Golanov A V, Antipina N A, Kostjuchenko V V, Trunin Yu Yu, Krasnyansky S A, Kozlov A V, Usachev D Yu
Burdenko Neurosurgical Center, Moscow, Russia.
Moscow Center Gamma Knife, Moscow, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2021;85(5):48-54. doi: 10.17116/neiro202185051.
Stereotactic method and new irradiation techniques ensured radiosurgical treatment with high precision and conformity and significantly expanded the indications for stereotactic irradiation in neurosurgery.
Over 15-year period, 29 976 patients underwent irradiation in various modes of fractionation on linear accelerators and Gamma Knife system at the first national radiosurgery center.
Stereotactic radiotherapy and radiosurgery are followed by minimal number of complications and side reactions. At the same time, 5-year control of tumor growth for skull base meningioma was 96.8%, neuroma - 97%, glomus tumor - 94%, pituitary adenoma - 96-98%, craniopharyngioma - 95% in overall 10-year survival 86%, pilocytic astrocytoma - 97.5% in overall 5-year survival 99%. In intracranial metastases, median overall survival after radiosurgery was 10.1 months, 24- and 36-month overall survival - 25.9% and 19.2%, respectively. In patients with recurrent high-grade glioma, overall survival was 27.4 months. In case of metastatic spine lesions, control of tumor growth within 1 year was achieved in 90% of patients, pain relief - in more than 50% of cases. Obliteration of AVM and dural fistula was found in more than 80% of patients in years after treatment. Reduction or disappearance of pain was also observed in 80% of patients with trigeminal neuralgia.
Stereotactic irradiation is effective and safe in patients with various pathologies of the central nervous system and characterized by high socio-economic indicators. Our own data indicate more significant role of stereotactic irradiation in the treatment of neurosurgical patients and make it possible to revise the existing treatment standards.
立体定向方法和新的放射技术确保了放射外科治疗的高精度和适形性，并显著扩大了神经外科立体定向放射治疗的适应症。
在15年多的时间里，第一家国家放射外科中心的29976例患者接受了直线加速器和伽玛刀系统不同分割模式的放射治疗。
立体定向放射治疗和放射外科治疗后的并发症和副作用数量极少。同时，颅底脑膜瘤的肿瘤生长5年控制率为96.8%，神经瘤为97%，血管球瘤为94%，垂体腺瘤为96 - 98%，颅咽管瘤10年总生存率为86%时5年控制率为95%，毛细胞型星形细胞瘤5年总生存率为99%时控制率为97.5%。在颅内转移瘤中，放射外科治疗后的中位总生存期为10.1个月，24个月和36个月的总生存率分别为25.9%和19.2%。在复发性高级别胶质瘤患者中，总生存期为27.4个月。在脊柱转移瘤患者中，90%的患者在1年内实现了肿瘤生长控制，超过50%的病例疼痛缓解。治疗后数年，超过80%的患者动静脉畸形和硬脑膜瘘闭塞。三叉神经痛患者中也有80%观察到疼痛减轻或消失。
立体定向放射治疗对中枢神经系统各种病变患者有效且安全，并具有较高的社会经济指标。我们自己的数据表明立体定向放射治疗在神经外科患者治疗中发挥着更重要的作用，并使得修订现有治疗标准成为可能。
