Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea.
Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.
J Neurooncol. 2018 Oct;140(1):135-143. doi: 10.1007/s11060-018-2943-0. Epub 2018 Jul 9.
To analyze the outcomes of gamma knife radiosurgery (GKS) for craniopharyngiomas and elucidate the optimal strategy.
Between 1998 and 2016, 35 patients underwent GKS for the treatment of 40 recurrent or residual craniopharyngiomas. Among 40 GKSs, 22 procedures were single-session GKSs and 18 procedures were fractionated GKSs. In cases of single-session GKS, the median marginal dose was 15 Gy (range 10-20 Gy). In cases of fractionated GKS, the median marginal dose was 6 Gy (range 5-7.5 Gy) of three fractions. The radiation dose was calculated to the biologic equivalent dose (BED) using α/β ratios of 10 and 2.
The location of the tumor, the distance between the optic nerve and tumor (> 10 mm), BED 10 (> 35 Gy), and BED2 (> 80 Gy) were statistically significant with overall response rate (P = 0.008, 0.02, 0.03, and 0.002, respectively). There was a statistically significant difference in progression-free survival according to the distance between the optic nerve and tumor (> 10 mm) and the location of tumor (P = 0.03 and 0.03, respectively). Multivariate logistic regression analysis showed the hypothalamus group had an odds ratio of 0.04 compared with the suprasellar group for tumor progression. The group with BED2 > 80 Gy had an odds ratio of 0.049 compared with the group with BED2 < 80 Gy.
A sufficient dose is required for treating craniopharyngiomas using single-session and fractionated GKS. The outcomes of GKS can be predicted according to the location of tumor, the distance between the optic nerve and tumor and BED value.
分析伽玛刀放射外科（GKS）治疗颅咽管瘤的结果，并阐明最佳策略。
1998 年至 2016 年间，35 例患者因 40 例复发性或残留颅咽管瘤而行 GKS 治疗。在 40 次 GKS 中，22 次为单次 GKS，18 次为分次 GKS。单次 GKS 的中位边缘剂量为 15 Gy（范围 10-20 Gy）。分次 GKS 的中位边缘剂量为 6 Gy（范围 5-7.5 Gy），共 3 次。使用 α/β 比值为 10 和 2 计算辐射剂量的生物等效剂量（BED）。
肿瘤位置、视神经与肿瘤之间的距离（>10 mm）、BED10（>35 Gy）和 BED2（>80 Gy）与总反应率具有统计学意义（P=0.008、0.02、0.03 和 0.002）。根据视神经与肿瘤之间的距离（>10 mm）和肿瘤位置，无进展生存率存在统计学差异（P=0.03 和 0.03）。多因素 logistic 回归分析显示，与鞍上组相比，下丘脑组肿瘤进展的优势比为 0.04。BED2>80 Gy 组的优势比为 0.049，低于 BED2<80 Gy 组。
单次和分次 GKS 治疗颅咽管瘤需要足够的剂量。根据肿瘤位置、视神经与肿瘤之间的距离和 BED 值，可以预测 GKS 的结果。
