Hôpital Maison Blanche, Reims Cedex, France.
Radiother Oncol. 2013 Feb;106(2):169-74. doi: 10.1016/j.radonc.2012.10.013. Epub 2012 Dec 4.
To evaluate long-term outcomes and efficacy of fractionated stereotactic radiotherapy in the treatment of acoustic neuromas.
Between January 1996 and December 2009, 158 acoustic neuromas were treated by FSR in 155 patients. They received a dose of 50.4 Gy, with a safety margin of 1-2mm with a median tumor volume at 2.45 mL (range: 0.17-12.5 mL) and a median follow-up duration at 60 months (range: 24-192).
FSR was well tolerated in all patients with mild sequelae consisting in radiation-induced trigeminal nerve impairments (3.2%), Grade 2 facial neuropathies (2.5%), new or aggravated tinnitus (2.1%) and VP shunting (2.5%). The treatment failed in four patients (2.5%) who had subsequent surgery respectively at 20, 38, 45 and 84 months post-FSR. The local tumor control rates were respectively 99.3%, 97.5% and 95.2% at 3, 5 and >7-year of follow-up. For initial Gardner-Robertson Grade 1 and 2 ANs, the preservation of useful hearing was possible in 54% of the cases; only Grade 1 ANs had stabilized during the course of the follow-up with 71% >7 years. However, hearing preservation was not correlated to the initial Koos Stage and to the radiation dose delivered to the cochlea. Tinnitus (70%), vertigo (59%), imbalance (46%) and ear mastoid pain (43%) had greatly improved post-FRS in most patients. Tumor control, hearing preservation and FRS toxicity were quite similar in patients with NF2, cystic acoustic neuroma, prior surgical resection and Koos Stage 4 AN. No secondary tumors were observed.
FSR is a safe and effective therapeutic for acoustic neuromas and could be an alternative to microsurgery. Compared to radiosurgery, there are no contraindications for fractioned doses of stereotactic radiotherapy especially for Stage-4 tumors and patients at high risk of hearing loss.
评估分次立体定向放射治疗听神经瘤的长期疗效。
1996 年 1 月至 2009 年 12 月，155 例患者的 158 个听神经瘤接受了 FSR 治疗。他们接受了 50.4Gy 的剂量，安全边界为 1-2mm，肿瘤体积中位数为 2.45mL（范围：0.17-12.5mL），中位随访时间为 60 个月（范围：24-192 个月）。
所有患者均能耐受 FSR，轻度后遗症包括放射性三叉神经损伤（3.2%）、2 级面神经病变（2.5%）、新的或加重的耳鸣（2.1%）和 VP 分流（2.5%）。4 例（2.5%）患者治疗失败，分别于 FSR 后 20、38、45 和 84 个月行后续手术。3、5 和>7 年随访时局部肿瘤控制率分别为 99.3%、97.5%和 95.2%。对于初始 Gardner-Robertson 1 级和 2 级 AN，54%的病例可能保留有用听力；仅 1 级 AN 在随访过程中保持稳定，71%的患者>7 年。然而，听力保存与初始 Koos 分期和耳蜗接受的放射剂量无关。耳鸣（70%）、眩晕（59%）、失衡（46%）和耳乳突疼痛（43%）在大多数患者接受 FRS 后得到了很大改善。NF2、囊性听神经瘤、先前手术切除和 Koos 4 期 AN 患者的肿瘤控制、听力保存和 FRS 毒性均相当。未观察到继发性肿瘤。
FSR 是治疗听神经瘤的一种安全有效的方法，可作为显微手术的替代方法。与放射外科相比，分次立体定向放射治疗没有剂量限制，特别是对于 4 期肿瘤和听力损失高危患者。
