Tsugawa Takahiko, Kobayashi Tatsuya, Hasegawa Toshinori, Iwai Yoshiyasu, Matsunaga Shigeo, Yamamoto Masaaki, Hayashi Motohiro, Kenai Hiroyuki, Kano Tadashige, Mori Hisae, Nagano Osamu, Hasegawa Seiko, Inoue Akira, Nagatomo Yasushi, Onoue Shinji, Sato Manabu, Yasuda Soichiro
Neurosurgery, Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, JPN.
Neurosurgery, Komaki City Hospital, Komaki, JPN.
Cureus. 2020 Feb 12;12(2):e6973. doi: 10.7759/cureus.6973.
Objective The optimal treatment for a craniopharyngioma has been controversial. Complete resection is ideal, but it has been difficult to obtain total resection in many cases because of intimate proximity to critical structures such as the optic pathway, hypothalamus, and pituitary gland. A growing number of studies have demonstrated the utility of radiosurgery in controlling residual or recurrent craniopharyngioma. However, most of them are small series. The aim of this multi-institutional study was to clarify the efficacy and safety of Gamma Knife (Elekta, Stockholm, Sweden) surgery for patients with a craniopharyngioma. Methods This was a multi-institutional retrospective study by 16 medical centers of the Japan Leksell Gamma Knife Society. Data on patients with craniopharyngiomas treated with Gamma Knife Surgery (GKS) between 1991 and 2013 were obtained from individual institutional review board-approved databases at each center. A total of 242 patients with craniopharyngioma were included in this study. The mean age of the patients was 41 (range, 3 to 86) years. The median follow-up time was 61.4 months (range, 3 to 180 months). The mean radiosurgery target volume was 3.1 ml (range, 0.03-22.3 ml), and the mean marginal dose was 11.4 Gy (range, 8-20.4 Gy). Results Two-hundred twenty patients were alive at the time of the last follow-up visit. The three-, five-, and 10-year overall survival rates after GKS were 95.4%, 92.5%, and 82.0%, respectively. The three-, five-, and 10-year progression-free survival rates after GKS were 73.1%, 62.2%, and 42.6% respectively. The rate of radiation-induced complications was 6.2%. Conclusion GKS is effective for controlling the tumor growth of craniopharyngiomas with an acceptable complication rate.
目的 颅咽管瘤的最佳治疗方法一直存在争议。完整切除是理想的治疗方式，但由于其与视神经通路、下丘脑和垂体等关键结构关系密切，在许多病例中难以实现全切。越来越多的研究表明放射外科手术在控制残留或复发性颅咽管瘤方面具有效用。然而，其中大多数是小样本研究。这项多机构研究的目的是阐明伽玛刀（瑞典斯德哥尔摩医科达公司）手术治疗颅咽管瘤患者的疗效和安全性。方法 这是一项由日本Leksell伽玛刀协会的16个医学中心开展的多机构回顾性研究。1991年至2013年间接受伽玛刀手术（GKS）治疗的颅咽管瘤患者的数据来自各中心经机构审查委员会批准的数据库。本研究共纳入242例颅咽管瘤患者。患者的平均年龄为41岁（范围3至86岁）。中位随访时间为61.4个月（范围3至180个月）。平均放射外科手术靶体积为3.1毫升（范围0.03 - 22.3毫升），平均边缘剂量为11.4 Gy（范围8 - 20.4 Gy）。结果 在最后一次随访时，220例患者存活。GKS术后3年、5年和10年的总生存率分别为95.4%、92.5%和82.0%。GKS术后3年、5年和10年的无进展生存率分别为73.1%、62.2%和42.6%。放射性并发症发生率为6.2%。结论 GKS在控制颅咽管瘤肿瘤生长方面有效，且并发症发生率可接受。
