Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic; Department of Neurosurgery and Neurooncology, Military University Hospital Prague, Czech Republic.
Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, Czech Republic.
J Clin Neurosci. 2022 Jun;100:196-203. doi: 10.1016/j.jocn.2022.04.031. Epub 2022 Apr 27.
Gamma Knife radiosurgery (GKR) can be a valuable treatment option for posterior cranial fossa meningiomas (PCFM). We retrospectively analyzed outcomes of GKR for PCFM.
Were included forty-six patients with 47 PCFM. Primary endpoint was tumor control. Secondary endpoint was clinical improvement. Biologically effective dose (BED) was evaluated in relationship to primary and secondary outcomes. Mean marginal dose was 12.4 Gy (median 12, 12-14). Mean BED was 63.6 Gy (median 65, 49.1-88.3). Mean target volume (TV) was 2.21 cc (range 0.3-8.9 cc).
Overall tumor control rate was 93.6% (44/47) after mean follow-up of 47.8 months ± 28.46 months (median 45.5, range 6-108). Radiological progression-free survival at 5 years was 94%. Higher pretherapeutic TVs were predictive for higher likelihood of tumor progression (Odds ratio, OR 1.448, 95% confidence interval - CI 1.001-2.093, p = 0.049). At last clinical follow-up, 28 patients (71.8%) remained stable, 10 (25.6%) improved and 1 patient (2.6%) worsened. Using logistic regression, the relationship between BED and clinical improvement was assessed (OR 0.903, standard error 0.59, coefficient 0.79-1.027, CI -0.10; 0.01; p = 0.14). The highest probability of clinical improvement corresponded to a range of BED values between 56 and 61 Gy.
Primary GKR for PCFM is safe and effective. Higher pretherapeutic TV was predictor of volumetric progression. Highest probability of clinical improvement might correspond to a range of BED values between 56 and 61 Gy, although this was not statistically significant. The importance of BED should be further validated in larger cohorts, other anatomical locations and other pathologies.
伽玛刀放射外科（GKR）可以成为后颅窝脑膜瘤（PCFM）的一种有价值的治疗选择。我们回顾性分析了 GKR 治疗 PCFM 的结果。
纳入了 46 例 47 个 PCFM 患者。主要终点是肿瘤控制。次要终点是临床改善。生物有效剂量（BED）与主要和次要结局进行了评估。平均边缘剂量为 12.4 Gy（中位数 12，12-14）。平均 BED 为 63.6 Gy（中位数 65，49.1-88.3）。平均靶体积（TV）为 2.21 cc（范围 0.3-8.9 cc）。
在平均随访 47.8±28.46 个月（中位数 45.5，范围 6-108）后，总体肿瘤控制率为 93.6%（44/47）。5 年时的影像学无进展生存率为 94%。较高的术前 TV 是肿瘤进展可能性较高的预测因素（优势比，OR 1.448，95%置信区间 - CI 1.001-2.093，p=0.049）。在最后一次临床随访时，28 例患者（71.8%）病情稳定，10 例（25.6%）改善，1 例（2.6%）恶化。使用逻辑回归评估了 BED 与临床改善之间的关系（OR 0.903，标准误差 0.59，系数 0.79-1.027，CI -0.10；0.01；p=0.14）。临床改善的最高概率对应于 BED 值在 56 至 61 Gy 之间的范围。
原发性 GKR 治疗 PCFM 安全有效。较高的术前 TV 是体积进展的预测因素。临床改善的最高概率可能对应于 BED 值在 56 至 61 Gy 之间的范围，但这没有统计学意义。BED 的重要性需要在更大的队列、其他解剖部位和其他病理中进一步验证。
