Wang Ling-Wei, Shiau Cheng-Ying, Chung Wen-Yuh, Wu Hsiu-Mei, Guo Wan-Yuo, Liu Kang-Du, Ho Donald Ming-Tak, Wong Tai-Tong, Pan David Hung-Chi
Cancer Center, Taipei Veterans General Hospital, Taiwan, Republic of China.
J Neurosurg. 2006 Dec;105 Suppl:127-32. doi: 10.3171/sup.2006.105.7.127.
The authors report the long-term treatment results of Gamma Knife surgery (GKS) for patients with low-grade astrocytomas who underwent surgery at a single institution.
A series of 21 patients (median age 20 years) with 25 intracranial low-grade astrocytomas (World Health Organization Grades I and II) were treated with GKS between 1993 and 2003. Among them, four underwent GKS as a primary treatment. Two underwent GKS as a treatment boost after radiotherapy. In the other 15 patients, GKS was performed as an adjuvant or salvage treatment for residual/recurrent tumors after the patients had undergone craniotomy. Tumor volumes ranged from 0.2 to 13.3 ml (median 2.4 ml). Prescription margin doses ranged from 8 to 18 Gy (median 14.5 Gy). Radiation volumes were 1.3 to 21.6 ml (median 3.6 ml). Patients underwent regular follow up, with neurological evaluation and magnetic resonance imaging studies obtained at 6-month intervals. One patient was lost to follow-up. The clinical follow-up time was 5 to 144 months (median 67 months). Complete tumor remission was seen in three patients. The 10-year progression-free patient survival rate after GKS was 65%. Tumor progression was found in six patients of whom five received further salvage treatment. All the tumor progression occurred within the GKS-treated volumes. Mild-to-moderate adverse radiation effects (AREs) were found in eight patients. Both of the patients who had undergone GKS as a treatment boost after radiotherapy developed AREs, but with good shrinkage of tumors.
Gamma Knife surgery provides durable long-term local tumor control with acceptable toxicity for some patients with highly selected low-grade astrocytomas.
作者报告了在单一机构接受手术的低级别星形细胞瘤患者接受伽玛刀手术（GKS）的长期治疗结果。
1993年至2003年间，对21例（中位年龄20岁）患有25个颅内低级别星形细胞瘤（世界卫生组织I级和II级）的患者进行了GKS治疗。其中，4例接受GKS作为初始治疗。2例在放疗后接受GKS作为治疗强化。在其他15例患者中，GKS作为开颅术后残留/复发性肿瘤的辅助或挽救治疗。肿瘤体积为0.2至13.3毫升（中位值2.4毫升）。处方边缘剂量为8至18 Gy（中位值14.5 Gy）。放射体积为1.3至21.6毫升（中位值3.6毫升）。患者接受定期随访，每6个月进行一次神经学评估和磁共振成像检查。1例患者失访。临床随访时间为5至144个月（中位值67个月）。3例患者出现肿瘤完全缓解。GKS后10年无进展患者生存率为65%。6例患者出现肿瘤进展，其中5例接受了进一步的挽救治疗。所有肿瘤进展均发生在GKS治疗体积内。8例患者出现轻度至中度放射性不良反应（AREs）。2例在放疗后接受GKS作为治疗强化的患者均出现了AREs，但肿瘤明显缩小。
对于部分经过严格筛选的低级别星形细胞瘤患者，伽玛刀手术可提供持久的长期局部肿瘤控制，且毒性可接受。
