Department of Neurological Surgery, Lars Leksell Gamma Knife Center, University of Virginia Health System, Charlottesville, VA 22908, USA.
J Neurooncol. 2011 Aug;104(1):305-13. doi: 10.1007/s11060-010-0494-0. Epub 2010 Dec 14.
Gamma Knife surgery (GKS) has emerged as a valuable adjuvant treatment modality for recurrent or residual craniopharyngioma. However, prognostic factors pertaining to progression-free survival (PFS) remain poorly understood. A study was conducted to address this issue. A total of 37 consecutive patients undergoing 39 sessions of GKS procedures targeting the solid portions of the tumors at our institution between 1989 and 2005 were analyzed. Twenty-one male and 16 female patients comprised this study. Median age at GKS was 36 years (range, 4-78). Median tumor volume was 1.6 cm(3) (range, 0.1-18.6), median marginal dose was 14.5 Gy (range, 6-25), and median maximal dose was 30 Gy (range, 15.6-60). Median follow-up was 50 months (range, 8-212). Univariate and multivariate analyses using Cox proportional hazards model were employed to identify the potential prognostic factors including tumor volume, marginal dose, gender, age at GKS, and status of visual field defect (VFD) in terms of in-field PFS. The actuarial 3- and 5-year in-field PFS were 84.8 and 67.0%, respectively. On univariate analysis, absence of VFD at GKS was a favorable prognostic factor (hazard ratio: 0.279; 95% CI, 0.085-0.913, P = 0.035), whereas on multivariate analysis, absence of VFD at GKS, tumor volume ≤1.6 cm(3), and marginal dose >14.5 Gy related to a longer in-field PFS. GKS may offer reasonable control of recurrent or residual craniopharyngiomas. There was a consistent correlation between absence of VFD at the time of GKS and in-field PFS.
伽玛刀手术（GKS）已成为治疗颅咽管瘤复发性或残留肿瘤的一种有价值的辅助治疗方法。然而，关于无进展生存期（PFS）的预后因素仍知之甚少。本研究旨在解决这一问题。对 1989 年至 2005 年间在我院接受 39 次针对肿瘤实性部分的 GKS 治疗的 37 例连续患者进行了分析。本研究包括 21 例男性和 16 例女性患者。GKS 时的中位年龄为 36 岁（范围，4-78 岁）。中位肿瘤体积为 1.6cm³（范围，0.1-18.6cm³），中位边缘剂量为 14.5Gy（范围，6-25Gy），最大剂量为 30Gy（范围，15.6-60Gy）。中位随访时间为 50 个月（范围，8-212 个月）。采用 Cox 比例风险模型进行单因素和多因素分析，以确定肿瘤体积、边缘剂量、性别、GKS 时年龄和视野缺损（VFD）状态等潜在的预后因素与肿瘤控制的关系。3 年和 5 年的局部无进展生存率分别为 84.8%和 67.0%。单因素分析显示，GKS 时无 VFD 是一个有利的预后因素（风险比：0.279；95%可信区间，0.085-0.913，P=0.035），而多因素分析显示，GKS 时无 VFD、肿瘤体积≤1.6cm³和边缘剂量>14.5Gy 与更长的局部无进展生存期相关。GKS 可能为复发性或残留颅咽管瘤的治疗提供合理的控制。GKS 时无 VFD 与局部无进展生存期之间存在一致的相关性。
