グリオーマの放射線治療成績

RESULTS OF RADIATION THERAPY OF MALIGNANT BRAIN TUMOURS

I．はじめに

　脳腫瘍に対する放射線治療はその大半が手術後照射であるが，放射線治療を必要としない脳腫瘍は良性腫瘍の一部に限られ，治療の対象となる症例は年々増加している。

　ただ，最も治療の困雑なグリオーマについてはそれが単に手術で切除できるということではすまされず，脳としての機能が保持できての治療でなければならないところに大きな問題がある。したがつて早期診断や手術手技の進歩があつても他臓器の悪性腫瘍とは異なり，根治的に大きく切除ないし摘出することが行なえず時には滅圧措置のみがなされることもまれではない。またponsや延髄のようにまつたく手のつかない部位もあり，放射線療法は不可欠の手段となつている。

Inspite of the progress of neurosurgical techniques, some of the brain tumours still can be removed only-incompletely or can not be removed at all, and the radiation therapy is important and indispensable for the treatment of the brain tumours. Reviewed re-sults of radiotherapy in 350 patients with histologi-cally verified malignant brain tumours and clinically malignant brain tumours (pontine tumours, brain stem tumours, so-called cerebellar tumours etc.) treated during April 1950-August 1967.

Radiation was performed in postoperative or in-operable cases. Standard tumour dose of 4,000-5,500. R was irradiated through two or three portales.

As a rule, before the irradiation, various types of the surgical decompressions were performed.

Classification and survival rate as follows :

1) Brain tumours (included pituitary adenomas). : 1y. 313/385 81.3%, 2y. 240/332 72.3%, 3y. 189/ 274 69.9%, 4y. 140/230 60.8%, 5y. 111/202 54.9%

2) Malignant brain tumours : 1y. 163/235 69.4%, 2y. 106/193 54.8%, 3y. 81/160 50.6%, 4y. 57/ 139 41.0%, 5y. 40/124 32.3%

3) Medulloblastoma. : 0.5y. 44/57 77%, 1y. 28/56 48%, 2y. 18/52 35%, 3y. 15/48 32%, 4y. 11/44 25%, 5y. 7/40 17.5%

4) Malignant meningioma : 2y. 13/14, 3y. 10/11, 5y. 6/8

5) Glioblastoma multiforme : 1y. 4/10, 3y. 3/8, 5y. 1/6

6) Astrocytoma I-II (Supratentorial) : 1y. 11/12, 3y. 4/5, 4y. 3/3

7) Pinealoma : 1y. 20/23, 2y. 12/15, 3y. 10/13, 5y. 3/4

8) Pons tumours : 1y. 6/26, 2y. 2/26, 3y. 1/23, 5y. 1/23

9) Midbrain tumours : 1y. 9/10, 2y. 6/9, 3y. 6/9, 5y. 4/7

10) Ependymoma : 1y. 14/16, 2y. 9/12, 3y. 5/5. 5y. 3/3

11) Hemangioblastoma cerebelli. : 1y. 9/11, 3y. 4/6, 5y. 3/5

12) Astrocytoma cerebelli : 5y. 6/6

13) Craniopharyngioma : 1y. 9/9, 3y. 5/5, 4y. 3/3, 5y. 1/1

14) Malig. pituitary tumours : 5y. 4/8

Radical radiotherapy is always indicated for all brain tumours.