Clinical Investigation Program, Harvard Medical School, Boston, Massachusetts, USA.
Doctor of Osteopathic Medicine Program, Arizona College of Osteopathic Medicine, Glendale, Arizona, USA.
World Neurosurg. 2021 Feb;146:322-331.e1. doi: 10.1016/j.wneu.2020.11.040. Epub 2020 Nov 16.
Cystic vestibular schwannomas (VS) are associated with unpredictable growth behavior and potentially worse surgical outcomes compared with their solid counterparts. Growth control and potential adverse effects of radiosurgery for cystic VS have created concerns surrounding this modality. We sought to compare the treatment efficacy and safety profile of radiosurgery between cystic and solid VS through a systematic review.
PubMed, EMBASE, Web of Science, and Cochrane were searched for related terms and studies reporting radiosurgical outcomes of cystic and solid VS. A meta-analysis was performed to compare the rates of tumor control. Random-effect models with generic inverse variance method was used to calculate overall pooled estimates. Study quality was assessed with the Newcastle Ottawa Criteria.
In total, 2989 studies were retrieved, and 6 including 1358 VS (79.89% solid; 20.11% cystic, median follow-up range 31.8-150 months) were selected. The median maximal dose was 25 Gy (range, 13-36 Gy) and the median marginal tumor dose was 12 Gy (10-18 Gy). There was no difference between cystic and solid VS (risk ratio, 1.02; 95% confidence interval 0.94-1.10; P = 0.69; I = 78%). Transient enlargement of cystic tumors may be associated with trigeminal or facial neuropathy.
The evidence collected by this study suggests that radiosurgery for cystic VS exhibits effective tumor control probabilities similar to solid VS. Consensus definitions and standard criteria are needed in the future to better understand the patterns of tumor growth and response to treatment following radiosurgery for cystic VS, as well as long-term neurological and functional outcomes.
与实体型听神经鞘瘤相比，囊性前庭神经鞘瘤的生长行为具有不可预测性，且手术结局可能更差。囊性听神经鞘瘤的生长控制和放射外科治疗的潜在不良反应引发了人们对这种治疗方式的关注。我们旨在通过系统评价比较囊性和实体型听神经鞘瘤接受放射外科治疗的疗效和安全性。
通过检索 PubMed、EMBASE、Web of Science 和 Cochrane 中与囊性和实体型听神经鞘瘤放射外科治疗结果相关的术语和研究，进行了一项荟萃分析。采用随机效应模型和通用倒数方差法比较肿瘤控制率。使用纽卡斯尔-渥太华量表评估研究质量。
共检索到 2989 篇研究，其中 6 项研究共纳入 1358 例听神经鞘瘤（79.89%为实体型，20.11%为囊性，中位随访时间范围为 31.8-150 个月）。最大剂量中位数为 25 Gy（范围，13-36 Gy），边缘肿瘤剂量中位数为 12 Gy（10-18 Gy）。囊性和实体型听神经鞘瘤之间无差异（风险比，1.02；95%置信区间 0.94-1.10；P=0.69；I=78%）。囊性肿瘤的短暂增大可能与三叉神经或面神经神经病有关。
本研究收集的证据表明，囊性听神经鞘瘤的放射外科治疗显示出与实体型听神经鞘瘤相似的有效肿瘤控制概率。未来需要达成共识定义和标准标准，以便更好地了解囊性听神经鞘瘤放射外科治疗后的肿瘤生长模式和对治疗的反应，以及长期的神经和功能结局。
