Neurological Surgery 脳神経外科34巻12号

2006年12月発行

連載 脳神経外科医療のtranslational research（2）

放射線外科治療

著者： 森美雅¹

所属機関： ¹名古屋共立病院放射線外科センター

ページ範囲：P.1281 - P.1289

Ⅰ．はじめに

　放射線外科治療（定位放射線治療）は，病巣に放射線を集中照射して治療する高度な先端医療の1つである．放射線を病巣に集中することで，周辺組織への照射を極力少なくし，より安全に高線量を照射して治療することができる¹⁰⁾．当初は機能外科の1つとして，放射線の集中照射治療が行われた⁵⁶⁾．その後，脳動静脈奇形⁴⁰⁾，聴神経腫瘍¹³⁾の治療に応用され，さらに，種々の脳腫瘍，最近では特に患者数の多い転移性脳腫瘍に対する有効な治療法として多数の患者が治療を受けている^36,37)．また，三叉神経痛などの機能的疾患にも非常に有効であることが示されている³⁸⁾．放射線外科治療は，当初から臨床使用され，臨床データの積み重ねにより発展してきた．ガンマナイフ（Gamma Knife，エレクタ社）によるものだけで，2005年末までに世界で約35万人の患者が治療を受けている（エレクタ社資料）．ガンマナイフは構造上，頭部病変の専用機である．コバルト60の崩壊により生じる安定した多数のガンマ線を集中照射する．患者頭部が頭蓋フレームを介してガンマナイフ本体と機械的に固定されるために，非常な高精度が保証される．最近では，このガンマナイフで示された各種病変に対する放射線外科治療の有効性が認知されたこともあり，その体幹部病変への応用が広がってきている．リニアックベースの定位放射線治療機が開発され，全身の定位放射線治療が行えるようになってきた．脳神経外科分野としては脊椎，脊髄腫瘍への応用が始まっている¹²⁾．体幹部の放射線治療では，放射線照射の機械精度，患者への照射の精度などのquality assurance（QA），quality control（QC）が問題となるため，臨床研究以外に精度管理の研究が多数なされている³⁵⁾．このように，放射線外科治療では臨床研究が先行している特徴がある．また，放射線外科治療の特長として，もとより開頭手術せずに低侵襲に治療できることが利点である．聴神経腫瘍，原発巣が既知の転移性脳腫瘍などmagnetic resonance imaging（MRI）等の画像のみで診断がつく場合，治療前の組織診断が省かれていることが多く，また，有効性が高いために，かえって治療後の組織標本が検討されない場合が多い．治療後の組織変化について，わずかの臨床報告^{7,11,14,28,43,48,56,58,59)}があるのみである．したがって適切な動物実験による解剖組織所見を含めた研究が非常に重要である⁴⁶⁾．当論文では，放射線外科治療に関する動物実験についての文献を概説したい．

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