Han Moon-Soo, Jang Woo-Youl, Moon Kyung-Sub, Lim Sa-Hoe, Kim In-Young, Jung Tae-Young, Jung Shin
Department of Neurosurgery, Brain Tumor Clinic & Gamma Knife Center, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea.
Department of Neurosurgery, Brain Tumor Clinic & Gamma Knife Center, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea.
World Neurosurg. 2017 Mar;99:477-483. doi: 10.1016/j.wneu.2016.12.056. Epub 2016 Dec 23.
Even with great advances in surgery and improved clinical outcome, morbidity and mortality are still high for large-volume intracranial meningiomas (MNGs). Recently, Gamma Knife radiosurgery (GKS) has proven to be a safe and effective treatment for many patients with intracranial MNGs. However, single-session GKS may increase the risk of radiation-induced toxicity for large MNGs. Recently, fractionated GKS (FGKS) has been performed for an increasing number of patients with surgically high-risk and large intracranial tumors. In this study, we report our results on the efficacy and safety of FGKS for large MNGs.
The authors performed a retrospective review of 70 patients who underwent GKS for large-volume (>10 cm) intracranial MNGs between 2004 and 2015, with a minimum follow-up of 12 months. The authors classified these patients into 2 groups of single-session GKS, FGKS. The patients were followed by clinical examination and serial imaging with magnetic resonance imaging.
In the single-session GKS group (42 patients), the median tumor volume was 15.2 cm (range 10.3-48.3 cm); the median prescription dose was 12 Gy (range 8-14 Gy), and the median follow-up duration was 57.8 months (range 14.5-128.4 months). In the FGKS group (28 patients), the median tumor volume was 21 cm (range 10.2-54.7 cm), and the median prescription was 7.5 Gy in 2 fractions (range 5-8 Gy), 6 Gy in 3 fractions (range 5-6.5 Gy), and 4.5 Gy in 4 fractions. The median follow-up duration for the FGKS group was 50 months (range 12.5-90.6 months). The overall 5-year tumor control rate was 92.9% in the FGKS group and 88.1% in the single-session GKS group. Fourteen (33.3%) symptomatic complications after single-session GKS were noted, including 5 cases of hemiparesis, 4 of seizure, 3 of peritumoral edema, and 2 of hydrocephalus. Two (7.1%) symptomatic complications after FGKS were noted, including 2 cases of hemiparesis. The FGKS group had higher progression-free survival (PFS) rate at 5 years (92.9% vs. 88.1%), but the differences did not reach statistical significance (P = 0.389). The patients in the FGKS group, however, experienced a lower complication rate compared with patients with a single-session GKS group (P = 0.017, hazard ratio, 5.7:1).
When the large-volume (>10 cm) intracranial MNGs are expected to have high morbidity after microsurgery and for patients that have a poor medical status for surgery, FGKS can be considered an alternative with good tumor control and lower complications rates compared with single-session GKS (P = 0.017).
尽管手术取得了巨大进展且临床疗效有所改善，但大型颅内脑膜瘤（MNGs）的发病率和死亡率仍然很高。最近，伽玛刀放射外科手术（GKS）已被证明对许多颅内MNGs患者是一种安全有效的治疗方法。然而，单次GKS可能会增加大型MNGs发生放射性毒性的风险。最近，越来越多手术风险高和颅内肿瘤大的患者接受了分次伽玛刀放射外科手术（FGKS）。在本研究中，我们报告了FGKS治疗大型MNGs的疗效和安全性结果。
作者对2004年至2015年间接受GKS治疗大型（>10 cm）颅内MNGs的70例患者进行了回顾性研究，随访时间至少为12个月。作者将这些患者分为单次GKS、FGKS两组。通过临床检查和磁共振成像进行系列影像学检查对患者进行随访。
在单次GKS组（42例患者）中，肿瘤体积中位数为15.2 cm（范围10.3 - 48.3 cm）；处方剂量中位数为12 Gy（范围8 - 14 Gy），随访时间中位数为57.8个月（范围14.5 - 128.4个月）。在FGKS组（28例患者）中，肿瘤体积中位数为21 cm（范围10.2 - 54.7 cm），处方剂量中位数为分2次7.5 Gy（范围5 - 8 Gy）、分3次6 Gy（范围5 - 6.5 Gy）和分4次4.5 Gy。FGKS组的随访时间中位数为50个月（范围12.5 - 90.6个月）。FGKS组的5年总体肿瘤控制率为92.9%，单次GKS组为88.1%。单次GKS术后出现14例（33.3%）有症状的并发症，包括5例偏瘫、4例癫痫、3例瘤周水肿和2例脑积水。FGKS术后出现2例（7.1%）有症状的并发症，包括2例偏瘫。FGKS组5年无进展生存率（PFS）更高（92.9%对88.1%），但差异未达到统计学意义（P = 0.389）。然而，与单次GKS组患者相比，FGKS组患者的并发症发生率更低（P = 0.017，风险比，5.7:1）。
当大型（>10 cm）颅内MNGs预计显微手术后发病率高且手术患者身体状况较差时，与单次GKS相比，FGKS可被视为一种具有良好肿瘤控制和较低并发症发生率的替代方法（P = 0.017）。
