Department of Surgery, Division of Neurosurgery, National University Hospital, Singapore, Singapore.
Department of Haematology-Oncology, National University Hospital, Singapore, Singapore.
Acta Neurochir (Wien). 2024 Feb 22;166(1):100. doi: 10.1007/s00701-024-05974-7.
Two-staged gamma knife surgery (GKS) is a method that may extend the upper tumor volume limit for using GKS in the management of brain metastases. However, the safety of treating very large posterior fossa lesions with this technique has not been well demonstrated. Therefore, we analyzed our experience in treating cerebellar metastases larger than 12 cm with two-staged GKS.
Four consecutive patients harboring 12 to 30 cm cerebellar metastases scheduled two-staged GKS were included in the study, and all but one patient completed the treatment. The treatment doses were 10-13 Gy. All patients were followed with regular MR imaging and clinical assessments, and the tumor volumes were measured on all treatment and follow-up images.
Tumor progression was not demonstrated in any of the patients. Tumor volumes decreased by, on average, more than half between the two stages. The median survival was 22 months, and no patient died due to intracranial tumor progression. Peritumoral edema at the first GKS resolved in all patients, replaced by asymptomatic mild T2 changes in two of them not requiring any treatment. No radiation-induced complication has developed thus far.
Staged GKS seems to be a feasible management option for very large cerebellar metastases.
两阶段伽玛刀手术（GKS）是一种可能扩大 GKS 治疗脑转移瘤的肿瘤体积上限的方法。然而，用这种技术治疗非常大的后颅窝病变的安全性尚未得到很好的证明。因此，我们分析了我们用两阶段 GKS 治疗直径大于 12cm 的小脑转移瘤的经验。
研究纳入了 4 例连续的、直径为 12 至 30cm 的小脑转移瘤患者，所有患者均接受了两阶段 GKS 治疗，除 1 例外，其余患者均完成了治疗。治疗剂量为 10-13Gy。所有患者均接受了定期的磁共振成像（MRI）和临床评估，并且在所有治疗和随访图像上测量了肿瘤体积。
所有患者均未出现肿瘤进展。肿瘤体积在两个阶段之间平均减少了一半以上。中位生存期为 22 个月，没有患者因颅内肿瘤进展而死亡。所有患者的第一次 GKS 后肿瘤周围水肿均得到缓解，其中 2 例无症状性轻度 T2 改变，无需任何治疗。迄今为止，没有发生与放射治疗相关的并发症。
分阶段 GKS 似乎是治疗非常大的小脑转移瘤的可行管理选择。
