Sheppard John P, Lagman Carlito, Prashant Giyarpuram N, Alkhalid Yasmine, Nguyen Thien, Duong Courtney, Udawatta Methma, Gaonkar Bilwaj, Tenn Stephen E, Bloch Orin, Yang Isaac
Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles (UCLA), Los Angeles, California, USA.
Department of Radiation Oncology, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles (UCLA), Los Angeles, California, USA.
World Neurosurg. 2018 Jun;114:e441-e446. doi: 10.1016/j.wneu.2018.03.005. Epub 2018 Mar 10.
To retrospectively compare ideal radiosurgical target volumes defined by a manual method (surgeon) to those determined by Adaptive Hybrid Surgery (AHS) operative planning software in 7 patients with vestibular schwannoma (VS).
Four attending surgeons (3 neurosurgeons and 1 ear, nose, and throat surgeon) manually contoured planned residual tumors volumes for 7 consecutive patients with VS. Next, the AHS software determined the ideal radiosurgical target volumes based on a specified radiotherapy plan. Our primary measure was the difference between the average planned residual tumor volumes and the ideal radiosurgical target volumes defined by AHS (dRV).
We included 7 consecutive patients with VS in this study. The planned residual tumor volumes were smaller than the ideal radiosurgical target volumes defined by AHS (1.6 vs. 4.5 cm, P = 0.004). On average, the actual post-operative residual tumor volumes were smaller than the ideal radiosurgical target volumes defined by AHS (2.2 cm vs. 4.5 cm; P = 0.02). The average difference between the ideal radiosurgical target volume defined by AHS and the planned residual tumor volume (dRV) was 2.9 ± 1.7 cm, and we observed a trend toward larger dRV in patients who lost serviceable facial nerve function compared with patients who maintained serviceable facial nerve function (4.7 cm vs. 1.9 cm; P = 0.06).
Planned subtotal resection of VS diverges from the ideal radiosurgical target defined by AHS, but whether that influences clinical outcomes is unclear.
回顾性比较7例前庭神经鞘瘤（VS）患者中，通过手动方法（外科医生）定义的理想放射外科靶体积与自适应混合手术（AHS）手术规划软件确定的靶体积。
4位主治医生（3位神经外科医生和1位耳鼻喉科医生）为7例连续性VS患者手动勾勒出计划残留肿瘤体积。接下来，AHS软件根据指定的放射治疗计划确定理想的放射外科靶体积。我们的主要测量指标是平均计划残留肿瘤体积与AHS定义的理想放射外科靶体积之间的差异（dRV）。
本研究纳入7例连续性VS患者。计划残留肿瘤体积小于AHS定义的理想放射外科靶体积（1.6对4.5 cm，P = 0.004）。平均而言，实际术后残留肿瘤体积小于AHS定义的理想放射外科靶体积（2.2 cm对4.5 cm；P = 0.02）。AHS定义的理想放射外科靶体积与计划残留肿瘤体积之间的平均差异（dRV）为2.9±1.7 cm，并且我们观察到与保留有用面神经功能的患者相比，失去有用面神经功能的患者中dRV有增大趋势（4.7 cm对1.9 cm；P = 0.06）。
VS的计划次全切除与AHS定义的理想放射外科靶体积不同，但这是否会影响临床结果尚不清楚。
