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立体定向放射外科手术可实现海绵窦脑膜瘤的长期肿瘤控制。

Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas.

作者信息

Lee John Y K, Niranjan Ajay, McInerney James, Kondziolka Douglas, Flickinger John C, Lunsford L Dade

机构信息

Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania, USA.

出版信息

J Neurosurg. 2002 Jul;97(1):65-72. doi: 10.3171/jns.2002.97.1.0065.

Abstract

OBJECT

To evaluate long-term outcomes of patients who have undergone stereotactic radiosurgery for cavernous sinus meningiomas, the authors retrospectively reviewed their 14-year experience with these cases.

METHODS

One hundred seventy-six patients harbored meningiomas centered within the cavernous sinus. Seventeen patients were lost to follow-up review, leaving 159 analyzable patients, in whom 164 procedures were performed. Seventy-six patients (48%) underwent adjuvant radiosurgery after one or more attempts at surgical resection. Eighty-three patients (52%) underwent primary radiosurgery. Two patients (1%) had previously received fractionated external-beam radiation therapy. Four patients (2%) harbored histologically verified atypical or malignant meningiomas. Conformal multiple isocenter gamma knife surgery was performed. The median dose applied to the tumor margin was 13 Gy. Neurological status improved in 46 patients (29%), remained stable in 99 (62%), and eventually worsened in 14 (9%). Adverse effects of radiation occurred after 11 procedures (6.7%). Tumor volumes decreased in 54 patients (34%), remained stable in 96 (60%), and increased in nine (6%). The actuarial tumor control rate for patients with typical meningiomas was 93.1 +/- 3.3% at both 5 and 10 years. For the 83 patients who underwent radiosurgery as their sole treatment, the actuarial tumor control rate at 5 years was 96.9 +/- 3%.

CONCLUSIONS

Stereotactic radiosurgery provided safe and effective management of cavernous sinus meningiomas. We believe it is the preferred management strategy for tumors of suitable volume (average tumor diameter < or = 3 cm or volume < or = 15 cm3).

摘要

目的

为评估接受立体定向放射外科治疗海绵窦脑膜瘤患者的长期预后,作者回顾性分析了他们14年中治疗这些病例的经验。

方法

176例患者患有以海绵窦为中心的脑膜瘤。17例患者失访,剩余159例可分析患者,共进行了164次手术。76例患者(48%)在一次或多次手术切除尝试后接受了辅助性放射外科治疗。83例患者(52%)接受了初次放射外科治疗。2例患者(1%)之前接受过分次外照射放疗。4例患者(2%)患有组织学证实的非典型或恶性脑膜瘤。采用适形多等中心伽玛刀手术。肿瘤边缘的中位剂量为13 Gy。46例患者(29%)神经状态改善,99例(62%)保持稳定,14例(9%)最终恶化。11次手术(6.7%)后出现放疗不良反应。54例患者(34%)肿瘤体积减小,96例(60%)保持稳定,9例(6%)增大。典型脑膜瘤患者在5年和10年时的精算肿瘤控制率为93.1±3.3%。对于83例仅接受放射外科治疗的患者,5年时的精算肿瘤控制率为96.9±3%。

结论

立体定向放射外科为海绵窦脑膜瘤提供了安全有效的治疗。我们认为它是适合体积肿瘤(平均肿瘤直径≤3 cm或体积≤15 cm³)的首选治疗策略。

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