Improvements in the radiotherapy of medulloblastoma, 1946–1975
Improvements in the radiotherapy of medulloblastoma, 1946–1975
复制标题
髓母细胞瘤放射治疗的改进，1946 年至 1975 年
作者：
T. Landberg;M. Lindgren;E. Cavallin;G. Svahn;G. Sundbärg;S. Garwicz;J. Lagergren;Viviann L. Gunnesson;A. Brun;S. Cronqvist
髓母细胞瘤的预后通常被报道为不佳，经常报道的五年生存率约为25%。然而，近年来一些医疗中心公布的结果显示可能的治愈率达到60%甚至更高。1946年至1975年间，瑞典隆德大学医院有50名儿童因髓母细胞瘤接受放疗。在此期间，靶区体积以三种不同方式确定，而靶区吸收剂量没有差异。当仅对显示的肿瘤进行治疗时，十年生存率为5%。如果同时包括脊髓硬膜下腔，该比率上升到25%，而当除了对显示的肿瘤进行治疗外，还对整个硬膜下腔进行治疗时，预计十年生存率为53%。显然，髓母细胞瘤放疗的靶区体积不仅应包括显示的肿瘤，还应包括从额叶尖端向下直至并包括第二骶椎节段的整个硬膜下腔。要达到的靶区吸收剂量大小尚未确定，但不仅应考虑治愈率，还应考虑幸存者的身体机能状态。从目前的病例系列来看，在六周内对显示的肿瘤给予不超过30次分割的45戈瑞吸收剂量，以及在四周内对硬膜下腔给予20次分割的30戈瑞吸收剂量，导致肿瘤治愈频率尚可且副作用最小。这种复杂治疗的实施要求技术具有高度的精确性。在本研究资料中，儿童的身体机能状态未受放疗影响。《癌症》45卷：670 - 678页，1980年。
The prognosis in medulloblastoma has often been reported to be gloomy, and five‐year survival rates of approximately 25% are often reported. In recent years, however, some centers have published results that indicate a possible cure rate of 60% or even more. During the years 1946–1975, 50 children received radiotherapy for medulloblastoma at the University Hospital, Lund, Sweden. During this period the target volume had been defined in three different ways, whereas the target‐absorbed dose had not differed. When only the demonstrated tumor was treated, the ten‐year survival rate was 5%. If the spinal subdural space also was included, it rose to 25%, and when the whole subdural space was treated in addition to the demonstrated tumor, the projected ten‐year survival rate was 53%. It is apparent that the target volume in the radiotherapy of medulloblastoma should include not only the demonstrated tumor but also the whole subdural space from the tip of the frontal lobes down to and including the second sacral segment. The size of the target‐absorbed dose to be aimed at is not settled, but should consider not only the cure rate but also the performance status of the survivors. It seems from the present series that an absorbed dose of 45 Gy in not more than 30 fractions over six weeks to the demonstrated tumor and 30 Gy in 20 fractions over four weeks to the subdural space resulted in a fair frequency of tumor healing and minimal side effects. The delivery of this complicated treatment demands a high degree of precision in the technique. In this material the performance status of the children was not affected by the radiation treatment. Cancer 45:670‐678, 1980.