radiotherapy. Nine patients who had undergone radiotherapy alone after biopsy-proven diagnosis served as the control group. The mean patient ages were 53 years and 56 years, respectively. Preoperative Karnofsky Performance Scale (KPS) scores were 80 (range 60-100) and 90 (range 50-100), respectively. The median margin dose for GKS was 12 Gy (9-16 Gy), and the total dose for radiotherapy was 60 Gy in 30 fractions. The mean follow-up duration was 7.2 months, the median patient survival time was 52 weeks (95% confidence interval [CI] 22-110.6 weeks) in the GKS group, and the median overall survival time was 28 weeks (95% CI 22.5-33.5 weeks) in the control group. The difference was not statistically significant (p = 0.0758). The estimated progression-free survival rate at 3 months was 75% in the GKS group and 45% in the control group (p = 0.082). The posttreatment KPS scores were either unchanged or improved in the GKS group, whereas it deteriorated by 20 or more points in six of nine patients of the control group (p = 0.004).
Gamma Knife surgery prior to radiotherapy may be helpful in preserving patients' daily activities in the adjuvant management of unresectable GBM.
作者进行了一项回顾性研究，以评估伽玛刀手术（GKS）联合放射治疗对不可切除的多形性胶质母细胞瘤（GBM）患者生存率和生活质量的疗效。
共有19例位于脑功能区的不可切除GBM患者符合本研究条件。从2002年1月开始，10例患者接受了GKS联合分次放射治疗。9例经活检确诊后仅接受放射治疗的患者作为对照组。患者的平均年龄分别为53岁和56岁。术前卡氏功能状态评分（KPS）分别为80（范围60 - 100）和90（范围50 - 100）。GKS的中位边缘剂量为12 Gy（9 - 16 Gy），放射治疗的总剂量为60 Gy，分30次给予。平均随访时间为7.2个月，GKS组患者的中位生存时间为52周（95%置信区间[CI] 22 - 110.6周），对照组的中位总生存时间为28周（95% CI 22.5 - 33.5周）。差异无统计学意义（p = 0.0758）。GKS组3个月时的无进展生存率估计为75%，对照组为45%（p = 0.082）。GKS组治疗后的KPS评分无变化或有所改善，而对照组9例患者中有6例下降了20分或更多（p = 0.004）。
放射治疗前进行伽玛刀手术可能有助于在不可切除GBM的辅助治疗中保留患者的日常活动能力。
