Wilson Hannah P, Price Patricia M, Ashkan Keyoumars, Edwards Andrew, Green Melanie M, Cross Timothy, Beaney Ronald P, Davies Rhiannon, Sibtain Amen, Plowman Nick P, Goldsmith Christy
Department of Surgery and Cancer, Imperial College London, London, GBR.
Department of Radiation Oncology, The Harley Street Clinic, London, GBR.
Cureus. 2018 Mar 27;10(3):e2380. doi: 10.7759/cureus.2380.
The study aim was to evaluate patient individualized Cyberknife® treatment for heterogeneous skull-base tumors. Patients treated between 2009 and 2013 at The Harley Street Clinic were studied. In total, 66 patients received 15-30 Gy in 1-5 fractions to a median planning target volume (PTV) of 6.4 cc, including patients with secondary, multiple, residual and recurrent tumors, and those with tumors of uncertain pathological type. Outcome analysis was pragmatically restricted to 35 patients who had single, primary tumors treated with curative intent, and sufficient diagnostic and outcome information. Sixteen vestibular schwannoma patients with median PTV 3.8 cc (range 0.81-19.6) received 18-25 Gy in 3-5 fractions: 81% showed no acute toxicity, 50% reported no late toxicity, 71% of symptoms were stable/improved and local control was 100% at 11.4 months median follow-up. Twelve meningioma patients with median PTV of 5.5 cc (range 0.68-22.3) received 17-30 Gy in 1-5 fractions: 83% experienced no acute toxicity, 33% reported no late toxicity, 88% of symptoms were stable/improved and local control was 100% at 22.1 months median follow-up. Seven patients with other tumor types with median PTV of 24.3 cc (range 7.6-100.5) received 15-28.5 Gy in 1-5 fractions: 57% experienced no acute toxicity, 57% reported no late toxicities, 66% of symptoms were stable and local control was 43% at 14.9 months median follow-up. When tumor types were considered together, smaller tumors (PTV < 6.4 cc) showed reduced acute toxicity (p = 0.01). Overall, smaller benign tumors showed low acute toxicity, excellent local control, and good symptom management: a focus on enhanced neurological preservation may refine outcomes. For other tumor types outcome was encouraging: a focus on optimal dose and fractionation scheduling may reduce toxicity and improve local control. Individual patient experiences are detailed where valuable lessons were gained for optimizing local control and minimizing toxicity.
本研究旨在评估针对异质性颅底肿瘤的患者个体化射波刀®治疗。对2009年至2013年在哈雷街诊所接受治疗的患者进行了研究。共有66例患者接受了15 - 30 Gy的剂量，分1 - 5次给予，计划靶体积（PTV）中位数为6.4 cc，包括继发性、多发性、残留性和复发性肿瘤患者，以及病理类型不确定的肿瘤患者。结果分析实际局限于35例接受了以治愈为目的治疗的单发原发性肿瘤患者，且有足够的诊断和结果信息。16例前庭神经鞘瘤患者，PTV中位数为3.8 cc（范围0.81 - 19.6），分3 - 5次接受了18 - 25 Gy的剂量：81%的患者无急性毒性反应，50%的患者报告无晚期毒性反应，71%的症状稳定/改善，在中位随访11.4个月时局部控制率为100%。12例脑膜瘤患者，PTV中位数为5.5 cc（范围0.68 - 22.3），分1 - 5次接受了17 - 30 Gy的剂量：83%的患者无急性毒性反应，33%的患者报告无晚期毒性反应，88%的症状稳定/改善，在中位随访22.1个月时局部控制率为100%。7例其他肿瘤类型患者，PTV中位数为24.3 cc（范围7.6 - 100.5），分1 - 5次接受了15 - 28.5 Gy的剂量：57%的患者无急性毒性反应，57%的患者报告无晚期毒性反应，66%的症状稳定，在中位随访14.9个月时局部控制率为43%。当综合考虑肿瘤类型时，较小的肿瘤（PTV < 6.4 cc）显示急性毒性降低（p = 0.01）。总体而言，较小的良性肿瘤显示出低急性毒性、良好的局部控制和良好的症状管理：关注增强神经保护可能会改善治疗结果。对于其他肿瘤类型，结果令人鼓舞：关注最佳剂量和分割方案可能会降低毒性并改善局部控制。详细介绍了个体患者的经验，从中获得了优化局部控制和最小化毒性的宝贵经验教训。
