Oh Hyuk-Jin, Cho Young Hyun, Kim Jeong Hoon, Kim Chang Jin, Kwon Do Hoon, Lee Doheui, Yoon KyoungJun
Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Neurooncol. 2020 Aug;149(1):87-93. doi: 10.1007/s11060-020-03575-9. Epub 2020 Jul 1.
Although stereotactic radiosurgery (SRS) has been proven to be effective and safe for treating intracranial meningiomas, concerns have been raised about the use of SRS for large-sized tumors involving the skull base that frequently encroach onto adjacent critical neural structures. The purpose of this study was to investigate the role of hypofractionated SRS as a therapeutic option for large-sized skull base meningiomas.
Thirty-one consecutive patients (median age: 55 years, 9 men and 22 women) who had been treated with hypofractionated SRS using CyberKnife for large-sized skull base meningiomas (> 10 cm in volume, median of 18.9 cm, range 11.6-58.2 cm) were enrolled. All patients harbored middle or posterior skull base tumors, most frequently of cavernous sinus (n = 7, 22.6%), petroclival (n = 6, 19.4%), or tentorial edge (n = 6, 19.4%) locations. SRS was delivered in five daily fractions (range 3-5 fractions) with a median cumulative dose of 27.8 Gy (range 22.6-27.8 Gy).
With a median follow-up of 57 months (range 9-98 months), tumor control was achieved for 28 (90.3%) of 31 patients. Treatment response on MRI included partial response (volume decrease > 20%) in 17 (54.8%) patients, stable in 11 (35.5%), and progression (volume increase > 20%) in 3 (9.7%). Of 21 patients with cranial neuropathy, 20 (95.2%) showed improved neurological status.
Our current results suggest a promising role of hypofractionated SRS for large-sized skull base megningiomas in terms of tumor control and neurological outcomes. It is a reasonable therapeutic option for select patients.
尽管立体定向放射外科手术（SRS）已被证明在治疗颅内脑膜瘤方面有效且安全，但对于将SRS用于涉及颅底的大型肿瘤（这些肿瘤经常侵犯相邻关键神经结构）的应用仍存在担忧。本研究的目的是探讨大分割SRS作为大型颅底脑膜瘤治疗选择的作用。
连续纳入31例使用射波刀进行大分割SRS治疗的大型颅底脑膜瘤患者（中位年龄：55岁，9例男性和22例女性），肿瘤体积均大于10 cm（中位体积为18.9 cm，范围11.6 - 58.2 cm）。所有患者均患有中颅底或后颅底肿瘤，最常见于海绵窦（n = 7，22.6%）、岩斜区（n = 6，19.4%）或小脑幕切迹边缘（n = 6，19.4%）部位。SRS分5次每日分割给予（范围3 - 5次分割），中位累积剂量为27.8 Gy（范围22.6 - 27.8 Gy）。
中位随访57个月（范围9 - 98个月），31例患者中有28例（90.3%）实现了肿瘤控制。MRI上的治疗反应包括17例（54.8%）患者部分缓解（体积减少>20%）、11例（35.5%）稳定以及3例（9.7%）进展（体积增加>20%）。在21例患有颅神经病变的患者中，20例（95.2%）神经功能状态得到改善。
我们目前的结果表明，大分割SRS在大型颅底脑膜瘤的肿瘤控制和神经学结果方面具有良好前景。对于特定患者而言，它是一种合理的治疗选择。
