Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan; Stereotactic Radiotherapy Center, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan.
Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan; Stereotactic Radiotherapy Center, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan; Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
World Neurosurg. 2020 Dec;144:e714-e722. doi: 10.1016/j.wneu.2020.09.059. Epub 2020 Sep 16.
We retrospectively assessed the effectiveness and safety of Gamma Knife radiosurgery (GKRS) for asymptomatic obstructive hydrocephalus associated with posterior fossa metastases, which was known empirically but not well discussed.
We reviewed the medical records of 27 patients who underwent GKRS for asymptomatic obstructive hydrocephalus related to posterior fossa metastases.
Cumulative control rates of hydrocephalus were 11.1%, 51.9%, 70.4%, and 74.6% at 1, 2, 3, and 6 months after GKRS. Primary gastrointestinal tract cancer (P = 0.001) was significantly correlated with unfavorable management. Evans ratio at GKRS (median 0.31) improved significantly compared with that at 1-3 months after GKRS (median 0.26) (P < 0.0001) and maintained at 6 to 12 months. Cumulative local tumor control rates were 91.7%, 70.8%, and 64.4% at 3, 6, and 12 months after GKRS. Primary gastrointestinal tract cancer (P = 0.018) and no conventional systemic agents (P = 0.027) were significantly correlated with unfavorable control. Cumulative incidence rates of adverse radiation effects were 0.0%, 16.7%, and 24.2% at 6, 9, and 12 months after GKRS. Primary gastrointestinal tract cancer (P < 0.0001) and single and 2- or 3-fraction GKRS (P < 0.0001) were significantly correlated with unfavorable outcomes. All but 1 patient avoided surgical procedure for hydrocephalus after GKRS.
The present findings suggest that GKRS is an effective and safe treatment for asymptomatic obstructive hydrocephalus caused by posterior fossa metastases, and all but 1 could avoid invasive surgical procedures for hydrocephalus. Posterior fossa metastases from gastrointestinal tract cancer resulted in unsatisfactory outcomes for control of hydrocephalus, tumor progression, and adverse radiation effects.
我们回顾性评估了伽玛刀放射外科（GKRS）治疗后颅窝转移相关无症状性梗阻性脑积水的有效性和安全性，这在经验上是已知的，但尚未得到充分讨论。
我们回顾性分析了 27 例因后颅窝转移而接受 GKRS 治疗无症状性梗阻性脑积水的患者的病历。
GKRS 后 1、2、3 和 6 个月时，脑积水的累积控制率分别为 11.1%、51.9%、70.4%和 74.6%。原发胃肠道肿瘤（P=0.001）与不良预后显著相关。GKRS 时的 Evans 比值（中位数 0.31）与 GKRS 后 1-3 个月时（中位数 0.26）相比显著改善（P<0.0001），并在 6-12 个月时保持稳定。GKRS 后 3、6 和 12 个月时的局部肿瘤累积控制率分别为 91.7%、70.8%和 64.4%。原发胃肠道肿瘤（P=0.018）和无常规全身治疗（P=0.027）与不良控制显著相关。GKRS 后 6、9 和 12 个月时，不良放射反应的累积发生率分别为 0.0%、16.7%和 24.2%。原发胃肠道肿瘤（P<0.0001）和单次和 2-或 3 分次 GKRS（P<0.0001）与不良结局显著相关。除 1 例患者外，所有患者在 GKRS 后均避免了脑积水的手术治疗。
本研究结果表明，GKRS 是治疗后颅窝转移相关无症状性梗阻性脑积水的有效且安全的方法，除 1 例外，所有患者均避免了对脑积水进行有创手术。来自胃肠道肿瘤的后颅窝转移导致脑积水、肿瘤进展和不良放射反应的控制效果不佳。
