Shi Siyu, Jin Michael C, Koenig Julie, Gibbs Iris C, Soltys Scott G, Chang Steven D, Li Gordon, Hayden Gephart Melanie, Hiniker Susan M, Pollom Erqi L
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
Stereotact Funct Neurosurg. 2019;97(3):189-194. doi: 10.1159/000502653. Epub 2019 Oct 7.
OBJECTIVE/BACKGROUND: We report efficacy and toxicity outcomes with stereotactic radiosurgery (SRS) for intracranial and spinal ependymoma.
We analyzed adult and pediatric patients with newly diagnosed or recurrent intracranial or spinal ependymoma lesions treated with SRS at our institution. Following SRS, local failure (LF) was defined as failure within or adjacent to the SRS target volume, while distant failure (DF) was defined as failure outside of the SRS target volume. Time to LF and DF was analyzed using competing risk analysis with death as a competing risk.Overall survival (OS) was calculated from the date of first SRS to the date of death or censored at the date of last follow-up using the Kaplan-Meier method.
Twenty-one patients underwent SRS to 40 intracranial (n = 30) or spinal (n = 10) ependymoma lesions between 2007 and 2018, most commonly with 18 or 20 Gy in 1 fraction. Median follow-up for all patients after first SRS treatment was 54 months (range 2-157). The 1-year, 2-year, and 5-year rates of survival among patients with initial intracranial ependymoma were 86, 74, and 52%, respectively. The 2-year cumulative incidences of LF and DF after SRS among intracranial ependymoma patients were 25% (95% CI 11-43) and 42% (95% CI 22-60), respectively. No spinal ependymoma patient experienced LF, DF, or death within 2 years of SRS. Three patients had adverse radiation effects.
SRS is a viable treatment option for intracranial and spinal ependymoma with excellent local control and acceptable toxicity.
目的/背景：我们报告了立体定向放射外科（SRS）治疗颅内和脊髓室管膜瘤的疗效和毒性结果。
我们分析了在本机构接受SRS治疗的新诊断或复发性颅内或脊髓室管膜瘤病变的成人和儿童患者。SRS治疗后，局部失败（LF）定义为SRS靶区内或其邻近区域的失败，而远处失败（DF）定义为SRS靶区外的失败。使用以死亡为竞争风险的竞争风险分析来分析LF和DF的发生时间。总生存期（OS）从首次SRS治疗日期计算至死亡日期，或使用Kaplan-Meier方法在最后一次随访日期进行截尾。
2007年至2018年间，21例患者接受了SRS治疗40个颅内（n = 30）或脊髓（n = 10）室管膜瘤病变，最常见的是单次给予18或20 Gy。首次SRS治疗后所有患者的中位随访时间为54个月（范围2 - 157个月）。初发颅内室管膜瘤患者的1年、2年和5年生存率分别为86%、74%和52%。颅内室管膜瘤患者SRS治疗后2年LF和DF的累积发生率分别为25%（95%CI 11 - 43）和42%（95%CI 22 - 60）。没有脊髓室管膜瘤患者在SRS治疗后2年内发生LF、DF或死亡。3例患者出现了放射性不良反应。
SRS是治疗颅内和脊髓室管膜瘤的一种可行选择，具有良好的局部控制和可接受的毒性。
