海绵窦海绵状血管瘤立体定向放射治疗疗效的系统评价

发布时间：2018-04-30 18:36

本文选题：海绵窦海绵状血管瘤 + 立体定向放射治疗　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:本文通过对符合纳入标准的有关立体定向放射治疗海绵窦海绵状血管瘤(cavernous sinus hemangiomas,CSHs)的文献进行荟萃分析,对立体定向放射外科治疗在海绵窦海绵状血管瘤治疗中的有效性和安全性进行系统评价,从而为临床治疗方案选择提供理论依据。方法:通过使用关键词检索及引文检索,检索Pub Med、Medline、Embase、OVID等数据库,纳入符合标准的文献并进行数据提取。文献纳入标准为:文献数据公开接受立体定向放射治疗的CSHs患者的随访信息,且提供每个患者的具体信息(年龄、性别、临床症状、肿瘤体积、放疗剂量、随访时间、肿瘤控制和症状改善等),且为英文文献。结果:纳入7篇文献,其中6篇文献关于伽马刀放射治疗,1篇文献关于射波刀分次放射治疗,最终得到131例CSHs患者的基本信息(包括男性39名,女性92名,平均年龄51.8岁,年龄范围19~80岁),其中27例患者通过组织活检确诊,104例患者通过影像学检查确诊。在纳入患者中,接受伽马刀放射治疗的患者有117例,接受射波刀分次放射治疗的患者有14例。患者肿瘤体积范围0.3~96.3cm3,平均(20.98±21.34)cm3。平均随访时间为38个月(6~164个月),最近一次影像学随访MRI检查显示:肿瘤完全消失4例(3.1%),肿瘤体积明显缩小95例(72.5%),肿瘤体积部分缩小22例(16.8%),肿瘤体积无变化10例(7.6%)。对从文献中所提取数据进行统计学分析,结果显示:放疗后肿瘤明显缩小或消失的患者跟肿瘤部分缩小或无变化患者相比,两者所接受放疗剂量之间有显著差异(P=0.044)。放疗前接受手术治疗的患者和以放疗为主要治疗的患者相比,肿瘤体积缩小的程度没有显著差异(P=0.171)。伽马刀放疗前是否手术对神经症状恢复的影响有显著差异(P0.001),放疗前未接受手术治疗的患者神经症状恢复更好。在巨大CSHs肿瘤控制方面,射波刀分次放射治疗和伽马刀放射治疗的治疗效果有显著差异(P=0.041),且射波刀分次放射治疗的疗效明显优于伽马刀的疗效。所有患者接受放疗后均未出现新发生的脑神经功能损害症状。结论:伽马刀放射治疗前手术影响神经系统症状恢复,但对肿瘤控制无显著影响。在巨大海绵窦海绵状血管瘤的治疗方面,射波刀分次放射治疗是一种安全有效的方法,疗效明显优于伽马刀放射治疗。立体定向放射治疗可有效避免显微外科手术治疗及介入、栓塞治疗的并发症,在随访期内控制肿瘤生长和改善神经系统症状的效果良好,可以作为治疗海绵窦海绵状血管瘤的主要方法,其长期疗效有待更进一步研究。本文是基于非随机观察性研究的系统评价,受限于样本量少、评估治疗效果无统一标准等因素,有待进一步随机对照研究为本病治疗策略的选择提供临床依据。
[Abstract]:Objective: to conduct a meta-analysis of the literature on stereotactic radiotherapy for cavernous sinus hemangiomatous cavernous hemangioma of cavernous sinus cavernous hemangioma (CSHs) according to the inclusive criteria. The efficacy and safety of stereotactic radiosurgery in the treatment of cavernous hemangioma of cavernous sinus were systematically evaluated. Methods: the database of Pub Medline Medline Embase OVID was retrieved by keyword retrieval and citation retrieval. The literature inclusion criteria were as follows: the literature data were followed up for CSHs patients who received stereotactic radiotherapy, and specific information was provided for each patient (age, sex, clinical symptoms, tumor volume, radiotherapy dose, follow-up time). Tumor control and symptom improvement, and so on, and is English literature. Results: seven articles were included, including 6 articles on gamma knife radiotherapy and 1 document on radiosurgery. The basic information of 131 patients with CSHs was obtained, including 39 males and 92 females, with an average age of 51.8 years. The age range was 1980 years old, of which 27 cases were diagnosed by biopsy. 104 cases were diagnosed by imaging examination. Of these patients, 117 received gamma knife radiotherapy and 14 received wave knife fractionation radiotherapy. The tumor volume ranged from 0.3 to 96.3cm ~ (3), with an average of 20.98 卤21.34 cm ~ (3). The average follow-up time was from 6 months to 164 months. The most recent imaging follow-up MRI showed that tumor disappeared completely in 4 cases, tumor volume decreased significantly in 95 cases, tumor volume decreased in 22 cases, and tumor volume did not change in 10 cases. The data extracted from the literature were statistically analyzed. The results showed that there was a significant difference in the dose of radiotherapy between the patients with significantly reduced or vanishing tumor after radiotherapy and the patients with partial or no change of tumor. There was no significant difference in the reduction of tumor volume between the patients undergoing surgery before radiotherapy and those who were treated mainly by radiotherapy. There was significant difference in the effect of gamma knife operation on the recovery of neurological symptoms before radiotherapy, and the recovery of neurological symptoms was better in the patients who did not receive surgical treatment before radiotherapy. In the control of giant CSHs tumor, there were significant differences between radiosurgery and Gamma knife radiotherapy, and the curative effect of radiosurgery was better than that of Gamma knife. No new symptoms of neurological impairment were found in all patients after radiotherapy. Conclusion: before gamma knife radiotherapy, the recovery of nervous system symptoms was affected, but the tumor control was not significantly affected. In the treatment of giant cavernous hemangioma, radiosurgery is a safe and effective method, and the curative effect is better than gamma knife radiotherapy. Stereotactic radiotherapy can effectively avoid the complications of microsurgical treatment, interventional therapy and embolization, and can control tumor growth and improve nervous system symptoms during the follow-up period. It can be used as the main method for the treatment of cavernous hemangioma of cavernous sinus. This paper is based on the systematic evaluation of non-random observational studies, which is limited by the lack of sample size and the lack of unified criteria for evaluation of therapeutic effects. Further randomized controlled studies are needed to provide clinical basis for the selection of treatment strategies for the disease.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.4

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