Grigsby P W, Garcia D M, Simpson J R, Fineberg B B, Schwartz H G
Mallinckrodt Institute of Radiology, Radiation Oncology Center, St. Louis, MO 63110.
Cancer. 1989 Jun 1;63(11):2124-9. doi: 10.1002/1097-0142(19890601)63:11<2124::aid-cncr2820631109>3.0.co;2-9.
This report is a retrospective analysis of 83 adults (greater than 16 years of age) with histologically proven or presumed primary neoplasms of the thalamus, hypothalamus, midbrain, pons, and medulla. Patients were treated with combined surgery and postoperative irradiation or with irradiation alone at the Washington University Medical Center (St. Louis, MO) from January 1950 through December 1984. Histologic analysis confirmed the diagnosis of tumor in 21, including nine with well-differentiated astrocytoma, four with astrocytoma with anaplasia, and eight with glioblastoma multiforme. Overall and disease-free survivals at 5 years were 28.7 and 23.2%, respectively. A statistical analysis was performed to ascertain the prognostic importance of the following variables: age, race, gender, duration of symptoms, cranial nerve paresis, primary site, extent of surgery, histology, and irradiation dose. The only factor identified by univariate analysis to be critical for survival was primary location of disease. Patients with supratentorial (thalamus/hypothalamus, midbrain) tumors had a 10-year disease-free survival of 15.4% compared to 29.6% for those with infratentorial (pons, medulla) tumors (P = 0.07). Patients with lesions of the pons had a 5-year disease-free survival of 35.8% compared to 13.8% for those with tumors of the thalamus (P = 0.05). Increasing irradiation dose was not correlated with superior survival. Factors evaluated but established to be insignificant were age (P = 0.27), race (P = 0.63), gender (P = 0.27), duration of symptoms (P = 0.19), cranial nerve paresis (P = 0.71), histologic type (P = 0.16), and extent of surgery (P = 0.94). Follow-up for 13 surviving patients ranged from 2.6 to 28.7 (mean, 12.0) years. Neurologic deficits in surviving patients were absent in 15% (two of 13), mild in 62% (eight of 23), and moderate in 23% (three of 13). One case of brain radionecrosis was identified (6000 cGy, 200 cGy daily).
本报告是对83例成人（年龄大于16岁）进行的回顾性分析，这些患者经组织学证实或推测患有丘脑、下丘脑、中脑、脑桥和延髓的原发性肿瘤。1950年1月至1984年12月期间，患者在华盛顿大学医学中心（密苏里州圣路易斯）接受了手术联合术后放疗或单纯放疗。组织学分析在21例中确诊了肿瘤，其中9例为高分化星形细胞瘤，4例为间变性星形细胞瘤，8例为多形性胶质母细胞瘤。5年总生存率和无病生存率分别为28.7%和23.2%。进行了统计学分析，以确定以下变量对预后的重要性：年龄、种族、性别、症状持续时间、颅神经麻痹、原发部位、手术范围、组织学类型和放疗剂量。单因素分析确定的唯一对生存至关重要的因素是疾病的原发部位。幕上（丘脑/下丘脑、中脑）肿瘤患者的10年无病生存率为15.4%，而幕下（脑桥、延髓）肿瘤患者为29.6%（P = 0.07）。脑桥病变患者的5年无病生存率为35.8%，而丘脑肿瘤患者为13.8%（P = 0.05）。增加放疗剂量与更好的生存率无关。评估但确定为无显著意义的因素有年龄（P = 0.27）、种族（P = 0.63）、性别（P = 0.27）、症状持续时间（P = 0.19）、颅神经麻痹（P = 0.71）、组织学类型（P = 0.16）和手术范围（P = 0.94）。13例存活患者的随访时间为2.6至28.7年（平均12.0年）。存活患者中，15%（13例中的2例）无神经功能缺损，62%（23例中的8例）为轻度，23%（13例中的3例）为中度。发现1例放射性脑坏死（6000 cGy，每日200 cGy）。
