伽玛刀放射外科治疗脑膜瘤后肿瘤内坏死引起的假性进展和瘤周水肿。
Pseudoprogression and peritumoral edema due to intratumoral necrosis after Gamma knife radiosurgery for meningioma.
机构信息
Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
出版信息
Sci Rep. 2022 Aug 11;12(1):13663. doi: 10.1038/s41598-022-17813-9.
Peritumoral cerebral edema is reported to be a side effect that can occur after stereotactic radiosurgery. We aimed to determine whether intratumoral necrosis (ITN) is a risk factor for peritumoral edema (PTE) when gamma knife radiosurgery (GKRS) is performed in patients with meningioma. In addition, we propose the concept of pseudoprogression: a temporary volume expansion that can occur after GKRS in the natural course of meningioma with ITN. This retrospective study included 127 patients who underwent GKRS for convexity meningioma between January 2019 and December 2020. Risk factors for PTE and ITN were investigated using logistic regression analysis. Analysis of variance was used to determine whether changes in tumor volume were statistically significant. After GKRS, ITN was observed in 34 (26.8%) patients, and PTE was observed in 10 (7.9%) patients. When postoperative ITN occurred after GKRS, the incidence of postoperative PTE was 18.970-fold (p = 0.009) greater. When a 70% dose volume ≥ 1 cc was used, the possibility of ITN was 5.892-fold (p < 0.001) higher. On average, meningiomas with ITN increased in volume by 128.5% at 6 months after GKRS and then decreased to 94.6% at 12 months. When performing GKRS in meningioma, a 70% dose volume ≥ 1 cc is a risk factor for ITN. At 6 months after GKRS, meningiomas with ITN may experience a transient volume expansion and PTE, which are characteristics of pseudoprogression. These characteristics typically improve at 12 months following GKRS.
瘤周水肿被报道为立体定向放射外科后可能出现的一种副作用。我们旨在确定当对脑膜瘤患者进行伽玛刀放射外科治疗（GKRS）时，瘤内坏死（ITN）是否是瘤周水肿（PTE）的危险因素。此外，我们提出了假性进展的概念：在具有 ITN 的脑膜瘤的自然病程中，GKRS 后可能会出现暂时的体积膨胀。这项回顾性研究纳入了 127 例 2019 年 1 月至 2020 年 12 月期间接受 GKRS 治疗的凸面脑膜瘤患者。使用逻辑回归分析调查 PTE 和 ITN 的危险因素。方差分析用于确定肿瘤体积的变化是否具有统计学意义。在 GKRS 后，观察到 34 例（26.8%）患者出现 ITN，10 例（7.9%）患者出现 PTE。当 GKRS 后发生术后 ITN 时，术后 PTE 的发生率增加了 18.970 倍（p=0.009）。当使用 70%剂量体积≥1cc 时，出现 ITN 的可能性增加了 5.892 倍（p<0.001）。平均而言，在 GKRS 后 6 个月，具有 ITN 的脑膜瘤体积增加了 128.5%，然后在 12 个月时减少到 94.6%。在对脑膜瘤进行 GKRS 时，70%剂量体积≥1cc 是 ITN 的危险因素。在 GKRS 后 6 个月，具有 ITN 的脑膜瘤可能会经历短暂的体积膨胀和 PTE，这是假性进展的特征。这些特征通常在 GKRS 后 12 个月内改善。
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