Sherry Alexander D, Bingham Brian, Kim Ellen, Monsour Meredith, Luo Guozhen, Attia Albert, Chambless Lola B, Cmelak Anthony J
Vanderbilt University School of Medicine, Nashville, TN, USA.
Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
J Radiosurg SBRT. 2020;6(4):287-294.
Radiation-associated malignancy and malignant transformation are risks associated with stereotactic radiosurgery (SRS); however, incidence is uncertain. The purpose of our study is to present the rate of radiation-associated malignancy and malignant transformation at our institution. After IRB approval, we undertook a retrospective cohort study evaluating patients treated with Gamma Knife® or linac-based SRS between 1990 and 2014 for benign CNS pathology with at least 5 years of clinical follow-up. Risk of transformation was calculated using the Kaplan-Meier method. A total of 273 patients met selection criteria. Median clinical follow-up after SRS was 11 years (range 5-27). Over 3,216 patient-years following SRS, we found zero cases of radiation-associated malignancy and two cases of radiation-associated malignant transformation for a crude rate of 0.73% or case rate of 0.62 per 1,000 patient-years. The Kaplan-Meier risk of malignant transformation at 5, 10, and 15 years was 0.4% (95% CI 0.05% 2.6%). These data support the continued use of SRS for benign intracranial pathology without significant concern for secondary malignancy.
放射性相关恶性肿瘤和恶性转化是立体定向放射外科手术（SRS）的相关风险；然而，其发生率尚不确定。我们研究的目的是呈现我院放射性相关恶性肿瘤和恶性转化的发生率。经机构审查委员会（IRB）批准后，我们进行了一项回顾性队列研究，评估1990年至2014年间接受伽玛刀®或直线加速器立体定向放射外科手术治疗的良性中枢神经系统疾病患者，这些患者至少有5年的临床随访。使用Kaplan-Meier方法计算转化风险。共有273例患者符合入选标准。立体定向放射外科手术后的中位临床随访时间为11年（范围5 - 27年）。在立体定向放射外科手术后超过3216患者年的时间里，我们发现放射性相关恶性肿瘤零例，放射性相关恶性转化两例，粗发生率为0.73%，或每1000患者年的病例率为0.62。5年、10年和15年时恶性转化的Kaplan-Meier风险为0.4%（95%置信区间0.05% - 2.6%）。这些数据支持继续将立体定向放射外科手术用于良性颅内疾病，而无需对继发性恶性肿瘤产生重大担忧。
