Gawish A, Walke M, Röllich B, Ochel H-J, Brunner T B
Department of Radiation Oncology, University Hospital Magdeburg, Magdeburg, Sachsen-Anhalt, Germany.
Department of Radiation Oncology, University Hospital Magdeburg, Magdeburg, Sachsen-Anhalt, Germany; Department of Radiation Oncology, Medical University of Graz, Graz, Austria.
Clin Oncol (R Coll Radiol). 2023 Jan;35(1):e40-e47. doi: 10.1016/j.clon.2022.10.014. Epub 2022 Nov 2.
To retrospectively analyse the long-term results of hypofractionated stereotactic radiation therapy (HSRT) applied in five fractions for vestibular schwannomas.
One hundred and thirty-four patients with vestibular schwannomas underwent medical treatment of HSRT. The median follow-up time interval was 54 months (range 6-121 months). All patients had a prescribed dose of 22 Gy in five fractions to D90. Restaging was carried out by thin-slice contrast-enhanced T1 magnetic resonance imaging. Progression was defined as 2 mm post-treatment tumour enlargement. Progression or death for any reason was counted as an event in progression-free survival rates. Acute toxicity was defined as adverse events occurring within 3 months of HSRT; long-term toxicity was defined as such events occurring after 3 months.
In 74/128 patients who had >6 months of follow-up (54%), the HSRT resulted in a partial or a complete response. The mean time interval for response in 50% of these was 4 years, whereas in 49 patients (38%) vestibular schwannomas failed to show any response, resulting in stable disease. Five of 128 patients (4%) showed marked progressive vestibular schwannomas after treatment in the first 3 years; two of them received conventionally fractionated radiation therapy. Local control at 3, 5 and 7 years was 96%, 95% and 94%, respectively. Seven were lost to follow-up. The median planning target volume was 2.1 ml (range 0.78-8.66). The 3- and 5-year progression-free survival rates were 95% and 94%, respectively. Seven patients reported a marked deterioration in hearing ability. Post-radiation therapy magnetic resonance imaging showed variability in oedema collection, but no patient suffered from radio-necrosis. Grade 2 temporary facial nerve disorders were observed in 10 patients (8%) 3-6 months after HSRT.
Delivering HSRT in five fractions for vestibular schwannoma appears safe and efficient, combining both efficiency and short treatment time while optimising neurological function preservation.
回顾性分析五分割立体定向放疗（HSRT）治疗前庭神经鞘瘤的长期疗效。
134例前庭神经鞘瘤患者接受了HSRT治疗。中位随访时间间隔为54个月（范围6 - 121个月）。所有患者D90的处方剂量为22 Gy，分五次给予。通过薄层增强T1磁共振成像进行重新分期。进展定义为治疗后肿瘤增大2 mm。无进展生存率中，任何原因导致的进展或死亡均计为一个事件。急性毒性定义为HSRT后3个月内发生的不良事件；长期毒性定义为3个月后发生的此类事件。
在128例随访时间>6个月的患者中，74例（54%）HSRT治疗后出现部分或完全缓解。其中50%患者的平均缓解时间间隔为4年，而49例患者（38%）的前庭神经鞘瘤未显示任何缓解，病情稳定。128例患者中有5例（4%）在治疗后的前3年出现明显进展性前庭神经鞘瘤；其中2例接受了常规分割放疗治疗。3年、5年和7年的局部控制率分别为96%、95%和94%。7例失访。中位计划靶体积为2.1 ml（范围0.78 - 8.66）。3年和5年无进展生存率分别为95%和94%。7例患者报告听力能力明显下降。放疗后磁共振成像显示水肿情况各异，但无患者发生放射性坏死。10例患者（8%）在HSRT后3 - 6个月出现2级暂时性面神经障碍。
五分割HSRT治疗前庭神经鞘瘤似乎安全有效，兼具高效性和短治疗时间，同时优化了神经功能的保留。
