Taori Suchet, Adida Samuel, Kann Michael R, Bhatia Shovan, Sefcik Roberta K, Burton Steven A, Flickinger John C, Zinn Pascal O, Gerszten Peter C
School of Medicine, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA.
Department of Neurological Surgery, Medical University of South Carolina, Charleston , South Carolina , USA.
Neurosurgery. 2024 Oct 11. doi: 10.1227/neu.0000000000003219.
The role of radiosurgery in the treatment of benign intracranial tumors is well established. However, there are limited long-term follow-up studies on outcomes after stereotactic radiosurgery (SRS) for benign intradural spinal tumors. In this article, we report a large single-institution experience in using SRS to treat patients with benign intradural tumors of the spine.
Overall, 184 patients (55% female) and 207 benign intradural tumors were treated. The median patient age was 52 years (range: 19-93). Tumor histology included schwannoma (38%), meningioma (15%), neurofibroma (21%), hemangioma (9%), hemangioblastoma (8%), hemangiopericytoma (5%), and paraganglioma (4%). Thirty-four (16%) lesions underwent resection before radiosurgery. Twenty-three (11%) lesions were NF1-mutated. The median single-fraction margin dose was 14 Gy (range: 11-20), and the median multifraction margin dose was 21 Gy (range: 15-30).
The median follow-up was 63 months (range: 1-258). At last follow-up, tumors volumetrically regressed (15%), remained stable (77%), or locally progressed (8%, median: 20 months [range: 3-161]) after SRS. The 1-, 5-, and 10-year local control rates were 97%, 92%, and 90%, respectively. On multivariable analysis, the absence of the NF1 mutation ( P = .004, hazard ratio: 0.23, 95% CI: 0.08-0.63) and single-fraction SRS ( P = .007, hazard ratio: 0.24, 95% CI: 0.08-0.68) correlated with improved local control. The median overall survival was 251 months (range: 1-258), and 1-, 5-, and 10-year overall survival rates were 95%, 85%, and 70%, respectively. For patients with pre-existing symptoms, tumor-associated pain and neurological deficits were noted to improve or remain stable in 85% and 87% of cases, respectively. Adverse radiation effects included delayed myelopathy (1%), acute pain flare (9%), dermatitis (0.5%), dysphagia (0.5%), and dysphonia (0.5%).
With long-term follow-up, spine radiosurgery is a safe and effective treatment for benign intradural tumors. In carefully selected patients, even with an NF1 mutation, SRS is associated with a high likelihood of local tumor control.
放射外科在治疗颅内良性肿瘤中的作用已得到充分证实。然而，关于立体定向放射外科（SRS）治疗硬脊膜内良性脊柱肿瘤后的长期随访研究有限。在本文中，我们报告了在一家单一机构使用SRS治疗脊柱硬脊膜内良性肿瘤患者的大量经验。
总共治疗了184例患者（55%为女性）和207个硬脊膜内良性肿瘤。患者中位年龄为52岁（范围：19 - 93岁）。肿瘤组织学类型包括神经鞘瘤（38%）、脑膜瘤（15%）、神经纤维瘤（21%）、血管瘤（9%）、血管母细胞瘤（8%）、血管外皮细胞瘤（5%）和副神经节瘤（4%）。34个（16%）病灶在放射外科治疗前接受了切除术。23个（11%）病灶存在NF1突变。单次分割边缘剂量中位数为14 Gy（范围：11 - 20），多次分割边缘剂量中位数为21 Gy（范围：15 - 30）。
中位随访时间为63个月（范围：1 - 258个月）。在最后一次随访时，放射外科治疗后肿瘤体积缩小（15%）、保持稳定（77%）或局部进展（8%，中位时间：20个月[范围：3 - 161个月]）。1年、5年和10年的局部控制率分别为97%、92%和90%。多变量分析显示，不存在NF1突变（P = 0.004，风险比：0.23，95%置信区间：0.08 - 0.63）和单次分割SRS（P = 0.007，风险比：0.24，95%置信区间：0.08 - 0.68）与更好的局部控制相关。中位总生存期为251个月（范围：1 - 258个月），1年、5年和10年的总生存率分别为95%、85%和70%。对于已有症状的患者，肿瘤相关疼痛和神经功能缺损在85%和87%的病例中分别有所改善或保持稳定。放射不良反应包括迟发性脊髓病（1%）、急性疼痛发作（9%）、皮炎（0.5%）、吞咽困难（0.5%）和发音困难（0.5%）。
经过长期随访，脊柱放射外科是治疗硬脊膜内良性肿瘤的一种安全有效的方法。在精心挑选的患者中，即使存在NF1突变，SRS也有很高的局部肿瘤控制可能性。
