Pialat Pierre-Marie, Fieux Maxime, Tringali Stéphane, Beldjoudi Guillaume, Pommier Pascal, Tanguy Ronan
Centre Léon Bérard, Radiotherapy, Lyon, France.
Department of Otolaryngology and Otoneurosurgery, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Lyon, France.
Adv Radiat Oncol. 2021 Mar 23;6(4):100694. doi: 10.1016/j.adro.2021.100694. eCollection 2021 Jul-Aug.
Our purpose was to study the outcomes of hypofractionated stereotactic radiation therapy (HSRT) in terms of hearing and radiologic response for vestibular schwannomas.
This was a longitudinal retrospective study at a referral center from 2011 to 2016. All treatments were performed on a Cyberknife device with a dose of 21 Gy (3 × 7 Gy) or 25 Gy (5 × 5 Gy). We assessed tumor response, neurologic outcomes (hearing and facial nerve function), and treatment toxicity.
A total of 82 patients were included. Fifty-three patients were treated with the 3 × 7 Gy scheme and 29 with the 5 × 5 Gy. Sixteen patients (20%) had a previous surgery. The median follow-up was 48 months (range, 12-88 months). We noted 3 recurrences leading to a control rate of 96.3%. In our cohort, predictive factors of vestibular schwannoma growth were a tumor volume >2 mm and a conformal index <1.1 ( < .0001). The treatment was well tolerated with only 5 grade III acute toxicities (4 vertigo and 1 headache) and no grade IV or V. As for late toxicity, we noticed 2 cases of mild peripheral facial palsy (House and Brackman grade II) in previously operated patients. There was 46.0% hearing preservation among patients with serviceable hearing after HSRT.
Our results suggest that HSRT using 3 or 5 fractions is a well-tolerated and effective regimen. These findings are in addition to the few previous hypofractionation studies and contribute to the validity of this treatment modality.
我们的目的是研究大分割立体定向放射治疗（HSRT）在前庭神经鞘瘤的听力和放射学反应方面的疗效。
这是一项2011年至2016年在一家转诊中心进行的纵向回顾性研究。所有治疗均在射波刀设备上进行，剂量为21 Gy（3×7 Gy）或25 Gy（5×5 Gy）。我们评估了肿瘤反应、神经学结果（听力和面神经功能）以及治疗毒性。
共纳入82例患者。53例患者采用3×7 Gy方案治疗，29例采用5×5 Gy方案治疗。16例患者（20%）曾接受过手术。中位随访时间为48个月（范围12 - 88个月）。我们注意到3例复发，控制率为96.3%。在我们的队列中，前庭神经鞘瘤生长的预测因素是肿瘤体积>2 mm和适形指数<1.1（P <.0001）。治疗耐受性良好，仅出现5例III级急性毒性反应（4例眩晕和1例头痛），无IV级或V级反应。至于晚期毒性，我们在既往接受过手术的患者中注意到2例轻度周围性面瘫（House和Brackman II级）。HSRT后仍有实用听力的患者中听力保留率为46.0%。
我们的结果表明，采用3或5次分割的HSRT是一种耐受性良好且有效的治疗方案。这些发现是对既往少数大分割研究的补充，有助于验证这种治疗方式的有效性。
