Akkus Yildirim Berna, Beduk Esen Caglayan Selenge, Pekgoz Omer Faruk, Unver Bengisu, Berber Tanju, Gurdal Necla, Uysal Emre
Cemil Tascioglu City Hospital, Department of Radiation Oncology, Istanbul, Turkey.
Clin Transl Oncol. 2024 Dec 16. doi: 10.1007/s12094-024-03790-0.
To evaluate the effect of fractionation and prognostic factors on local control (LC) in the treatment of vestibular schwannoma (VS).
The medical records of 104 patients with vestibular schwannoma who were treated with stereotactic radiosurgery (SRS) from January 2015 to September 2023 were retrospectively collected. SRS was performed using Cyberknife robotic lineer accelerator. The primary endpoint of this study was LC rates. The chi-square test or Fischer's exact test, where appropriate, was used to compare progression rates in patients with small (< 20 cc) and large tumors (≥ 20 cc) which were treated in different fractionation schemes.
The median total prescribed dose was 18 Gy (range, 12-30 Gy). With a median 54.8 month follow-up period (range, 3.4-111.9 month), 12 (12%) patients had progressive disease. Regression in tumor size, and stable disease was observed in 49 (47%) and 43 (41%) patients, respectively. The 3-y LC rate was 89% in all cohort and similar between patients who received SRS in 1, 3, and 5 fractions (p = 0.074). LC rates were slightly lower in patients with large tumors than those with small tumors (83% vs 94%, p = 0.200). Patients with large tumors (≥ 20 cc) which was treated with SRS in 1 fraction had a higher rate of progression compared to patients with small tumors (< 20 cc) (100% vs 0%, p = 0.006). But there was no difference between progression rates in large and small tumors, which were treated in 3, and 5 fractions (p = 0.100 and p = 1.000, respectively). No prognostic factors were found to predict tumor progression.
Both SRS and fractionated stereotactic radiotherapy (FSRT) provides high LC in patients with VS, however, FSRT may be preferred for large tumors due to higher LC rates compared to single fraction SRS.
评估分割放疗及预后因素对前庭神经鞘瘤（VS）治疗中局部控制（LC）的影响。
回顾性收集2015年1月至2023年9月期间接受立体定向放射外科治疗（SRS）的104例前庭神经鞘瘤患者的病历。使用射波刀机器人直线加速器进行SRS。本研究的主要终点是LC率。采用卡方检验或费舍尔精确检验（适当时）比较接受不同分割方案治疗的小肿瘤（<20 cc）和大肿瘤（≥20 cc）患者的进展率。
总处方剂量中位数为18 Gy（范围12 - 30 Gy）。中位随访期为54.8个月（范围3.4 - 111.9个月），12例（12%）患者出现疾病进展。分别有49例（47%）和43例（41%）患者肿瘤大小缩小及病情稳定。所有队列的3年LC率为89%，接受1次、3次和5次分割SRS治疗的患者之间相似（p = 0.074）。大肿瘤患者的LC率略低于小肿瘤患者（83%对94%，p = 0.200）。与小肿瘤（<20 cc）患者相比，接受1次分割SRS治疗的大肿瘤（≥20 cc）患者进展率更高（100%对0%，p = 0.006）。但接受3次和5次分割治疗的大、小肿瘤患者进展率之间无差异（分别为p = 0.100和p = 1.000）。未发现预测肿瘤进展的预后因素。
SRS和分割立体定向放射治疗（FSRT）均可为VS患者提供较高的LC，但由于与单次分割SRS相比LC率更高，FSRT可能更适用于大肿瘤。
