松果体细胞瘤立体定向放射外科治疗的长期疗效：一项国际多中心研究

Long-Term Outcomes of Stereotactic Radiosurgery for Pineocytomas: An International Multicenter Study.

作者信息

Hamel Andréanne, Tourigny Jean-Nicolas, Niranjan Ajay, Lunsford L Dade, Wei Zhishuo, Srinivasan Priyanka N, Liscak Roman, May Jaromir, Martínez Moreno Nuria, Martínez Álvarez Roberto, Lee Cheng-Chia, Yang Huai-Che, Tripathi Manjul, Kumar Narendra, Mashiach Elad, Kondziolka Douglas, Briggs Robert G, Yu Cheng, Zada Gabriel, Franzini Andrea, Pecchioli Guido, Bowden Gregory N, Dayawansa Samantha, Sheehan Jason, Mathieu David

机构信息

Service de neurochirurgie, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke , Québec , Canada.

Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA.

出版信息

Neurosurgery. 2024 Nov 7;97(1):174-181. doi: 10.1227/neu.0000000000003261.

DOI:10.1227/neu.0000000000003261

PMID:39508591

Abstract

BACKGROUND AND OBJECTIVES

Pineocytomas are grade 1 tumors arising from the pineal parenchyma. Gross total resection can potentially cure these benign lesions but can be associated with morbidity. This study was designed to provide multi-institutional data to evaluate the results of stereotactic radiosurgery (SRS) for pineocytomas.

METHODS

Centers participating in the International Radiosurgery Research Foundation were asked to review their database and provide data for patients who had SRS for histology confirmed grade 1 pineocytomas, for whom clinical and imaging follow-up of at least 6 months was available.

RESULTS

In total, 38 patients underwent SRS as part of the management of a pineocytoma. The median age at SRS was 39 years (range 8-76). SRS was performed as primary approach in 68%, adjuvant after partial resection 19%, and at recurrence in 13% of patients. The median margin dose was 15 Gy (range 11-25 Gy). The median treatment volume was 3.35 cc (range 0.1-17.9 cc). Local tumor control was achieved in 92% of patients, with a mean actuarial progression-free survival of 21.6 years (median not reached). At last follow-up, 82% were still controlled, 8% had local recurrence, and 10% had cerebrospinal fluid dissemination. Tumor control was significantly better when SRS was used as primary care compared with the adjuvant or recurrent setting ( P = .016). Five patients (13%) died during follow-up, all from tumor progression. The actuarial mean survival duration was 24.3 years, with a 5-year survival rate of 91%, and an estimated rate of 76% at 29 years. Larger tumor volume at SRS was found to be correlated to increased risk of death ( P = .045). Transient symptomatic adverse radiation effects were observed in 4 patients (11%).

CONCLUSION

SRS appears safe and effective for the management of pineocytomas. Long-term tumor control is achieved in most cases. SRS can be offered to selected patients as an alternative to surgical resection.

摘要

背景与目的

松果体细胞瘤是起源于松果体实质的1级肿瘤。全切除有可能治愈这些良性病变，但可能会导致并发症。本研究旨在提供多机构数据，以评估立体定向放射外科（SRS）治疗松果体细胞瘤的效果。

方法

要求参与国际放射外科研究基金会的中心查阅其数据库，并提供接受SRS治疗且组织学确诊为1级松果体细胞瘤患者的数据，这些患者有至少6个月的临床和影像学随访资料。

结果

共有38例患者接受SRS作为松果体细胞瘤治疗的一部分。接受SRS时的中位年龄为39岁（范围8 - 76岁）。68%的患者将SRS作为主要治疗方法，19%在部分切除后作为辅助治疗，13%在复发时接受SRS治疗。中位边缘剂量为15 Gy（范围11 - 25 Gy）。中位治疗体积为3.35 cc（范围0.1 - 17.9 cc）。92%的患者实现了局部肿瘤控制，平均无进展生存期为21.6年（未达到中位值）。在最后一次随访时，82%的患者仍处于肿瘤控制状态，8%出现局部复发，10%出现脑脊液播散。与辅助治疗或复发时相比，将SRS作为主要治疗时肿瘤控制明显更好（P = 0.016）。5例患者（13%）在随访期间死亡，均死于肿瘤进展。精算平均生存期为24.3年，5年生存率为91%，29年估计生存率为76%。发现接受SRS时肿瘤体积较大与死亡风险增加相关（P = 0.045）。4例患者（11%）出现短暂的有症状放射性不良反应。