Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
Int J Radiat Oncol Biol Phys. 2010 Jan 1;76(1):193-200. doi: 10.1016/j.ijrobp.2009.01.064.
To evaluate the outcomes of patients with vestibular schwannoma (VS) treated with fractionated stereotactic radiotherapy (FSRT) vs. those treated with stereotactic radiosurgery (SRS).
This study is based on an analysis of 200 patients with 202 VSs treated with FSRT (n = 172) or SRS (n = 30). Patients with tumor progression and/or progression of clinical symptoms were selected for treatment. In 165 out of 202 VSs (82%), RT was performed as the primary treatment for VS, and for 37 VSs (18%), RT was conducted for tumor progression after neurosurgical intervention. For patients receiving FSRT, a median total dose of 57.6 Gy was prescribed, with a median fractionation of 5 x 1.8 Gy per week. For patients who underwent SRS, a median single dose of 13 Gy was prescribed to the 80% isodose.
FSRT and SRS were well tolerated. Median follow-up time was 75 months. Local control was not statistically different for both groups. The probability of maintaining the pretreatment hearing level after SRS with doses of < or =13 Gy was comparable to that of FSRT. The radiation dose for the SRS group (< or =13 Gy vs. >13 Gy) significantly influenced hearing preservation rates (p = 0.03). In the group of patients treated with SRS doses of < or =13 Gy, cranial nerve toxicity was comparable to that of the FSRT group.
FSRT and SRS are both safe and effective alternatives for the treatment of VS. Local control rates are comparable in both groups. SRS with doses of < or =13 Gy is a safe alternative to FSRT. While FSRT can be applied safely for the treatment of VSs of all sizes, SRS should be reserved for smaller lesions.
评估接受分割立体定向放射治疗（FSRT）与立体定向放射外科治疗（SRS）的听神经鞘瘤（VS）患者的治疗结果。
本研究基于对 200 例 202 个 VS 患者的分析，其中 172 例接受 FSRT 治疗，30 例接受 SRS 治疗。选择肿瘤进展和/或临床症状进展的患者进行治疗。在 202 个 VS 中，有 165 个（82%）为 RT 作为 VS 的主要治疗方法，37 个（18%）为神经外科干预后肿瘤进展的 RT。对于接受 FSRT 的患者，处方的中位总剂量为 57.6 Gy，中位分割剂量为每周 5 次 x 1.8 Gy。对于接受 SRS 的患者，处方的中位单次剂量为 13 Gy 至 80%等剂量线。
FSRT 和 SRS 均耐受良好。中位随访时间为 75 个月。两组的局部控制率无统计学差异。SRS 剂量<或=13 Gy 组与 FSRT 组相比，保留术前听力水平的概率相当。SRS 组（<或=13 Gy 与>13 Gy）的放射剂量显著影响听力保留率（p = 0.03）。在接受 SRS 剂量<或=13 Gy 的患者组中，颅神经毒性与 FSRT 组相当。
FSRT 和 SRS 都是治疗 VS 的安全有效的替代方法。两组的局部控制率相当。SRS 剂量<或=13 Gy 是 FSRT 的安全替代方法。虽然 FSRT 可安全用于治疗所有大小的 VS，但 SRS 应保留用于较小的病变。
