Glioblastoma Multiformeの手術と遠隔成績

GLIOBLASTOMA MULTIFORME:A Statistical Survey of 40 Cases in Relation of Surgery to Follow up Results

I．緒言

　Glioblastoma multiformeの治療成績はこの10余年の間にいちじるしく向上したと言える。すなわち積極的摘出と効果的な放射線療法の併用がしばしば術後の患者にある期間を限つて有意な生活を可能にし，単なる生検を行なう程度の手術では死亡率が依然高いのに比して優に1年近い平均生存が期待され，まれに長期生存例の報告をみることも可能となつた。

　この手術的治療の見解と立場を文献のうえにたどることはすこぶる興味深いものがある。

Fourty cases of verified glioblastoma multiforme were analysed from operative findings and procedure. Utilizing the smear test of neoplastic tissue demar-cation of each tumor was investigated and 42% of the glioblastomas were found to have macroscopically good or fair demarcation, however, 40 % of the tumors had bilateral extension already by the time of surgery. The surgical procedure was classified into 3 groups depending upon the surgical accessi-bility of the neoplastic demarcation; they were total, subtotal and partial removal. Additionally extensive lobectomy for establishing internal decompression was combined in 27 cases. Each case was given Cobalt irradiation in the amount aiming 5000 rad or more postoperatively.

Postoperative results, including the general and neurological, were devided into 4 groups; A for excellent through D for hospital death. Of 17 cases of A group total removal was affected in 8 cases, partial removal in 6 cases and the ratio of good vs. poor demarcation was 5 to 6. No specific difference which could be attributable to postoperative results in A group was drawn from demarcation and / or type of surgery as long as sufficient internal decom-pression was performed. The average USEFUL postoperative survival time of group A was 9.94 months, 20 months being the longest, in this series. Death occurred approximately 2 months after onset of apparent symptom of recurrence and onset of symptomatic recurrence in Group A showed as much as only 1 to 2 months difference in relation to good vs. poor demarcation and but 4 months in total or subtotal vs. partial removal. Over all it could be emphasized that 40 % of glioblastoma multiforme cases would be entitled to reasonable improvement for a period of 10 months on the average if sufficient space had been established intracranially at the time of surgery and postoperative Cobalt irradiation had been completed.