Combs Stephanie E, Thilmann Christoph, Debus Jürgen, Schulz-Ertner Daniela
Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
Int J Radiat Oncol Biol Phys. 2006 Apr 1;64(5):1341-7. doi: 10.1016/j.ijrobp.2005.10.024. Epub 2006 Feb 7.
To evaluate the effectiveness and long-term outcome of stereotactic radiosurgery (SRS) for acoustic neuromas (AN).
Between 1990 and 2001, we treated 26 patients with 27 AN with SRS. Two patients suffered from neurofibromatosis type 2. Before SRS, a subtotal or total resection had been performed in 3 and in 5 patients, respectively. For SRS, a median single dose of 13 Gy/80% isodose was applied.
The overall actuarial 5-year and 10-year tumor control probability in all patients was 91%. Two patients developed tumor progression after SRS at 36 and 48 months. Nineteen patients (73%) were at risk of treatment-related facial nerve toxicity; of these, 1 patient developed a complete facial nerve palsy after SRS (5%). A total of 93% of the lesions treated were at risk of radiation-induced trigeminal neuralgia. Two patients (8%) developed mild dysesthesia of the trigeminal nerve after SRS. The hearing preservation rate in patients with useful hearing before SRS was 55% at 9 years.
Stereotactic radiosurgery results in good local control rates of AN and the risk of cranial nerve toxicities is acceptable. As toxicity is lower with fractionated stereotactic radiotherapy, SRS should be reserved for smaller lesions.
评估立体定向放射外科（SRS）治疗听神经瘤（AN）的有效性和长期疗效。
1990年至2001年间，我们用SRS治疗了26例患者的27个听神经瘤。2例患者患有2型神经纤维瘤病。在进行SRS之前，分别有3例和5例患者接受了次全切除或全切除。对于SRS，单次剂量中位数为13 Gy/80%等剂量线。
所有患者的总体5年和10年肿瘤控制概率为91%。2例患者在SRS后36个月和48个月出现肿瘤进展。19例患者（73%）有发生与治疗相关的面神经毒性的风险；其中，1例患者在SRS后出现完全性面神经麻痹（5%）。接受治疗的病变中有93%有发生放射性三叉神经痛的风险。2例患者（8%）在SRS后出现轻度三叉神经感觉异常。SRS前听力正常的患者9年时的听力保留率为55%。
立体定向放射外科导致听神经瘤的局部控制率良好，且颅神经毒性风险可接受。由于分次立体定向放射治疗的毒性较低，SRS应保留用于较小的病变。
