Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
J Neurooncol. 2020 Jun;148(2):363-372. doi: 10.1007/s11060-020-03531-7. Epub 2020 May 13.
Stereotactic radiosurgery (SRS) is a potential re-irradiation treatment for recurrent intracranial ependymoma after prior radiation therapy. The purpose of this study was to examine the efficacy and safety of repeated SRS in the treatment of recurrent intracranial ependymomas.
This is a retrospective study of consecutive patients with residual or recurrent intracranial ependymomas who were treated with SRS between 1993 and 2018. Tumor progression was defined as a ≥ 10% increase in tumor volume. Tumor regression was defined as a ≥ 10% reduction in tumor volume. A tumor that remained within 10% of its original volume was defined as stable. Tumor control comprised tumor regression and stability. Time-dependent analyses were performed using two treatment failure endpoint definitions: (1) evidence of local tumor progression or distant metastasis (single SRS analysis), and (2) lack of tumor response to SRS (repeated SRS analysis). These analyses were adjusted for the competing risk of death.
The study comprised 37 patients (65 intracranial ependymomas) who underwent multiple SRS sessions (range: 1-7). Median age was 10.2 years (range: 0.8-53.8 years), and median tumor volume was 1.5 mL (range: 0.01-22.5 mL). The median radiation dose was 13.3 Gy (range: 7.9-22.0 Gy) at a median isodose line of 57% (range: 50-90%). Overall tumor control rates in the single SRS analysis adjusting for the competing risk of death were 53.6%, 30.5%, and 23.6% at 1, 3, and 5 years, respectively. Overall tumor control rates in the repeated SRS analysis adjusting for the competing risk of death were 70.6%, 50.4%, and 43.1% at 1, 3, and 5 years, respectively. Prior gross total resection was the only independent predictor of overall tumor control after SRS (aHR = 25.62 (1.55-422.1), p = 0.02).
Repeated GKRS appeared to be an effective treatment strategy for recurrent or residual intracranial ependymomas, with acceptable complication rates.
立体定向放射外科（SRS）是一种潜在的复发性颅内室管膜瘤再放疗治疗方法，在接受过放射治疗后。本研究的目的是研究重复 SRS 治疗复发性颅内室管膜瘤的疗效和安全性。
这是一项对 1993 年至 2018 年间接受 SRS 治疗的残留或复发性颅内室管膜瘤患者进行的连续患者回顾性研究。肿瘤进展定义为肿瘤体积增加≥10%。肿瘤退缩定义为肿瘤体积减少≥10%。肿瘤体积保持在原始体积的 10%以内被定义为稳定。肿瘤控制包括肿瘤退缩和稳定。使用两种治疗失败终点定义进行时间依赖性分析：（1）局部肿瘤进展或远处转移的证据（单次 SRS 分析），以及（2）SRS 无肿瘤反应（重复 SRS 分析）。这些分析针对死亡的竞争风险进行了调整。
本研究包括 37 例（65 个颅内室管膜瘤）患者接受了多次 SRS 治疗（范围：1-7 次）。中位年龄为 10.2 岁（范围：0.8-53.8 岁），中位肿瘤体积为 1.5 毫升（范围：0.01-22.5 毫升）。中位放射剂量为 13.3Gy（范围：7.9-22.0Gy），等剂量线为 57%（范围：50-90%）。在调整死亡竞争风险后，单次 SRS 分析中的总体肿瘤控制率分别为 53.6%、30.5%和 23.6%，在 1、3 和 5 年时。在调整死亡竞争风险后，重复 SRS 分析中的总体肿瘤控制率分别为 70.6%、50.4%和 43.1%，在 1、3 和 5 年时。SRS 后，肿瘤全切除是总体肿瘤控制的唯一独立预测因素（aHR=25.62（1.55-422.1），p=0.02）。
GKRS 重复治疗似乎是治疗复发性或残留颅内室管膜瘤的有效治疗策略，并发症发生率可接受。
