Thakkar Vipul V, Chao Samuel T, Barnett Gene H, Susan LeGrand, Rasmussen Peter, Vogelbaum Michael A, Reddy Chandana A, Jamison Betty, Suh John
Southeast Radiation Oncology Group, Charlotte, North Carolina,USA.
Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio, USA.
J Radiosurg SBRT. 2012;1(4):281-286.
This study was initiated to evaluate the impact of intracranial radiosurgery for non-malignant indications on a patient's quality of life (QOL).The study sample includes a total of 31 patients treated with single-fraction Gamma Knife radiosurgery (GKRS) for a non-malignant indication. Patients were treated at the Cleveland Clinic from 2005 through 2007 and all underwent pretreatment evaluation including screening for depression and anxiety, serum hemoglobin, hematocrit, calcium, albumin and thyroid stimulating hormone. Each patient was followed prospectively for eight weeks after treatment using a validated tool to assess fatigue and a separate questionnaire assessing quality of life. Dose and volume of GKRS were based on institutional practice and indication. The 13 question Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F) was used to assess fatigue. Six additional questions assessing QOL outcomes not measured by the FACIT-F were added. Patients completed the questionnaire prior to GKRS and weekly for eight weeks. Questionnaires were scored using the FACIT scoring guidelines with a maximum score of 52. The additional questions were scored similarly with higher scores correlating with better QOL. The indications for treatment were arteriovenous malformation (5), schwannoma (12), trigeminal neuralgia (7), meningioma (4), pituitary adenoma (2), and glomus tumor (1). Median radiosurgery dose was 15 Gy (range 12-82 Gy). Doses for trigeminal neuralgia were prescribed to the 100% isodose line (IDL) while other lesions were treated to approximately the 50% IDL. Median volume of tissue treated was 2.5 cc (range 0.132-15.4 cc). Analysis of the 31 patients and 227 person-weeks of follow-up shows that GKRS does not adversely impact fatigue and QOL during the first 8 weeks after treatment. Mean FACIT-F score was 43 at baseline and 41, 43, 45, 43, 46, 44, 45, 47 at weeks 1-8 respectively after GKRS. In addition, questions assessing patients' quality of life, and ability to work and exercise showed no decline after GKRS. Mean baseline score for these questions was 13 and 18, 19, 19, 19, 20, 19, 19 and 21 at weeks 1-8 after GK. This analysis of a prospective data set indicates that Gamma Knife radiosurgery does not adversely impact levels of fatigue or quality of life during the first 8 weeks after treatment for benign indications.
本研究旨在评估颅内放射外科手术治疗非恶性疾病对患者生活质量（QOL）的影响。研究样本包括31例因非恶性疾病接受单次伽玛刀放射外科手术（GKRS）治疗的患者。这些患者于2005年至2007年在克利夫兰诊所接受治疗，所有患者均接受了治疗前评估，包括抑郁症和焦虑症筛查、血清血红蛋白、血细胞比容、钙、白蛋白和促甲状腺激素检查。每位患者在治疗后使用经过验证的工具进行为期八周的前瞻性随访，以评估疲劳程度，并使用另一份问卷评估生活质量。GKRS的剂量和体积基于机构实践和适应症。使用13个问题的慢性病治疗功能评估疲劳量表（FACIT-F）来评估疲劳程度。另外增加了6个问题，用于评估FACIT-F未测量的生活质量结果。患者在GKRS治疗前及治疗后的八周内每周完成一次问卷。问卷根据FACIT评分指南进行评分，最高分为52分。其他问题的评分方式类似，分数越高表明生活质量越好。治疗适应症包括动静脉畸形（5例）、神经鞘瘤（12例）、三叉神经痛（7例）、脑膜瘤（4例）、垂体腺瘤（2例）和球瘤（1例）。放射外科手术的中位剂量为15 Gy（范围为12 - 82 Gy）。三叉神经痛的剂量处方至100%等剂量线（IDL），而其他病变则治疗至约50% IDL。治疗组织的中位体积为2.5 cc（范围为0.132 - 15.4 cc）。对这31例患者和227人周的随访分析表明，GKRS在治疗后的前8周内不会对疲劳和生活质量产生不利影响。GKRS治疗前FACIT-F平均评分为43分，治疗后第1 - 8周分别为41分、43分、45分、43分、46分、44分、45分、47分。此外，评估患者生活质量、工作和运动能力的问题在GKRS治疗后没有下降。这些问题的基线平均分数为13分，GKRS治疗后第1 - 8周分别为18分、19分、19分、19分、20分、19分、19分和21分。对前瞻性数据集的这一分析表明，伽玛刀放射外科手术在治疗良性疾病后的前8周内不会对疲劳水平或生活质量产生不利影响。
