Ha Myeong Hun, Jang Woo Youl, Jung Tae Young, Kim In Young, Lim Sa Hoe, Moon Kyung Sub, Jung Shin
Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.
Brain Tumor Res Treat. 2020 Oct;8(2):83-92. doi: 10.14791/btrt.2020.8.e16.
Although Gamma Knife radiosurgery (GKRS) has been widely used for intracranial meningiomas as an alternative or adjuvant treatment, guidelines have not been established for the selection of patients with petroclival meningioma (PCM) for GKRS. In this study, we reported the factors related to tumor progression and postoperative complications in PCM patients treated by GKRS, with a review of the literatures.
Between 2004 and 2019, 64 patients (52 patients for alternative and 12 patients for adjuvant treatment) with PCM underwent GKRS in our institution. The clinical and radiological factors were retrospectively analyzed. The mean radiologic follow-up duration was 58.4 months (range, 6-164 months). The mean tumor volume and diameter before GKRS were 13.4 cm³ and 2.9 cm, respectively. The median marginal dose was 12 Gy (range, 10-14 Gy) with a 50% median isodose line. Fractionation was used in 19 cases (29%, two fractionations in 5 cases & three fractionations in 14 cases).
Progression was noted in 7 cases (10.9%) and the progression-free survival rates were 91.1% at 5 years and 69.6% at 10 years. Although large in volume, moderate to severe peritumoral edema and male gender were somewhat related to progression, they did not reach statistical significance. Ten patients (15.6%) developed complications after GKRS. The most common complication was cranial nerve deficit (n=8), followed by hemiparesis, cognitive dysfunction, and hydrocephalus. Large size (maximal diameter ≥5 cm) [hazard ratio (HR) 0.091, 95% confidence interval (CI) 0.014-0.608; =0.013] and multiplicity (HR 0.102, 95% CI 0.018-0.573; =0.009) were independent factors for developing complications after GKRS.
GKRS can be considered an effective and safe treatment for large-volume PCM. However, for patients with large size or multiple masses, the treatment method should be determined with caution because the probability of complications after GKRS may increase.
尽管伽玛刀放射外科手术（GKRS）已被广泛用于颅内脑膜瘤的替代或辅助治疗，但对于岩斜脑膜瘤（PCM）患者选择GKRS治疗尚未建立指南。在本研究中，我们报告了GKRS治疗PCM患者中与肿瘤进展和术后并发症相关的因素，并对文献进行了综述。
2004年至2019年期间，我院64例PCM患者（52例为替代治疗，12例为辅助治疗）接受了GKRS。对临床和影像学因素进行回顾性分析。平均影像学随访时间为58.4个月（范围6 - 164个月）。GKRS前平均肿瘤体积和直径分别为13.4 cm³和2.9 cm。中位边缘剂量为12 Gy（范围10 - 14 Gy），中位等剂量线为50%。19例（29%）采用了分次治疗（5例分2次，14例分3次）。
7例（10.9%）出现进展，5年无进展生存率为91.1%，10年为69.6%。尽管肿瘤体积大、中度至重度瘤周水肿和男性性别与进展有一定相关性，但未达到统计学意义。10例患者（15.6%）在GKRS后出现并发症。最常见的并发症是脑神经功能缺损（n = 8），其次是偏瘫、认知功能障碍和脑积水。肿瘤大（最大直径≥5 cm）[风险比（HR）0.091，95%置信区间（CI）0.014 - 0.608；P = 0.013]和多发（HR 0.102，95% CI 0.018 - 0.573；P = 0.009）是GKRS后发生并发症的独立因素。
GKRS可被认为是治疗大体积PCM的有效且安全的方法。然而，对于肿瘤大或多发的患者应谨慎确定治疗方法，因为GKRS后并发症的发生率可能会增加。
