Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC.
Department of Neurosurgery, Chang Gung Memorial Hospital at Keelung, Chang Gung University, Keelung, Taiwan, ROC.
J Clin Neurosci. 2020 Nov;81:409-415. doi: 10.1016/j.jocn.2020.09.058. Epub 2020 Oct 24.
Application of radiosurgery to the newly diagnosed or post-operative residual perioptic lesions has been proved to improve tumor control. However, risk of vision injury induced by radiosurgery may increase substantially if the radiation dose is too high or tumor is close to the optic apparatus. The purpose of this study was to evaluate the safety and the effectiveness of fractionated stereotactic radiosurgery (FSRS) for perioptic tumors. We retrospectively analyzed 60 consecutive patients with 53 meningiomas and 7 schwannomas treated with FSRS between October 2007 and February 2020. We administered a marginal dose of 6-7 Gy (mean 6.8 Gy) per fraction and delivered 3 fractions in 3 consecutive days. The median tumor volume was 6.31 cm (range 0.3-58.23 cm). The mean minimum lesion-optic distance (MLOD) is 0.85 mm (range 0-3 mm). After mean follow-up period of 69.6 months (range 6.82-156.32 months; median 58.9 months), the tumor control rates at 1, 3, 5, 8 and 13 years were 98.3%, 93.4%, 90.60%, 88.4% and 88.4%, respectively. Four out of the 60 tumors (6.7%) experienced a transient volume increase after FSRS. None of the patients developed visual impairment related to radiation induced optic neuropathy (RION) after FSRS. In conclusion, FSRS offers an alternative treatment option in treating perioptic meningiomas and schwannomas with acceptable tumor control rates and good visual preservation in the present study.
立体定向分次放射外科治疗新诊断或术后残留眶周病变已被证实可提高肿瘤控制率。然而，如果辐射剂量过高或肿瘤靠近视觉器官，放射外科引起视力损伤的风险会大大增加。本研究旨在评估分次立体定向放射外科（FSRS）治疗眶周肿瘤的安全性和有效性。我们回顾性分析了 2007 年 10 月至 2020 年 2 月间接受 FSRS 治疗的 60 例连续患者，其中 53 例为脑膜瘤，7 例为神经鞘瘤。我们给予 6-7Gy（平均 6.8Gy）的边缘剂量，分 3 次连续 3 天给予。肿瘤体积中位数为 6.31cm（范围 0.3-58.23cm）。平均最小病变-视神经距离（MLOD）为 0.85mm（范围 0-3mm）。平均随访 69.6 个月（范围 6.82-156.32 个月；中位数 58.9 个月）后，肿瘤控制率在 1、3、5、8 和 13 年分别为 98.3%、93.4%、90.60%、88.4%和 88.4%。60 个肿瘤中有 4 个（6.7%）在 FSRS 后经历了短暂的体积增加。FSRS 后无患者发生与放射性视神经病变（RION）相关的视力损害。总之，在本研究中，FSRS 为治疗眶周脑膜瘤和神经鞘瘤提供了一种可选择的治疗方案，具有可接受的肿瘤控制率和良好的视力保留。
