Radiation and Oncology Unit, Department of Radiology, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand.
Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Asia Pac J Clin Oncol. 2022 Oct;18(5):e247-e254. doi: 10.1111/ajco.13592. Epub 2021 Jul 26.
The study aimed to evaluate the long-term clinical outcomes of patients with vestibular schwannoma (VS) treated with stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (HSRT) with frameless robotic whole-body radiosurgery system (CyberKnife ).
This retrospective analysis of prospectively collected data included 123 consecutive patients with VS treated at the Radiosurgery center, Ramathibodi Hospital, Bangkok, Thailand. SRS was recommended for patients with unserviceable hearing and Koos grade I-III tumors, and HSRT for patients with serviceable hearing or Koos grade III-IV tumors. Between March 2009 and December 2015, 23 patients (19%) were treated with SRS, whereas 100 (81%) received HSRT. The commonly used regimen was 12 Gy in one fraction for SRS and 18 Gy in three fractions for HSRT.
After a median follow-up of 72 months (range: 12-123 months), the 5-year and 8-year progression-free survival (PFS) rates for the whole cohort were 96% and 92%, respectively. The PFS was not significantly different between the SRS and HSRT groups (p = 0.23). Among 28 patients with serviceable hearing in the HSRT group, the 5-year and 8-year hearing preservation rates were 87% and 65%, respectively. The rate of nonauditory complications was 14%. Koos grade III/IV was a predictor of disease progression and was associated with nonauditory complications.
SRS and HSRT with the CyberKnife system provided excellent long-term tumor control with a low rate of nonauditory complications. HSRT may result in acceptable hearing preservation rates.
本研究旨在评估采用无框架机器人全身放射外科系统（CyberKnife）行立体定向放射外科（SRS）和分次立体定向放射治疗（HSRT）治疗前庭神经鞘瘤（VS）患者的长期临床结果。
本研究回顾性分析了泰国曼谷 Ramathibodi 医院放射外科中心连续收治的 123 例 VS 患者的前瞻性收集数据。对于听力不佳且 Koos 分级为 I-III 级的患者推荐行 SRS，对于听力可保留或 Koos 分级为 III-IV 级的患者推荐行 HSRT。2009 年 3 月至 2015 年 12 月，23 例（19%）患者接受 SRS 治疗，100 例（81%）患者接受 HSRT 治疗。常用方案为 SRS 单次 12Gy 和 HSRT 分 3 次 18Gy。
中位随访时间为 72 个月（范围：12-123 个月），全组患者的 5 年和 8 年无进展生存率（PFS）分别为 96%和 92%。SRS 和 HSRT 两组患者的 PFS 无显著差异（p=0.23）。在 HSRT 组中 28 例听力可保留的患者中，5 年和 8 年的听力保留率分别为 87%和 65%。非听觉并发症发生率为 14%。Koos 分级 III/IV 是疾病进展的预测因素，与非听觉并发症相关。
CyberKnife 系统行 SRS 和 HSRT 可获得极好的长期肿瘤控制效果，且非听觉并发症发生率较低。HSRT 可能获得可接受的听力保留率。
