头部伽玛刀剂量分割治疗

头部伽玛刀剂量分割治疗 一、头部伽玛刀剂量分割治疗概况: “伽玛刀剂量分割治疗”是一种新的治疗理念和方法，属于伽玛刀治疗的一大新进展。“伽玛刀剂量分割治疗”既保留了伽玛刀大剂量聚焦照射的优势，又吸取放疗射线多次重复照射的长处，既能大大提高肿瘤的控制率，又能减低对正常脑子的损害。“伽玛刀剂量分割治疗”适用于各种脑肿瘤，良性的或恶性的，尤其是体积较大的肿瘤。常见的有脑胶质瘤、脑转移瘤、脑膜瘤、垂体腺瘤、听神经瘤等等;还有比较少见的脑内淋巴瘤、松果体区肿瘤、脊索瘤、骨软骨瘤、鼻咽癌、上颌窦癌、眼眶内肿瘤等等。 二、头部伽玛刀剂量分割治疗脑肿瘤最好 “手术、放疗和化疗”是躯干肿瘤治疗的三大法宝。但脑肿瘤的治疗还是以“手术+伽玛刀”为主。主要是因为脑肿瘤的化疗，疗效十分有限;而脑肿瘤的放疗，一直存在副作用大的问。头部伽玛刀虽然也属于放疗范畴，但已经脱胎换股，成为非一般放疗，是立体定向技术引导下的精确放疗，已经属于立体定向放射外科的范畴，并且是立体定向放射外科的“金标准”，到如今头部伽马刀已经成为脑肿瘤治疗的主要手段，甚至对于相当一部分病人，已经超越手术，成为首选治疗方法。而伽玛刀剂量分割治疗，在此基础上又有了新发展。 三、头部伽玛刀剂量分割治疗的优势 头部伽玛刀，之所以优于包括X-刀、射波刀、托姆刀、直线加速器等在内的其他设备，成为脑肿瘤立体定向放射外科的“金标准”，是因为头部伽马刀具有三大绝对优势:(1)准确无误的三维立体定位;(2)无可比拟的射线三维空间聚焦;(3)高度一致的肿瘤三维适形。头部伽玛刀剂量分割治疗，在具备此三大优势的同时，还将头部伽玛刀的一次性大剂量照射，改成多次重复的中等剂量照射。这项改进，使头部伽玛刀治疗不仅适合体积较小的肿瘤，对体积较大的肿瘤也会有满意疗效。 四、头部伽玛刀剂量分割治疗的产生与发展 所谓“剂量分割”，就是将肿瘤致死剂量分成若干份，进行多次重复照射。它在常规放射治疗中早已被普遍采用，可是“头部伽玛刀剂量分割治疗”却没有先例。这其中的问题和困难four section" (energy-saving, and section to, and water, and section material), "four no" (no air pollution, and no dust pollution, and no noise pollution, and no sewage pollution), "five of" (that bright of, and hardening, and green, and landscaping, and purification). (B) construction management organization Construction organization and management, according to the actual situation set up civilization construction management team, chaired by the project manager, Deputy Project Manager Deputy head, site management and logistics, security of per capita as members, daily management of civilized construction leadership chaired by leader. (C) civil construction implementation plan implementing the building site construction construction site management regulations and relevant civilization site standards set by the company. Civilized construction in construction organization planning requirements is to improve basic conditions of civilized construction management, based on layout and management system on the basis of responsibility to the people, the Executive Board in order to ensure, check as a means of managing the construction. 1, sequential job----program construction, job order is reasonable, not caused due to reverse the process over again, wasting and blocking other construction jobs, job schedule clear, organized personnel and institutional arrangements, not chaotic, not idling. ----For 2, according to materials, 存在于三个层面:(1)治疗理念的改变;(2)具体方法的设计;(3)实际经验的。胡泽勇主任医师是“头部伽玛刀剂量分割治疗”理念的倡导者;是“头部伽玛刀剂量分割治疗”具体方法的发明设计者;也是“头部伽玛刀剂量分割治疗”的专家，积累了丰富的临床经验，已经为成千上万例病人解决了病痛。 五、头部伽玛刀剂量分割治疗的倡导者 胡泽勇医师在上世纪八十年代末研究生毕业后，就一直从事神经外科临床工作，早期从事开颅手术治疗脑肿瘤十余年，九十年代初期参与了国内首台X-刀的自主研发和临床应用，九十年代中期转向头部伽玛刀治疗，有近二十年头部伽玛刀治疗经验，亲手为上万病人解决病痛。胡泽勇医师在总结多年应用头部伽玛刀的经验后，在头部伽玛刀学界最早提出“伽玛刀剂量分割治疗”，不懈的追求和探索为较大体积的脑肿瘤的伽玛刀治疗带来了新的希望，实践证明这具有划时代的意义。 六、头部伽玛刀剂量分割治疗的理论依据 头部伽玛刀通过立体定向空间聚焦的方法，将无数束伽玛射线全方位汇聚于肿瘤，进行一次性大剂量照射，使肿瘤变性坏死、缩小消失。具有创伤轻、周期短、痛苦小等优点。但针对体积较大的脑肿瘤，这种“一次性大剂量照射”会导致明显的副作用，甚至颅内高压。“头部伽玛刀剂量分割治疗”能减轻这些副作用的放射生物学理论依据在于:?多次重复照射可以将上一次照射残存下来的肿瘤细胞再增殖(乏氧休眠细胞再氧合)后杀灭之;?由于脑组织对射线的耐受剂量高于肿瘤组织，当每次的照射剂量降低至这两者之间时，射线能致死性损伤肿瘤细胞，却对正常脑组织只产生亚致死性损伤;前一种损伤是不可逆的，而后一种损伤在治疗间期(大于6小时)内可以自行修复。 七、头部伽玛刀剂量分割治疗的过程 “伽玛刀剂量分割治疗”整个疗程需要3-5天。基本过程与一般伽玛刀治疗相同，包括:头架安装、定位扫描、治疗计划、治疗实施。关键技术在于头架的重复安装、头架位置的校准和治疗剂量的分配。这需要一些专利技术保障和丰富的实际操作经验。治疗间期常规口服镇four section" (energy-saving, and section to, and water, and section material), "four no" (no air pollution, and no dust pollution, and no noise pollution, and no sewage pollution), "five of" (that bright of, and hardening, and green, and landscaping, and purification). (B) construction management organization Construction organization and management, according to the actual situation set up civilization construction management team, chaired by the project manager, Deputy Project Manager Deputy head, site management and logistics, security of per capita as members, daily management of civilized construction leadership chaired by leader. (C) civil construction implementation plan implementing the building site construction construction site management regulations and relevant civilization site standards set by the company. Civilized construction in construction organization planning requirements is to improve basic conditions of civilized construction management, based on layout and management system on the basis of responsibility to the people, the Executive Board in order to ensure, check as a means of managing the construction. 1, sequential job----program construction, job order is reasonable, not caused due to reverse the process over again, wasting and blocking other construction jobs, job schedule clear, organized personnel and institutional arrangements, not chaotic, not idling. ----For 2, according to materials, 静、止吐、止痛和消炎等药物以消除不适。治疗结束一般不会有太多不良反应，可以直接回家休养，再定期回医院复查就是。 八、头部伽玛刀剂量分割治疗的十大典型病例 (一)低级别(I-II级)脑胶质瘤: 脑胶质瘤的治疗，学界普遍推崇开颅手术，随后放疗+化疗。存在的缺点是创伤大、脑损伤严重。因为低级别胶质瘤发展初期多数没有症状，等到能被发现，肿瘤往往体积巨大，因此手术全切范围很大，不必要的脑功能损害普遍存在。其实低级别胶质瘤特别适合头部伽玛刀剂量分割治疗，而且治疗效果出奇的好，不仅可以使肿瘤消失，还没有任何副损伤。受益过的病人也特别多，只是目前还没有被广泛了解。 额部巨大胶质瘤，伽玛刀剂量分割治疗后1年肿瘤完全消失。 (二)体积巨大的脑转移瘤: 脑转移瘤，是指躯干肿瘤(如肺癌、肝癌、乳腺癌、前列腺癌等等)通过血液、淋巴或局部侵犯等途径，转移到脑内的肿瘤。脑转移瘤应该首选头部伽玛刀治疗，这已经被学界普遍认可，治疗效果好且快。但对于发现较晚的脑转移瘤，肿瘤体积已经很大，肿瘤直径>75px时，单次的伽玛刀治疗就有可能出现脑水肿的风险。这种情形下，最好选择头部伽玛刀剂量分割治疗，可以避免不必要的开颅手术。 four section" (energy-saving, and section to, and water, and section material), "four no" (no air pollution, and no dust pollution, and no noise pollution, and no sewage pollution), "five of" (that bright of, and hardening, and green, and landscaping, and purification). (B) construction management organization Construction organization and management, according to the actual situation set up civilization construction management team, chaired by the project manager, Deputy Project Manager Deputy head, site management and logistics, security of per capita as members, daily management of civilized construction leadership chaired by leader. (C) civil construction implementation plan implementing the building site construction construction site management regulations and relevant civilization site standards set by the company. Civilized construction in construction organization planning requirements is to improve basic conditions of civilized construction management, based on layout and management system on the basis of responsibility to the people, the Executive Board in order to ensure, check as a means of managing the construction. 1, sequential job----program construction, job order is reasonable, not caused due to reverse the process over again, wasting and blocking other construction jobs, job schedule clear, organized personnel and institutional arrangements, not chaotic, not idling. ----For 2, according to materials, four section" (energy-saving, and section to, and water, and section material), "four no" (no air pollution, and no dust pollution, and no noise pollution, and no sewage pollution), "five of" (that bright of, and hardening, and green, and landscaping, and purification). (B) construction management organization Construction organization and management, according to the actual situation set up civilization construction management team, chaired by the project manager, Deputy Project Manager Deputy head, site management and logistics, security of per capita as members, daily management of civilized construction leadership chaired by leader. (C) civil construction implementation plan implementing the building site construction construction site management regulations and relevant civilization site standards set by the company. Civilized construction in construction organization planning requirements is to improve basic conditions of civilized construction management, based on layout and management system on the basis of responsibility to the people, the Executive Board in order to ensure, check as a means of managing the construction. 1, sequential job----program construction, job order is reasonable, not caused due to reverse the process over again, wasting and blocking other construction jobs, job schedule clear, organized personnel and institutional arrangements, not chaotic, not idling. ----For 2, according to materials, four section" (energy-saving, and section to, and water, and section material), "four no" (no air pollution, and no dust pollution, and no noise pollution, and no sewage pollution), "five of" (that bright of, and hardening, and green, and landscaping, and purification). (B) construction management organization Construction organization and management, according to the actual situation set up civilization construction management team, chaired by the project manager, Deputy Project Manager Deputy head, site management and logistics, security of per capita as members, daily management of civilized construction leadership chaired by leader. (C) civil construction implementation plan implementing the building site construction construction site management regulations and relevant civilization site standards set by the company. Civilized construction in construction organization planning requirements is to improve basic conditions of civilized construction management, based on layout and management system on the basis of responsibility to the people, the Executive Board in order to ensure, check as a means of managing the construction. 1, sequential job----program construction, job order is reasonable, not caused due to reverse the process over again, wasting and blocking other construction jobs, job schedule clear, organized personnel and institutional arrangements, not chaotic, not idling. ----For 2, according to materials, 后颅凹多发巨大脑转移瘤，伽玛刀剂量分割治疗后3月肿瘤基本消失。 (三)位于重要功能区的脑肿瘤: 脑内重要功能区比较多，如运动感觉语言区、脑干、视丘下部等。这些部位的肿瘤，如果能选择头部伽玛刀剂量分割治疗，不仅可以取得较好的疗效，而且会大大减少不必要的功能损害。 脑干海绵状血管瘤，伽玛刀剂量分割治疗后2年后复查，病变基本消失。 (四)松果体区肿瘤 松果体是位于大脑正中央的一个很小的正常结构，其功能尚不被了解，但其周围却是肿瘤的高发区，尤其是儿童。由于位置深、周围结构复杂，松果体区肿瘤的治疗，常常选择先做试验性放疗，如果效果好(生殖细胞瘤)，就继续放疗，有可能治愈。效果不好才考虑开颅手术，手术难度大，难全切，远期疗效不尽人意。实际上，松果体区肿瘤首选伽玛刀剂量分割治疗，也是一个比较明智的选择。由此治疗后会有两种结局:一部分肿瘤在短期内(1个月)four section" (energy-saving, and section to, and water, and section material), "four no" (no air pollution, and no dust pollution, and no noise pollution, and no sewage pollution), "five of" (that bright of, and hardening, and green, and landscaping, and purification). (B) construction management organization Construction organization and management, according to the actual situation set up civilization construction management team, chaired by the project manager, Deputy Project Manager Deputy head, site management and logistics, security of per capita as members, daily management of civilized construction leadership chaired by leader. (C) civil construction implementation plan implementing the building site construction construction site management regulations and relevant civilization site standards set by the company. Civilized construction in construction organization planning requirements is to improve basic conditions of civilized construction management, based on layout and management system on the basis of responsibility to the people, the Executive Board in order to ensure, check as a means of managing the construction. 1, sequential job----program construction, job order is reasonable, not caused due to reverse the process over again, wasting and blocking other construction jobs, job schedule clear, organized personnel and institutional arrangements, not chaotic, not idling. ----For 2, according to materials, 完全消失(如生殖细胞瘤)，随后便进行全脑全脊髓放疗，结合化疗治愈的可能性较大;另一部分肿瘤治疗后，体积变化不大，就可以继续观察，有的肿瘤变小消失需要2-4年时间。只要肿瘤不再增大就是。 松果体区肿瘤，伽玛刀剂量分割治疗后2月复查，病变基本消失。 (五)脑内原发性淋巴瘤 近年来，脑内原发性淋巴瘤有增多的趋势，没有经验的大夫会当作脑胶质瘤或脑转移瘤治疗。脑淋巴瘤的特点是对放疗极度敏感，主要选择放疗加化疗。直接选择头部伽玛刀剂量分割治疗，会取得非常满意的疗效，可以说是立杆见影、刀到病除。更大的优势是:肿瘤再复发还可以重复治疗。 开颅手术后肿瘤残留，伽玛刀剂量分割治疗后2月复查，病变基本消失。 (六)体积巨大的良性肿瘤 脑内良性肿瘤常见的有:脑膜瘤、垂体瘤、听神经瘤、颅咽管瘤、三叉神经纤维瘤、海绵状血管瘤等等。良性肿瘤手术全切后不易复发、可以治愈，因此首推开颅手术。但如果手术难four section" (energy-saving, and section to, and water, and section material), "four no" (no air pollution, and no dust pollution, and no noise pollution, and no sewage pollution), "five of" (that bright of, and hardening, and green, and landscaping, and purification). (B) construction management organization Construction organization and management, according to the actual situation set up civilization construction management team, chaired by the project manager, Deputy Project Manager Deputy head, site management and logistics, security of per capita as members, daily management of civilized construction leadership chaired by leader. (C) civil construction implementation plan implementing the building site construction construction site management regulations and relevant civilization site standards set by the company. Civilized construction in construction organization planning requirements is to improve basic conditions of civilized construction management, based on layout and management system on the basis of responsibility to the people, the Executive Board in order to ensure, check as a means of managing the construction. 1, sequential job----program construction, job order is reasonable, not caused due to reverse the process over again, wasting and blocking other construction jobs, job schedule clear, organized personnel and institutional arrangements, not chaotic, not idling. ----For 2, according to materials, 度大，全切困难;或者手术创伤大、致残致死率高;或者病人不适合不愿意手术，最好优先 选择头部伽玛刀治疗。少数特殊情况，肿瘤体积巨大，肿瘤直径>75px，最好选择头部伽玛 刀剂量分割治疗。 (七)体积巨大的颅底恶性肿瘤 所谓颅底肿瘤就是发生在脑子底下、下方的肿瘤;由于肿瘤位置深、结构复杂、体积大;因 此手术难度大、创伤大、致残率高、复发率高;手术后常常需要结合放疗，很少选择单次的 four section" (energy-saving, and section to, and water, and section material), "four no" (no air pollution, and no dust pollution, and no noise pollution, and no sewage pollution), "five of" (that bright of, and hardening, and green, and landscaping, and purification). (B) construction management organization Construction organization and management, according to the actual situation set up civilization construction management team, chaired by the project manager, Deputy Project Manager Deputy head, site management and logistics, security of per capita as members, daily management of civilized construction leadership chaired by leader. (C) civil construction implementation plan implementing the building site construction construction site management regulations and relevant civilization site standards set by the company. Civilized construction in construction organization planning requirements is to improve basic conditions of civilized construction management, based on layout and management system on the basis of responsibility to the people, the Executive Board in order to ensure, check as a means of managing the construction. 1, sequential job----program construction, job order is reasonable, not caused due to reverse the process over again, wasting and blocking other construction jobs, job schedule clear, organized personnel and institutional arrangements, not chaotic, not idling. ----For 2, according to materials, 头部伽玛刀治疗。但是头部伽玛刀剂量分割治疗的出现，就改变了这个局面。体积巨大的颅底恶性肿瘤，选择头部伽玛刀剂量分割治疗，常常会有满意的疗效，其反应轻、副作用少，而且肿瘤复发后可以重复治疗。因此大大提高了患者的满意度。这其中包括:颅底脊索瘤、颅底骨软骨瘤、上颌窦癌颅底转移、鼻咽癌颅底转移等等。 (八)颅底巨大的海绵状血管瘤 颅底海绵状血管瘤，常常侵犯海绵窦，发展迅速、侵蚀范围广。手术切除出血多、难度大。高兴的是近年来发现:颅底海绵状血管瘤伽玛刀治疗的疗效十分神奇，因此应该首选头部伽玛刀治疗。对于颅底巨大的海绵状血管瘤，最好选择头部伽玛刀剂量分割治疗。 four section" (energy-saving, and section to, and water, and section material), "four no" (no air pollution, and no dust pollution, and no noise pollution, and no sewage pollution), "five of" (that bright of, and hardening, and green, and landscaping, and purification). (B) construction management organization Construction organization and management, according to the actual situation set up civilization construction management team, chaired by the project manager, Deputy Project Manager Deputy head, site management and logistics, security of per capita as members, daily management of civilized construction leadership chaired by leader. (C) civil construction implementation plan implementing the building site construction construction site management regulations and relevant civilization site standards set by the company. Civilized construction in construction organization planning requirements is to improve basic conditions of civilized construction management, based on layout and management system on the basis of responsibility to the people, the Executive Board in order to ensure, check as a means of managing the construction. 1, sequential job----program construction, job order is reasonable, not caused due to reverse the process over again, wasting and blocking other construction jobs, job schedule clear, organized personnel and institutional arrangements, not chaotic, not idling. ----For 2, according to materials, four section" (energy-saving, and section to, and water, and section material), "four no" (no air pollution, and no dust pollution, and no noise pollution, and no sewage pollution), "five of" (that bright of, and hardening, and green, and landscaping, and purification). (B) construction management organization Construction organization and management, according to the actual situation set up civilization construction management team, chaired by the project manager, Deputy Project Manager Deputy head, site management and logistics, security of per capita as members, daily management of civilized construction leadership chaired by leader. (C) civil construction implementation plan implementing the building site construction construction site management regulations and relevant civilization site standards set by the company. Civilized construction in construction organization planning requirements is to improve basic conditions of civilized construction management, based on layout and management system on the basis of responsibility to the people, the Executive Board in order to ensure, check as a means of managing the construction. 1, sequential job----program construction, job order is reasonable, not caused due to reverse the process over again, wasting and blocking other construction jobs, job schedule clear, organized personnel and institutional arrangements, not chaotic, not idling. ----For 2, according to materials,