Kim Byung Sup, Im Yong-Seok, Woo Kyung In, Kim Yoon-Duk, Lee Jung-Il
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
World Neurosurg. 2015 Oct;84(4):1005-13. doi: 10.1016/j.wneu.2015.04.042. Epub 2015 Apr 27.
This study was performed to analyze the outcome of multisession gamma knife radiosurgery (GKS) in benign tumors located at the orbital apex.
Medical records of 23 patients who underwent multisession GKS for benign orbital apex tumors were reviewed retrospectively. Three patients were diagnosed by histology, and the other 20 patients were given the diagnoses on the basis of clinical and radiological findings. Diagnoses included cavernous hemangioma (8 cases), meningioma (8 cases), and schwannoma (7 cases). All patients were treated with 4 sessions of GKS with 12 hours of interval. Median marginal dose in each session was 5 Gy (range, 4.5-5.5 Gy) at the 50% isodose line (range, 50%-55%).
Mean clinical and imaging follow-up duration after treatment were 52.1 and 34.2 months, respectively. Tumor control was achieved in 22 patients (95.7%). Significant tumor shrinkage was observed in 17 patients (73.9%), and mean tumor volume reduction rate was 53.9%. Visual function was improved in 16 patients (69.6%) and stable in 4 patients (17.4%). Deterioration of visual acuity was reported by 3 patients (13.0%). Clinical and radiological response to multisession GKS was most excellent in cavernous hemangiomas with tumor control in all patients, and the mean tumor volume reduction rate was 68.3%.
Multisession GKS proved to be an effective and safe management strategy for benign orbital apex tumors. Response to treatment was different according to the pathology, and multisession GKS may be considered as the initial treatment of choice for specific pathology such as cavernous hemangioma.
本研究旨在分析多疗程伽玛刀放射外科治疗（GKS）位于眶尖的良性肿瘤的疗效。
回顾性分析23例接受多疗程GKS治疗眶尖良性肿瘤患者的病历。3例经组织学诊断，其余20例根据临床和影像学检查结果确诊。诊断包括海绵状血管瘤（8例）、脑膜瘤（8例）和神经鞘瘤（7例）。所有患者均接受4个疗程的GKS治疗，间隔12小时。每个疗程在50%等剂量线（范围50%-55%）处的中位边缘剂量为5 Gy（范围4.5-5.5 Gy）。
治疗后临床和影像学平均随访时间分别为52.1个月和34.2个月。22例患者（95.7%）实现了肿瘤控制。17例患者（73.9%）观察到明显的肿瘤缩小，平均肿瘤体积缩小率为53.9%。16例患者（69.6%）视力改善，4例患者（17.4%）视力稳定。3例患者（13.0%）报告视力下降。多疗程GKS对海绵状血管瘤的临床和影像学反应最为优异，所有患者均实现肿瘤控制，平均肿瘤体积缩小率为68.3%。
多疗程GKS被证明是治疗眶尖良性肿瘤的一种有效且安全的管理策略。根据病理情况，治疗反应有所不同，多疗程GKS可被视为特定病理类型如海绵状血管瘤的首选初始治疗方法。
