Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
J Neurooncol. 2018 Sep;139(3):679-688. doi: 10.1007/s11060-018-2913-6. Epub 2018 May 30.
Stereotactic radiation technique is widely reported as an effective treatment for various types of benign intracranial tumors. However, single fraction radiosurgery (SRS) is not recommended for tumors located close to the optic apparatus due to the restricted radiation tolerance dose of the optic pathway. Recent advances in radiotherapy include advanced frameless radiosurgery using hypofractionated stereotactic radiotherapy (HSRT), and this has become an attractive treatment option for perioptic tumors within 2-3 mm of the optic pathway. Accordingly, the aim of this study was to investigate the clinical outcomes of perioptic tumors treated with HSRT using CyberKnife® (CK) robotic radiosurgery system relative to tumor control, vision preservation and toxicity.
This retrospective analysis of prospectively collected data included consecutive 100 patients that were diagnosed with and treated for perioptic tumor at the Radiosurgery center, Ramathibodi Hospital during the January 2009 to December 2012 study period.
The median tumor volume was 6.81 cm (range 0.37-51.6), and the median prescribed dose was 25 Gy (range 20-35) in 5 fractions (range 3-5). After the median follow-up time of 37.5 months (range 21-103), two patients developed tumor progression at 6 and 34 months post-HSRT. The 5-year overall survival was 97%, and the 5-year local control was 97.5%. At the last follow-up, no vision deterioration or newly developed hypopituitarism was detected in our study.
Although a longer follow-up is needed, HSRT yields a high level of local control and vision preservation, and should be considered a treatment of choice for perioptic tumor located close to the optic apparatus.
立体定向放射技术被广泛报道为治疗各种类型良性颅内肿瘤的有效方法。然而，由于视神经通路的辐射耐受剂量有限，单次分割放射外科手术（SRS）不推荐用于靠近视器的肿瘤。放射治疗的最新进展包括使用分次立体定向放射治疗（HSRT）的无框架立体定向放射外科手术，对于位于视路 2-3 毫米内的眶周肿瘤，这已成为一种有吸引力的治疗选择。因此，本研究旨在探讨使用 CyberKnife®（CK）机器人放射外科系统进行 HSRT 治疗眶周肿瘤的临床结果，包括肿瘤控制、视力保护和毒性。
这是一项对前瞻性收集数据的回顾性分析，纳入了 2009 年 1 月至 2012 年 12 月期间在 Ramathibodi 医院放射外科中心诊断和治疗眶周肿瘤的 100 例连续患者。
肿瘤体积中位数为 6.81cm（范围 0.37-51.6），中位处方剂量为 25Gy（范围 20-35），分为 5 个剂量（范围 3-5）。中位随访时间为 37.5 个月（范围 21-103）后，有 2 例患者在 HSRT 后 6 个月和 34 个月时出现肿瘤进展。5 年总生存率为 97%，5 年局部控制率为 97.5%。在最后一次随访时，我们的研究中未发现视力恶化或新发生的垂体功能减退。
尽管需要更长的随访时间，但 HSRT 可获得较高的局部控制率和视力保护率，应被视为靠近视器的眶周肿瘤的治疗选择。
