Park Kyung-Jae, Kano Hideyuki, Iyer Aditya, Liu Xiaomin, Tonetti Daniel A, Lehocky Craig, Faramand Andrew, Niranjan Ajay, Flickinger John C, Kondziolka Douglas, Lunsford L Dade
1Department of Neurosurgery, College of Medicine, Korea University, Seoul, Korea.
Departments of2Neurological Surgery.
J Neurosurg. 2018 Jul 20;130(6):1799-1808. doi: 10.3171/2018.2.JNS172361. Print 2019 Jun 1.
The authors of this study evaluate the long-term outcomes of stereotactic radiosurgery (SRS) for cavernous sinus meningioma (CSM).
The authors retrospectively assessed treatment outcomes 5-18 years after SRS in 200 patients with CSM. The median patient age was 57 years (range 22-83 years). In total, 120 (60%) patients underwent Gamma Knife SRS as primary management, 46 (23%) for residual tumors, and 34 (17%) for recurrent tumors after one or more surgical procedures. The median tumor target volume was 7.5 cm3 (range 0.1-37.3 cm3), and the median margin dose was 13.0 Gy (range 10-20 Gy).
Tumor volume regressed in 121 (61%) patients, was unchanged in 49 (25%), and increased over time in 30 (15%) during a median imaging follow-up of 101 months. Actuarial tumor control rates at the 5-, 10-, and 15-year follow-ups were 92%, 84%, and 75%, respectively. Of the 120 patients who had undergone SRS as a primary treatment (primary SRS), tumor progression was observed in 14 (11.7%) patients at a median of 48.9 months (range 4.8-120.0 months) after SRS, and actuarial tumor control rates were 98%, 93%, 85%, and 85% at the 1-, 5-, 10-, and 15-year follow-ups post-SRS. A history of tumor progression after microsurgery was an independent predictor of an unfavorable response to radiosurgery (p = 0.009, HR = 4.161, 95% CI 1.438-12.045). Forty-four (26%) of 170 patients who had presented with at least one cranial nerve (CN) deficit improved after SRS. Development of new CN deficits after initial microsurgical resection was an unfavorable factor for improvement after SRS (p = 0.014, HR = 0.169, 95% CI 0.041-0.702). Fifteen (7.5%) patients experienced permanent CN deficits without evidence of tumor progression at a median onset of 9 months (range 2.3-85 months) after SRS. Patients with larger tumor volumes (≥ 10 cm3) were more likely to develop permanent CN complications (p = 0.046, HR = 3.629, 95% CI 1.026-12.838). Three patients (1.5%) developed delayed pituitary dysfunction after SRS.
This long-term study showed that Gamma Knife radiosurgery provided long-term tumor control for most patients with CSM. Patients who underwent SRS for progressive tumors after prior microsurgery had a greater chance of tumor growth than the patients without prior surgery or those with residual tumor treated after microsurgery.
本研究的作者评估立体定向放射外科治疗（SRS）海绵窦脑膜瘤（CSM）的长期疗效。
作者回顾性评估了200例CSM患者接受SRS治疗5至18年后的治疗效果。患者中位年龄为57岁（范围22 - 83岁）。总共120例（60%）患者接受伽玛刀SRS作为初始治疗，46例（23%）用于治疗残留肿瘤，34例（17%）用于治疗一次或多次手术治疗后的复发性肿瘤。肿瘤中位靶体积为7.5 cm³（范围0.1 - 37.3 cm³），中位边缘剂量为13.0 Gy（范围10 - 20 Gy）。
在中位101个月的影像学随访期间，121例（61%）患者的肿瘤体积缩小，49例（25%）无变化，30例（15%）随时间增大。5年、10年和15年随访时的精算肿瘤控制率分别为92%、84%和75%。在120例接受初始SRS治疗（初始SRS）的患者中，14例（11.7%）患者在SRS后中位48.9个月（范围4.8 - 120.0个月）出现肿瘤进展，SRS后1年、5年、10年和15年随访时的精算肿瘤控制率分别为98%、93%、85%和85%。显微手术后有肿瘤进展史是对放射外科治疗反应不佳的独立预测因素（p = 0.009，HR = 4.161，95% CI 1.438 - 12.045）。170例至少有一项颅神经（CN）功能缺损的患者中，44例（26%）在SRS后有所改善。初次显微手术切除后出现新的CN功能缺损是SRS后改善的不利因素（p = 0.014，HR = 0.169，95% CI 0.041 - 0.702）。15例（7.5%）患者在SRS后中位9个月（范围2.3 - 85个月）出现永久性CN功能缺损，且无肿瘤进展证据。肿瘤体积较大（≥10 cm³）的患者更易发生永久性CN并发症（p = 0.046，HR = 3.629，95% CI 1.026 - 12.838）。3例（1.5%）患者在SRS后出现延迟性垂体功能障碍。
这项长期研究表明，伽玛刀放射外科为大多数CSM患者提供了长期的肿瘤控制。与未接受过手术或接受显微手术后残留肿瘤治疗的患者相比，因先前显微手术后肿瘤进展而接受SRS治疗的患者肿瘤生长的可能性更大。
