Yianni John, Rowe Jeremy, Khandanpour Nader, Nagy Gabor, Hoggard Nigel, Radatz Matthias, Kemeny Andras
Department of Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield, UK.
Br J Neurosurg. 2012 Jun;26(3):361-6. doi: 10.3109/02688697.2011.635818. Epub 2011 Dec 15.
Pineal tumours continue to present considerable clinical dilemmas and challenges. We were, therefore, interested to review our cumulative experience with a view to formulating a potential treatment strategy.
A retrospective analysis of all patients treated with Stereotactic radiosurgery (SRS) for pineal tumours in one centre between 1987 and 2009. Forty-four patients (66% male) were treated radiosurgically with a mean age(± 1 sd) of 33.6 (16.4) years. Eleven had biopsy-proven pineal parenchymal tumours (PPT), six astrocytomas, three ependymomas, two papillary epithelial tumours and two germ cell tumours. Twenty (45%) patients had no definitive histology despite attempted surgical biopsy in 11. Prior to radiosurgery, 17 had undergone craniotomy, 10 radiotherapy and four chemotherapy. Nine patients were referred for primary SRS.
Fifty Gamma knife treatments were performed on 44 patients prescribing 18.1 (4.2) Gy with a treatment volume of 3.8 (3.8) cm( 3 ). Routine clinical and MRI assessments were reviewed to calculate control rates. Mean follow up was 62.5 (52.9) months. Five patients (two ependymomas and three PPT) died at 36.2 (36.7) months after initial radiosurgical treatment. Overall progression-free survival (PFS) results were 93% at 1 year, 77% at 5 years, 67% at 10 and 20 years. Log-rank analysis revealed that higher initial tumour grade (P = 0.04), previous radiotherapy (P = 0.002) and radiological evidence of necrosis (P = 0.03) were associated with worse outcomes. The 5-year PFS for patients who possessed these 'aggressive' features was 47.1% compared with 91% for those patients who did not have these features. No persistent complications were attributed to SRS.
These results further demonstrate the increasingly significant role played by STRS in the treatment of pineal tumours. Based on our findings, we believe a re-examination of the role of more established therapies for this patient group may be warranted.
松果体肿瘤在临床上仍然存在诸多难题与挑战。因此，我们希望回顾我们的累积经验，以制定出一种潜在的治疗策略。
对1987年至2009年间在一个中心接受立体定向放射外科治疗（SRS）的松果体肿瘤患者进行回顾性分析。44例患者（66%为男性）接受了放射外科治疗，平均年龄（±1标准差）为33.6（16.4）岁。11例经活检证实为松果体实质肿瘤（PPT），6例为星形细胞瘤，3例为室管膜瘤，2例为乳头状上皮肿瘤，2例为生殖细胞肿瘤。20例（45%）患者尽管进行了11次手术活检仍未获得明确的组织学诊断。在进行放射外科治疗之前，17例患者接受了开颅手术，10例接受了放疗，4例接受了化疗。9例患者接受了原发性SRS治疗。
对44例患者进行了50次伽玛刀治疗，处方剂量为18.1（4.2）Gy，治疗体积为3.8（3.8）cm³。通过回顾常规临床和MRI评估来计算控制率。平均随访时间为62.5（52.9）个月。5例患者（2例室管膜瘤和3例PPT）在初次放射外科治疗后36.2（36.7）个月死亡。总体无进展生存期（PFS）结果为1年时93%，5年时77%，10年和20年时67%。对数秩分析显示，初始肿瘤分级较高（P = 0.04）、既往接受过放疗（P = 0.002）以及有坏死的影像学证据（P = 0.03）与较差的预后相关。具有这些“侵袭性”特征的患者5年PFS为47.1%，而没有这些特征的患者为91%。没有因SRS导致的持续性并发症。
这些结果进一步证明了立体定向放射外科在松果体肿瘤治疗中发挥着越来越重要的作用。基于我们的研究结果，我们认为可能有必要重新审视针对该患者群体的更成熟治疗方法的作用。
