Flickinger J C, Kondziolka D, Niranjan A, Lunsford L D
Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
J Neurosurg. 2001 Jan;94(1):1-6. doi: 10.3171/jns.2001.94.1.0001.
The goal of this study was to define tumor control and complications of radiosurgery encountered using current treatment methods for the initial management of patients with unilateral acoustic neuroma.
One hundred ninety patients with previously untreated unilateral acoustic neuromas (vestibular schwannomas) underwent gamma knife radiosurgery between 1992 and 1997. The median follow-up period in these patients was 30 months (maximum 85 months). The marginal radiation doses were 11 to 18 Gy (median 13 Gy), the maximum doses were 22 to 36 Gy (median 26 Gy), and the treatment volumes were 0.1 to 33 cm3 (median 2.7 cm3). The actuarial 5-year clinical tumor-control rate (no requirement for surgical intervention) for the entire series was 97.1+/-1.9%. Five-year actuarial rates for any new facial weakness, facial numbness, hearing-level preservation, and preservation of testable speech discrimination were 1.1+/-0.8%, 2.6+/-1.2%, 71+/-4.7%, and 91+/-2.6%, respectively. Facial weakness did not develop in any patient who received a marginal dose of less than 15 Gy (163 patients). Hearing levels improved in 10 (7%) of 141 patients who exhibited decreased hearing (Gardner-Robertson Classes II-V) before undergoing radiosurgery. According to multivariate analysis, increasing marginal dose correlated with increased development of facial weakness (p = 0.0342) and decreased preservation of testable speech discrimination (p = 0.0122).
Radiosurgery for acoustic neuroma performed using current procedures is associated with a continued high rate of tumor control and lower rates of posttreatment morbidity than those published in earlier reports.
本研究的目的是明确在采用当前治疗方法对单侧听神经瘤患者进行初始治疗时，放射外科手术的肿瘤控制情况及并发症。
1992年至1997年间，190例未经治疗的单侧听神经瘤（前庭神经鞘瘤）患者接受了伽玛刀放射外科手术。这些患者的中位随访期为30个月（最长85个月）。边缘辐射剂量为11至18 Gy（中位剂量13 Gy），最大剂量为22至36 Gy（中位剂量26 Gy），治疗体积为0.1至33 cm³（中位体积2.7 cm³）。整个系列的5年精算临床肿瘤控制率（无需手术干预）为97.1±1.9%。任何新发面部无力、面部麻木、听力保留以及可测试言语辨别力保留的5年精算率分别为1.1±0.8%、2.6±1.2%、71±4.7%和91±2.6%。在接受边缘剂量小于15 Gy的患者中（163例），无一例发生面部无力。在接受放射外科手术前听力下降（Gardner-Robertson II-V级）的141例患者中，10例（7%）听力有所改善。根据多变量分析，边缘剂量增加与面部无力发生率增加（p = 0.0342）以及可测试言语辨别力保留率降低（p = 0.0122）相关。
采用当前程序进行的听神经瘤放射外科手术与持续较高的肿瘤控制率相关，且与早期报告相比，治疗后发病率较低。
