Chao Samuel T, Thakkar Vipul V, Barnett Gene H, Vogelbaum Michael A, Angelov Lilyana, Weil Robert J, Rasmussen Peter, Reuther Alwyn M, Jamison Betty, Neyman Gennady, Suh John H
Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Technol Cancer Res Treat. 2012 Apr;11(2):117-22. doi: 10.7785/tcrt.2012.500240.
Purpose of this study is to determine the types, incidence, and severity of acute complications of intracranial stereotactic radiosurgery (SRS), specifically Gamma Knife (GK). Patients who had never had previous SRS were eligible for this prospective IRB-approved study. The questionnaire used applicable questions from CTCAE v.3.0, the Brief Pain Questionnaire (Short Form), Brief Fatigue Inventory, and the Tinnitus Handicap Inventory. Questionnaires were obtained prior to Gamma Knife (GK), 1 week, 1 month, and 2 months to assess complications. Seventy-six eligible patients (median age of 62 years) had complete data and were analyzed. Diagnoses included: 26 (34%) with brain metastases, 15 (20%) with trigeminal neuralgia, 12 (16%) with schwannoma, 10 (13%) with meningioma, 7 (9%) with arteriovenous malformation, 3 (4%) with pituitary adenoma, and 3 (4%) with other. At 1 week, 24% developed minimal scalp numbness (p =0.0004 baseline compared to 1 week). Only 13% had minimal scalp numbness at 1 month and 2% at 2 months (both p=NS compared to baseline). There was no difference in scalp tingling between baseline and the various time points. Thirteen percent developed pin site pain at 1 week with a median intensity level of 2 out of 10. By one month, only 3% had pin site pain with a median intensity level of 3 out of 10. Four percent developed pin-site infection at 1 week and none at 1 and 2 months. There was no significant difference in nausea from baseline at 1 week, but there was worsening nausea at 1 month (p =0.0114). By 1 month, 10% reported new local hair loss. 23%, 16%, and 15% complained of new/worsening fatigue at 1 week, 1 month, and 2 months, respectively, but 40% reported fatigue at baseline. Balance improved following SRS over all time periods (for all comparisons, p <0.009). 1%, 6%, and 3% developed new tinnitus at 1 week, 1 month, and 2 months, respectively, which was significant when comparing baseline to non-baseline (p =0.0269). Thirty-two patients were employed prior to SRS. Three (9%) patients did not return to work. Twenty-seven (84%) patients returned to work a median of 4 days after SRS. Two people did not report their employment status after SRS. There was no significant difference in face swelling, headache, eye pain, vomiting, seizures, or passing out at any intervals compared to baseline. This prospective study demonstrates that GK is well tolerated with few patients developing major acute effects. Many patients are able to return to work shortly after GK.
本研究的目的是确定颅内立体定向放射外科手术（SRS），特别是伽玛刀（GK）急性并发症的类型、发生率和严重程度。此前从未接受过SRS的患者符合这项经机构审查委员会（IRB）批准的前瞻性研究的条件。所使用的问卷采用了来自《肿瘤患者生活质量测定量表通用版（第3.0版）》（CTCAE v.3.0）、简明疼痛问卷（简表）、简明疲劳量表和耳鸣障碍量表中的适用问题。在伽玛刀（GK）治疗前、1周、1个月和2个月获取问卷以评估并发症。76名符合条件的患者（中位年龄62岁）有完整数据并进行了分析。诊断包括：26例（34%）脑转移瘤、15例（20%）三叉神经痛、12例（16%）神经鞘瘤、10例（13%）脑膜瘤、7例（9%）动静脉畸形、3例（4%）垂体腺瘤和3例（4%）其他疾病。在1周时，24%的患者出现轻微头皮麻木（与基线相比，p =0.0004）。在1个月时，只有13%的患者有轻微头皮麻木，2个月时为2%（与基线相比，p均无统计学意义）。基线与各时间点之间头皮刺痛无差异。13%的患者在1周时出现针道疼痛，疼痛强度中位数为10分制中的2分。到1个月时，只有3%的患者有针道疼痛，疼痛强度中位数为10分制中的3分。4%的患者在1周时出现针道感染，1个月和2个月时均无感染。与基线相比，1周时恶心无显著差异，但1个月时恶心加重（p =0.0114）。到1个月时，10%的患者报告有新的局部脱发。分别有23%、16%和15%的患者在1周、1个月和2个月时抱怨有新的/加重的疲劳，但40%的患者在基线时就报告有疲劳。在所有时间段内，SRS后平衡能力均有所改善（所有比较，p <0.009）。分别有1%、6%和3%的患者在1周、1个月和2个月时出现新的耳鸣，与基线相比差异有统计学意义（p =0.0269）。32名患者在SRS治疗前有工作。3例（9%）患者未重返工作岗位。27例（84%）患者在SRS治疗后中位4天重返工作岗位。2人未报告SRS治疗后的就业状况。与基线相比，在任何时间段内面部肿胀、头痛、眼痛、呕吐、癫痫发作或昏厥均无显著差异。这项前瞻性研究表明，GK耐受性良好，很少有患者出现严重急性效应。许多患者在GK治疗后不久就能重返工作岗位。
