Astradsson Arnar, Munck Af Rosenschöld Per, Poulsgaard Lars, Ohlhues Lars, Engelholm Svend Aage, Feldt-Rasmussen Ulla, Marsh Reginald, Roed Henrik, Juhler Marianne
Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.
Department of Traumatic Brain Injury and Neurorehabilitation, Rigshospitalet, Hvidovre, Denmark.
Clin Transl Radiat Oncol. 2019 Feb 7;15:93-98. doi: 10.1016/j.ctro.2019.02.001. eCollection 2019 Feb.
The purpose of this study was to examine the occurrence of cerebral infarction (ischemic stroke), in a large combined cohort of patients with anterior skull base meningiomas, pituitary adenomas and craniopharyngiomas, after fractionated stereotactic radiation therapy (FSRT).
All patients, 18 years and older, with anterior skull base meningiomas, pituitary adenomas and craniopharyngiomas, treated with fractionated stereotactic radiation, in our center, from January 1999 to December 2015 were identified. In total 169 patients were included. The prescription dose to the tumor was 54 Gy for 164 patients (97%) and 46.0-52.2 Gy for 5 patients (3%). Cases of cerebral infarctions subsequent to FSRT were identified from the Danish National Patient Registry and verified with review of case notes. The rate of cerebral infarction after FSRT was compared to the rate in the general population with a one sample -test after standardization for age and year. We explored if age, sex, disease type, radiation dose and dose per fraction was associated with increased risk of cerebral infarction using univariate Cox models.
At a median follow-up of 9.3 years (range 0.1-16.5), 7 of the 169 patients (4.1%) developed a cerebral infarction, at a median 5.7 years (range 1.2-11.5) after FSRT. The mean cerebral infarction rate for the general population was 0.0035 and 0.0048 for the FSRT cohort (p = 0.423). Univariate cox models analysis showed that increasing age correlated significantly with the cerebral infarction risk, with a hazard ratio of 1.090 (p = 0.013).
Increased risk of cerebral infarction after FSRT of anterior skull base tumors was associated with age, similar to the general population. Our study revealed that FSRT did not introduce an excess risk of cerebral infarction.
本研究的目的是在接受分次立体定向放射治疗（FSRT）的前颅底脑膜瘤、垂体腺瘤和颅咽管瘤患者的大型联合队列中，研究脑梗死（缺血性卒中）的发生情况。
确定了1999年1月至2015年12月在我们中心接受分次立体定向放射治疗的所有18岁及以上的前颅底脑膜瘤、垂体腺瘤和颅咽管瘤患者。共纳入169例患者。164例患者（97%）的肿瘤处方剂量为54 Gy，5例患者（3%）为46.0 - 52.2 Gy。FSRT后发生脑梗死的病例从丹麦国家患者登记处识别，并通过病例记录复查进行核实。在对年龄和年份进行标准化后，使用单样本检验将FSRT后脑梗死发生率与一般人群的发生率进行比较。我们使用单变量Cox模型探讨年龄、性别、疾病类型、放射剂量和分次剂量是否与脑梗死风险增加相关。
在中位随访9.3年（范围0.1 - 16.5年）时，169例患者中有7例（4.1%）发生脑梗死，中位时间为FSRT后5.7年（范围1.2 - 11.5年）。一般人群的平均脑梗死发生率为0.0035，FSRT队列的为0.0048（p = 0.423）。单变量Cox模型分析显示，年龄增加与脑梗死风险显著相关，风险比为1.090（p = 0.013）。
前颅底肿瘤FSRT后脑梗死风险增加与年龄有关，与一般人群相似。我们的研究表明，FSRT不会增加脑梗死风险。
