Kondziolka Douglas, Nathoo Narendra, Flickinger John C, Niranjan Ajay, Maitz Ann H, Lunsford L Dade
Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Neurosurgery. 2003 Oct;53(4):815-21; discussion 821-2. doi: 10.1093/neurosurgery/53.4.815.
Stereotactic radiosurgery is the principal therapeutic alternative to resecting benign intracranial tumors. The goals of radiosurgery are the long-term prevention of tumor growth, the maintenance of patient function, and the prevention of new neurological deficits or adverse radiation effects. Evaluation of long-term outcomes more than 10 years after radiosurgery is needed.
We evaluated 285 consecutive patients who underwent radiosurgery for benign intracranial tumors between 1987 and 1992. Serial imaging studies were obtained, and clinical evaluations were performed. Our series included 157 patients with vestibular schwannomas, 85 patients with meningiomas, 28 patients with pituitary adenomas, 10 patients with other cranial nerve schwannomas, and 5 patients with craniopharyngiomas. Prior surgical resection had been performed in 44% of these patients, and prior radiotherapy had been administered in 5%. The median follow-up period was 10 years.
Overall, 95% of the 285 patients in this series had imaging-defined local tumor control (63% had tumor regression, and 32% had no further tumor growth). The actuarial tumor control rate at 15 years was 93.7%. In 5% of the patients, delayed tumor growth was identified. Resection was performed after radiosurgery in 13 patients (5%). No patient developed a radiation-induced tumor. Eighty-one percent of the patients were still alive at the time of this analysis. Normal facial nerve function was maintained in 95% of patients who had normal function before undergoing treatment for acoustic neuromas.
Stereotactic radiosurgery provided high rates of tumor growth control, often with tumor regression, and low morbidity rates in patients with benign intracranial tumors when evaluated over the long term. This study supports radiosurgery as a reliable alternative to surgical resection for selected patients with benign intracranial tumors.
立体定向放射外科是切除颅内良性肿瘤的主要治疗替代方法。放射外科的目标是长期预防肿瘤生长、维持患者功能以及预防新的神经功能缺损或不良放射效应。需要对放射外科治疗10年以上的长期结果进行评估。
我们评估了1987年至1992年间连续285例接受颅内良性肿瘤放射外科治疗的患者。进行了系列影像学检查并开展了临床评估。我们的系列研究包括157例前庭神经鞘瘤患者、85例脑膜瘤患者、28例垂体腺瘤患者、10例其他颅神经鞘瘤患者以及5例颅咽管瘤患者。这些患者中44%曾接受过手术切除，5%曾接受过放疗。中位随访期为10年。
总体而言，该系列285例患者中有95%实现了影像学定义的局部肿瘤控制（63%肿瘤缩小，32%肿瘤无进一步生长）。15年时的精算肿瘤控制率为93.7%。5%的患者出现了肿瘤延迟生长。13例患者（5%）在放射外科治疗后接受了手术切除。没有患者发生放射性诱导肿瘤。在本次分析时，81%的患者仍然存活。在接受听神经瘤治疗前面神经功能正常的患者中，95%的患者维持了正常面神经功能。
长期评估显示，立体定向放射外科在颅内良性肿瘤患者中实现了高肿瘤生长控制率，通常伴有肿瘤缩小，且发病率较低。本研究支持放射外科作为部分颅内良性肿瘤患者手术切除的可靠替代方法。
