Slane Benjamin G, Goyal Uma, Grow Joel L, Morrison Christopher, Hullett Craig R, Gordon John, Sanan Abhay, Stea Baldassarre
Cancer Treatment Centers of America, Goodyear, Arizona.
University of Arizona, Department of Radiation Oncology, Tucson, Arizona.
Pract Radiat Oncol. 2017 May-Jun;7(3):e233-e241. doi: 10.1016/j.prro.2016.10.016. Epub 2016 Oct 28.
We evaluated and compared the radiographic and clinical outcomes of patients with vestibular schwannomas treated with single fraction stereotactic radiosurgery (SRS), 5 fractions of hypofractionated stereotactic radiation therapy (hSRT), or 25 to 30 fractions of conventionally fractionated stereotactic radiation therapy (cfSRT).
Fifty-six patients treated with LINAC-based SRS (median, 12.5 Gy), hSRT (25 Gy), or cfSRT (median, 54 Gy) were retrospectively reviewed. Fractionation was based on the size of the tumor, proximity to the brainstem, and potential risk of neurological sequelae. Median follow-up time was 55.2 months.
The pretreatment median tumor diameter was significantly smaller for SRS (1.14 cm) compared with hSRT (1.7 cm) (P = .03) and cfSRT (2.0 cm) (P < .001). The overall local tumor control was 96.4%: 100% SRS, 100% hSRT, and 90% cfSRT (P = .19). Tumor regression was observed in 53.3% of SRS, 76.2% of hSRT, and 90% of cfSRT (P = .05). There was less transient expansion of tumors treated with cfSRT (5%) than with SRS (53.3%) or hSRT (28.6%) (P = .005). The median time to regression was 13.8 months for SRS, 14.2 months for hSRT, and 5.5 months for cfSRT (P = .34). There was a 3.6% incidence of grade 3 trigeminal neuropathy, but there was no grade 3 facial neuropathy.
All 3 regimens demonstrated similar excellent local control with minimal toxicity; however, the ability of hSRT to treat larger tumors with comparable outcomes to SRS and greater patient convenience when compared with cfSRT suggest that hSRT may offer the optimal treatment approach.
我们评估并比较了接受单次分割立体定向放射外科治疗（SRS）、5次分割的低分割立体定向放射治疗（hSRT）或25至30次分割的常规分割立体定向放射治疗（cfSRT）的前庭神经鞘瘤患者的影像学和临床结果。
回顾性分析了56例接受基于直线加速器的SRS（中位剂量12.5 Gy）、hSRT（25 Gy）或cfSRT（中位剂量54 Gy）治疗的患者。分割方式根据肿瘤大小、与脑干的距离以及神经后遗症的潜在风险确定。中位随访时间为55.2个月。
与hSRT（1.7 cm）（P = 0.03）和cfSRT（2.0 cm）（P < 0.001）相比，SRS组治疗前肿瘤中位直径显著更小（1.14 cm）。总体局部肿瘤控制率为96.4%：SRS组为100%，hSRT组为100%，cfSRT组为90%（P = 0.19）。SRS组53.3%、hSRT组76.2%和cfSRT组90%观察到肿瘤缩小（P = 0.05）。cfSRT治疗的肿瘤出现短暂增大的比例（5%）低于SRS组（53.3%）或hSRT组（28.6%）（P = 0.005）。SRS组肿瘤缩小的中位时间为13.8个月，hSRT组为14.2个月，cfSRT组为5.5个月（P = 0.34）。3级三叉神经病变发生率为3.6%，但无3级面神经病变。
所有3种治疗方案均显示出相似的良好局部控制且毒性极小；然而，hSRT治疗较大肿瘤的能力与SRS相当，且与cfSRT相比患者便利性更高，这表明hSRT可能是最佳治疗方法。
