Chen Meng-Chao, Pan David Hung-Chi, Chung Wen-Yuh, Liu Kang-Du, Yen Yu-Shu, Chen Ming-Teh, Wong Tai-Tong, Shih Yang-Hsin, Wu Hsiu-Mei, Guo Wan-Yuo, Shiau Cheng-Ying, Wang Ling-Wei, Lin Chii-Wann
Department of Neurosurgery, Taipei City Hospital, Taiwan, Republic of China.
Stereotact Funct Neurosurg. 2011;89(3):185-93. doi: 10.1159/000326780. Epub 2011 May 5.
Central neurocytoma (CN) is considered to be a benign neuronal tumor with possible atypical behavior. Microsurgery, radiation therapy (RT) and radiosurgery all have been used in treating this rare disease during the past decade. In this study, the authors present the experience with gamma knife radiosurgery (GKRS) on 14 patients with CN during a median follow-up period of 65 months and document the safety and efficacy of GKRS in the treatment of CN.
Between November 1997 and December 2009, 14 patients pathologically diagnosed with CN were treated with GKRS. Follow-up magnetic resonance imaging (MRI) was performed at 6-month intervals. Tumor volume and adverse radiation effects (ARE) were documented to evaluate tumor response to GKRS. The Karnofsky Performance Scale (KPS) and neurological status were used to assess clinical outcome. The mean radiation dose prescribed to the tumor margin was 12.1 Gy (ranging from 11 to 13 Gy). The mean tumor volume was 19.6 ml (ranging from 3.5 to 48.9 ml). The mean follow-up period was 70 months (ranging from 30 to 140 months), and the median follow-up period was 65 months.
Tumor shrinkage was found in all patients at the final MRI follow-up. The mean volume reduction was 69% (ranging from 47 to 87%). No tumor progression, ARE or radiation-related toxicity developed in any of the cases. The KPS scores of all patients were the same or had increased, and the neurological functions were all stable without deterioration at the final follow-up.
In our observations, GKRS was found to be an effective and safe alternative as adjuvant therapy for pathology-confirmed CN. The tumor volume and functional outcome can be controlled with a favorable result in long-term observation. Compared with RT and microsurgery, GKRS plays an important role in the treatment of CN as a minimally invasive technique with low morbidity. Regular long-term MRI follow-up should be mandatory to document the tumor response and possible recurrence. Multicenter consortia should be considered for further investigation and evaluation of GKRS for such a rare tumor.
中枢神经细胞瘤（CN）被认为是一种具有可能的非典型行为的良性神经元肿瘤。在过去十年中，显微手术、放射治疗（RT）和放射外科手术都已用于治疗这种罕见疾病。在本研究中，作者介绍了14例CN患者接受伽玛刀放射外科手术（GKRS）的经验，随访中位时间为65个月，并记录了GKRS治疗CN的安全性和有效性。
1997年11月至2009年12月期间，14例经病理诊断为CN的患者接受了GKRS治疗。每隔6个月进行一次随访磁共振成像（MRI）。记录肿瘤体积和不良放射效应（ARE）以评估肿瘤对GKRS的反应。采用卡诺夫斯基功能状态评分（KPS）和神经状态来评估临床结果。规定的肿瘤边缘平均放射剂量为12.1 Gy（范围为11至13 Gy）。平均肿瘤体积为19.6 ml（范围为3.5至48.9 ml）。平均随访期为70个月（范围为30至140个月），中位随访期为65个月。
在最后一次MRI随访时，所有患者均发现肿瘤缩小。平均体积缩小69%（范围为47%至87%）。所有病例均未出现肿瘤进展、ARE或放射相关毒性。所有患者的KPS评分相同或有所提高，在最后一次随访时神经功能均稳定且无恶化。
在我们的观察中，发现GKRS作为经病理证实的CN的辅助治疗是一种有效且安全的选择。在长期观察中，肿瘤体积和功能结果可以得到控制，效果良好。与RT和显微手术相比，GKRS作为一种微创技术且发病率低，在CN的治疗中发挥着重要作用。应定期进行长期MRI随访以记录肿瘤反应和可能的复发情况。对于这种罕见肿瘤的GKRS进一步研究和评估，应考虑多中心联合研究。
