Kumar Narendra, Srinivasa Gulladamane Yogesh, Madan Renu, Salunke Pravin
Department of Radiotherapy, PGIMER, Chandigarh, India.
Department of Neurosurgery, PGIMER, Chandigarh, India.
Clin Neurol Neurosurg. 2018 Mar;166:91-98. doi: 10.1016/j.clineuro.2018.01.027. Epub 2018 Jan 31.
Surgical excision of pineal parenchymal tumors(PPT), though desirable for good long term outcome, may not always be possible. Role of adjuvant radiotherapy (RT) in residual PPT's is not well delineated. The purpose of this single institutional retrospective study is to assess the role of radiotherapy in residual PPT's.
Between 2006-2016, fourteen patients with residual PPT's were treated with adjuvant radiotherapy (12 with 3D conformal RT). Eight had pineocytomas (PC), 4 pineal parenchymal tumors with intermediate differentiation (PPID) and 2 pineoblastomas (PB). Doses of 45-54 Gy was delivered in 1.8-2 Gy per fraction. Cranio-spinal irradiation(CSI) was given to one case of PB and PPID each, with drop lesions at presentation. Patients were followed up at regular intervals.
The average Planning Target Volume (PTV) was 279.4cc. Clinico-radiological response was noted in all with complete disappearance of tumor in 4 patients with PC and 2 with PPID. Delayed recurrence (36-72 months later, median 42.5 months) was seen in 3 patients with PC and early recurrence in both with PB (median 28 months). Overall median follow-up for PC and PB was 54 and 31.5 months respectively. Two patients with PC and 2 with PB expired. The median follow-up for PPID was 21.5 months with no deaths or recurrences.
Some PC and PPID may behave aggressively and recur or spread along neural axes requiring close follow up. Radiotherapy appears to be effective in patients with residual PC, PPID. Re-irradiation or radiosurgery may help in recurrences.
松果体实质肿瘤（PPT）的手术切除虽然有利于获得良好的长期预后，但并非总是可行。辅助放疗（RT）在残留PPT中的作用尚未明确界定。本单中心回顾性研究的目的是评估放疗在残留PPT中的作用。
2006年至2016年间，14例残留PPT患者接受了辅助放疗（12例采用三维适形放疗）。8例为松果体细胞瘤（PC），4例为中等分化的松果体实质肿瘤（PPID），2例为松果体母细胞瘤（PB）。剂量为45 - 54Gy，每次分割剂量为1.8 - 2Gy。1例PB和1例PPID患者因初诊时伴有播散性病灶接受了全脑全脊髓照射（CSI）。患者定期接受随访。
平均计划靶体积（PTV）为279.4cc。所有患者均观察到临床放射学反应，4例PC患者和2例PPID患者肿瘤完全消失。3例PC患者出现延迟复发（36 - 72个月后，中位时间42.5个月），2例PB患者均出现早期复发（中位时间28个月）。PC和PB的总体中位随访时间分别为54个月和31.5个月。2例PC患者和2例PB患者死亡。PPID的中位随访时间为21.5个月，无死亡或复发。
部分PC和PPID可能具有侵袭性，会复发或沿神经轴扩散，需要密切随访。放疗似乎对残留PC、PPID患者有效。再次放疗或立体定向放射外科治疗可能有助于治疗复发。
