| Radiation-induced gliomas is a deadly radiation therapy complications.The actual incidence of the complications is a low incidence,although which is not completely clear.But now many disease has long life extension.So the period between radiotherapy and induced gliomas is extended.More cases of induced gliomas will occure.The radiological surgical treatments such as gamma knife has various superiority,which has been widely applied in surgical treatment now.Research about induced gliomas after radiological surgical treatments has appeared more important and urgent.Materials and methodsGeneral informationRefer to gliomas of the First Affiliated Hospital of China Medical University neurosurgery ward from 1990 to now.Preliminary screened the diagnostic criteria of cases through the complain,past history and present history illness.And then further refer to surgical records,pathology.Find the diagnostic criteria of cases finally. Patients were followed up.Diagnostic criteriaIn 1948 Cahan has proposed the diagnostic criteria about radiotherapy induced tumor:1 Tumor must occur in the radiotherapy area.2 There must be a sufficient long incubation period.3 Tumor tissue types must be different with first tumor.4 Patients must havn't a tumor development tendency of disease,such as tuberous sclerosis, shading sex dry skin.Now this standard has been widely adopted.Immunohistochemical studyFind the pathological wax according to the pathological record,and then make Immunohistochemical study.PBS replace the first antibody is blank control.To appear brown granular is positive results. ResultBased on 2100 gliomas of the First Affiliated Hospital of China Medical University neurosurgery ward from 1990 until now,three patients were found with the diagnostic criteria.Through follow-up,one patient clinical data is integrity.Find the pathological wax,HE dyeing.Pathologic diagnosis are graven by respectively three pathologist doctors.All diagnose gliomaâ… -â…¡grade.Do immunohistochemical study.DiscussionRadiation-Induced gliomas is a kind of many factors event,which is not only depend on the radiation dose,also depends on the basis of the patients and disease patients condition,etc.In early 1960s have relevant literature about induced tumor within the coverage area after radiotherapy.Since then,people have reported constantly and the number of cases related increased continuously.One of three patients had completic clinical material.Diagnostic cavernous hemangioma is clear,and there is the causality between induced glioma and radiotherapy.Through a series of immunohistochemical staining,support pathology classification and the long-term survive.Induced glioma after radiotherapy cavernous blood vessels was reported abroad only one,and is the first in domestic.Immunohistochemical result discussion1.GFAP expressionGFAP is astrocytes characteristic marker.Immunohistochemical stain result shown cells express more,and support pathology low level,which may shown tumor no obvious infiltration and diffusion,so patient can the long-term survival.2.Ki-67 expressionKi-67 is specific expression of nuclear antigen during cell proliferation.The patient's tumor cells express less Ki-67,which explain cell less hyperplasia, splitting less,and pathology of low level,isn't a high level of malignant.Patient can long-term survive.3.P53 expressionAt the height of malignant tumor,P53 gene mutation is high frequency.The patient's tumor cells express less P53.P53 gene mutations is less,and pathology level is low.4.MHC expressionThe patient's tumor antigen expression MHC is high,which cause the immune response strongly,and inhibit the growth of tumor cells.So the prognosis is better.5.MGMT expressionThe tumor cells are more MGMT expression so that the patient can inhibit chemotherapy drugs.6.CD133 and nestin expressionThe tumor cells have small CD133 nestin and expression,which support cancer stem cells theory.The mechanism of radiotherapy induced tumor is the same with other way.To sum up,Immunohistochemical result support a low level gliomas,Due to tumor cells express more GFAP and MHC,which can inhibit tumor cell's infiltration and diffusion,at the same time can induce the immune response of body.So the patient can long-term survive.Tumor cells have expressed less Ki-67,which express tumor cell proliferation and support a diagnostic glial low level.These show tumor cell's attack is poor,also support patient's the long-term survive postoperatively.Tumor cells express less P53,CD133 and nestin,which may explain the cause about the radiation therapy and induced glioma.Relevant factors of the radiation-Induced intracranial neoplasm Currently1,The age when accepted radiotherapy.2,Chemotherapy.3,The radiation dose.4,The time factor.Radiation-Induced gliomas may trigger mechanism1,Radiation can affect the normal function of cells surrounding.2,Radiation can cause cell hyperplasia and mutation.3,Radiation-induced gliomas have some clinical features.Now the reasons of radiation-induced gliomas is not entirely clear,but through the above analysis,there are the difference between inducing intracranial lesions after radiotherapy and spontaneous intracranial lesions,also exist more contact.These cases featuresThrough incomplete statistics about 2100 gliomas of the First Affiliated Hospital of China Medical University neurosurgery ward.We found three patients and all is adult male patient.Age from 32-67,interval 8 months to 4 years.On average,compared with foreign literature the incubation period is short.All induced intracranial malignant tumor is after Gamma knife treatment,which isn't the same with abroad.The most radiation-induced gliomas is after common radiotherapy abroad.The patient's age is small than generally spontaneous patients,which is the same with abroad.All cases was benign lesions before Gamma knife treatment,which is the same with foreign.ConclusionGamma knife radiosurgery treatments is an important part in the neural surgical treatment of diseases.But the radiation therapy can induce intracranial malignant tumor, although now most people think it is very low incidence,but some think the risk of radiation-induced tumor is greatly underestimated.Now many children accepted radiation surgical treatment for benign disease because of their superiority,due to the above cases have a long survival,also means a longer incubation period compared with the normal people,the incidence of a disease will increase.Induced intracranial malignant tumor after radiotherapy is only individual phenomenon.Therefore, radiation-induced intracranial malignant tumor is related with patients themselves genotypes,physical and primary disease factors.With the current research on such diseases,people may find the associated risk factors in the future.Although the incidence of the disease is very low,but the consequences are serious.So when patients is adviced to accept radiotherapy,emphasize the intracranial malignant tumors may cause. |
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