Badakhshi Harun, Graf Reinhold, Böhmer Dirk, Synowitz Michael, Wiener Edzard, Budach Volker
Departments for Radiation Oncology, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
J Radiat Res. 2014 Mar 1;55(2):288-92. doi: 10.1093/jrr/rrt101. Epub 2013 Aug 26.
We assessed local control (LC) and functional outcome after linac-based stereotactic radiosurgery (SRS) for vestibular schwannoma (VS).
Between 1998 and 2008, 190 patients with VS were treated with SRS. All patients had tumors <2 cm diameter. Patients received 13.5 Gy prescribed to the 80th isodose at the tumor margin. The primary endpoint was LC. Secondary endpoints were symptomatic control and morbidity.
Median follow-up was 40 months. LC was achieved in 88% of patients. There were no acute reactions exceeding Grade I. Trigeminal nerve dysfunction was present in 21.6% (n = 41) prior to SRS. After treatment, 85% (n = 155) had no change, 4.4,% (n = 8) had a relief of symptoms, 10.4% (n = 19) had new symptoms. Facial nerve dysfunction was present in some patients prior to treatment, e.g. paresis (12.6%; n = 24) and dysgeusia (0.5%; n = 1). After treatment 1.1% (n = 2) reported improvement and 6.1% (n = 11) experienced new symptoms. Hearing problems before SRS were present in 69.5% of patients (n = 132). After treatment, 62.6% (n = 144) had no change, 10.4% (n = 19) experienced improvement and 26.9% (n = 49) became hearing impaired.
This series of SRS for small VS provided similar LC rates to microsurgery; thus, it is effective as a non-invasive, image-guided procedure. The functional outcomes observed indicate the safety and effectiveness of linac-based SRS. Patients may now be informed of the clinical equivalence of SRS to microsurgery.
我们评估了基于直线加速器的立体定向放射外科治疗（SRS）前庭神经鞘瘤（VS）后的局部控制（LC）和功能结果。
1998年至2008年间，190例VS患者接受了SRS治疗。所有患者的肿瘤直径均<2 cm。患者在肿瘤边缘接受13.5 Gy的剂量，该剂量规定在第80等剂量线上。主要终点是LC。次要终点是症状控制和发病率。
中位随访时间为40个月。88%的患者实现了LC。没有超过I级的急性反应。SRS治疗前，21.6%（n = 41）的患者存在三叉神经功能障碍。治疗后，85%（n = 155）的患者症状无变化，4.4%（n = 8）的患者症状缓解，10.4%（n = 19）的患者出现新症状。一些患者在治疗前存在面神经功能障碍，例如轻瘫（12.6%；n = 24）和味觉障碍（0.5%；n = 1）。治疗后，1.1%（n = 2）的患者报告症状改善，6.1%（n = 11）的患者出现新症状。SRS治疗前，69.5%（n = 132）的患者存在听力问题。治疗后，62.6%（n = 144）的患者听力无变化，10.4%（n = 19）的患者听力改善，26.9%（n = 49）的患者听力受损。
这一系列针对小型VS的SRS治疗提供了与显微手术相似的LC率；因此，它作为一种非侵入性的、图像引导的手术是有效的。观察到的功能结果表明基于直线加速器的SRS的安全性和有效性。现在可以告知患者SRS与显微手术在临床上的等效性。
