目的 研究髓母细胞瘤患者应用三维适形放疗（3D conformal radiation therapy，3D⁃CRT）或调强放疗（intensity⁃modulated radiotherapy，IMRT）、手术和放疗之间的时间间隔以及化疗等因素对复发模 式和预后的影响。方法 分析 2009 年 5 月至 2017 年 9 月收治的 36 例髓母细胞瘤患者资料。统计分析各 组患者不同临床分期、病理类型及治疗方式对生存时间的影响。生存分析采用 Kaplan⁃Meier 法比较各组 的生存差异。结果 3D⁃CRT 组 9 例中有 7 例复发，IMRT 组 27 例中有 9 例复发。IMRT 组患者的 5 年无进 展生存率（progression⁃free survival，PFS）为 65.8%，明显高于 3D⁃CRT 组的 22.2%（P < 0.05），两组的 5 年总生 存率（overall survival，OS）分别为和 62.1%和 44.4%，差异无统计学意义（P > 0.05）。手术放疗间隔＜12 周 组的 PFS 明显优于间隔＞12 周组（P < 0.05）。M0 组患者的 PFS、OS 均优于 M2/M3 组（P < 0.05）。在多因素 Cox风险模型分析显示，放疗前残留病变、复发或转移是PFS的独立预后因素（P < 0.05）。结论 与3D⁃CRT 相比，IMRT 组的脊髓复发风险更低。手术与放疗之间的间隔时间应≤ 12 周。放疗前无残留病灶、无复发 和扩散的髓母细胞瘤患者放疗后的PFS 和OS 较高。

Objective To explore the impacts of 3D conformal radiation therapy（3D⁃CRT）or intensity⁃ modulated radiotherapy（IMRT），time interval from surgery to radiotherapy，and use of chemotherapy on the recur⁃ rence pattern and survival. Methods The data on 36 patients with medulloblastoma who had been treated from May 2009 to September 2017 were analyzed. The impacts of different clinical stages，pathological types，and treat⁃ ment methods on the survival stage were analyzed in each group. The Kaplan ⁃Meier method was used to compare the survival differences between differentgroups. Results Seven of the 9 patients in the 3D ⁃CRT group and 9 of the 27 in the IMRT group had recurrence. The 5⁃year progression⁃free survival（PFS）rate was significantly higher in the IMRT group than in the 3D⁃CRT group（65.8% vs. 22.2%，P < 0.05），but there was no statistical difference in the 5⁃year overall survival（OS）（62.1% vs. 44.4%，P > 0.05）. The PFS and OS were better in the M0 group than in the M2/M3 groups（P < 0.05）. The PFS of surgery to radiation interval time < 12⁃week group was superior to that of the > 12⁃week group（P < 0.05）. In the multivariate Cox proportional hazards analysis，residual lesions， recurrence，or metastasis before radiotherapy were independent prognostic factors for PFS（P < 0.05）. Conclusions IMRT has a lower risk of spinal cord recurrence than 3D ⁃ CRT. The interval between surgery and radiotherapy should be shorter than or equal to 12 weeks. The PFS and OS were higher in patients without residual lesions ， recurrence，and spread before radiotherapy.