Gagliardi Filippo, Bailo Michele, Spina Alfio, Donofrio Carmine A, Boari Nicola, Franzin Alberto, Fava Arianna, Del Vecchio Antonella, Bolognesi Angelo, Mortini Pietro
Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
World Neurosurg. 2017 May;101:540-553. doi: 10.1016/j.wneu.2017.02.041. Epub 2017 Feb 16.
First-line therapy for low-grade gliomas (LGGs) is surgery, in some cases followed by radiotherapy and chemotherapy. Gamma Knife radiosurgery (GKRS) has gained more relevance in the management of these tumors. The aim of this study was to assess efficacy and safety of GKRS for treatment of LGGs.
Between 2001 and 2014, 42 treatments were performed on 39 patients harboring LGGs; 48% of patients underwent previous surgery, and 20.5% underwent previous radiotherapy. Mean tumor volume was 2.7 cm, and median margin dose was 15 Gy.
Mean follow-up was 60.5 months (range, 6-164 months). Actuarial progression-free survival was 74.9%, 52.8%, and 39.1% at 1 year, 5 years, and 10 years; actuarial overall survival was 97.4%, 94.6%, and 91.8% at 9 months, 1 year, and 5 years. Solid tumor control was achieved in 69.2% of patients, whereas cystic enlargement was recorded in 12.9% of cases. At last follow-up, volume reduction was recorded in 57.7% of cases, and median volume decreased by 33.3%. Clinical improvement was observed in 52.4% of patients. Karnofsky performance scale score was improved in 15 patients (45.5%), unchanged in 17 patients (51.5%), and worsened in 1 patient (3%). Mean posttreatment scores of 36-item short form health survey domains did not significantly differ from scores in a healthy Italian population.
This study confirms safety and effectiveness of GKRS for LGGs in controlling tumor growth, relevantly improving patients' overall and progression-free survival. GKRS improved patients' functional performance and quality of life, optimizing social functioning and minimizing disease-related psychological impact.
低级别胶质瘤（LGG）的一线治疗方法是手术，某些情况下术后会进行放疗和化疗。伽玛刀放射外科手术（GKRS）在这些肿瘤的治疗中发挥着越来越重要的作用。本研究的目的是评估GKRS治疗LGG的疗效和安全性。
2001年至2014年期间，对39例患有LGG的患者进行了42次治疗；48%的患者曾接受过手术，20.5%的患者曾接受过放疗。平均肿瘤体积为2.7 cm，中位边缘剂量为15 Gy。
平均随访时间为60.5个月（范围6 - 164个月）。1年、5年和10年的无进展生存率分别为74.9%、52.8%和39.1%；9个月、1年和五年的总生存率分别为97.4%、94.6%和91.8%。69.2%的患者实现了实体瘤控制，而12.9%的病例出现了囊性扩大。在最后一次随访时，57.7%的病例记录到体积缩小，中位体积减少了33.3%。52.4%的患者观察到临床改善。15例患者（45.5%）的卡氏功能状态评分得到改善，17例患者（51.5%）不变，1例患者（3%）恶化。36项简短健康调查领域的治疗后平均得分与意大利健康人群的得分无显著差异。
本研究证实了GKRS治疗LGG在控制肿瘤生长方面的安全性和有效性，显著提高了患者的总生存率和无进展生存率。GKRS改善了患者的功能表现和生活质量，优化了社会功能，将疾病相关的心理影响降至最低。
