Department of Radiation Medicine, MedStar Georgetown University Hospital Washington, DC, USA.
Front Oncol. 2013 May 17;3:121. doi: 10.3389/fonc.2013.00121. eCollection 2013.
To examine tumor control, hearing preservation, and complication rates after frameless fractionated stereotactic radiosurgery (SRS) in patients with vestibular schwannomas (VS).
Thirty-seven patients treated with fractionated SRS from 2002 to 2011 were retrospectively analyzed. Ninety-five percent were treated with 25 Gy in five fractions, targeting a median tumor volume of 1.03 cc (range 0.14-7.60).
With a median follow-up of 4.25 years (range, 15 months-9 years), no tumors required an additional treatment resulting in 100% tumor control rate. Radiographic control rate was 91% in 32 patients at a median follow-up of 3 years. Of the 14 patients with serviceable hearing and with audiograms, the hearing preservation rate was 78% at a median follow-up of 18 months. Twenty-six patients with serviceable hearing pretreatment, were evaluated by a phone survey with a hearing preservation rate of 73% at a 5 year median follow-up. There were two cases that developed both new increased trigeminal parasthesias and facial spasms but there were no cases of facial weakness. Patient had 96% of good to excellent satisfaction rate with the treatment at a median follow-up of 5 years.
Frameless fractionated SRS treatment of VS results in good rate of tumor control. Hearing preservation rate and rates of cranial nerve toxicity are comparable to what is reported in the literature. Patients choose this modality because of its non-invasive nature and are generally very satisfied with their long term outcome.
研究无框架分次立体定向放射外科（SRS）治疗前庭神经鞘瘤（VS）的肿瘤控制、听力保护和并发症发生率。
回顾性分析了 2002 年至 2011 年间接受分次 SRS 治疗的 37 例患者。95%的患者接受 25Gy 分 5 次照射，肿瘤靶区平均体积为 1.03cc（范围 0.14-7.60）。
中位随访时间为 4.25 年（范围 15 个月至 9 年），没有肿瘤需要额外治疗，肿瘤控制率达到 100%。在中位随访 3 年时，32 例患者的肿瘤控制率为 91%。在 14 例有可利用听力且有听力图的患者中，听力保留率为 78%，中位随访时间为 18 个月。26 例治疗前有可利用听力的患者通过电话调查进行评估，中位随访 5 年的听力保留率为 73%。有 2 例患者同时出现新的三叉神经感觉异常和面肌痉挛，但无面神经无力。在中位随访 5 年时，患者对治疗的满意度为 96%，良好率和优秀率分别为 73%和 23%。
无框架分次 SRS 治疗 VS 的肿瘤控制率良好。听力保护率和颅神经毒性发生率与文献报道的相似。患者选择这种治疗方式是因为其非侵入性，并且对长期效果普遍非常满意。
