Verma Onam, Mishra Sandeep, Tripathi Manjul, Sheehan Jason P
Gamma Knife Radiosurgery, Department of Neurosurgery, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
All-India Institute of Medical Sciences (AIIMS), New Delhi, India.
J Neurooncol. 2025 Mar;172(1):13-30. doi: 10.1007/s11060-024-04901-1. Epub 2025 Jan 17.
Even a gross total resection of a benign epidermoid tumor (ET) carries a high risk of recurrence. The management strategy mostly involves redo surgical excision but at a significant cost of morbidity and mortality. The role of adjuvant radiation therapies in this scenario is still undefined.
To evaluate the feasibility, safety, efficacy, and complication profile of radiosurgery as a standalone or adjuvant therapy for intracranial epidermoid in the published literature.
Following PRISMA guidelines, a comprehensive search of the databases PubMed, Embase, Scopus, and Web of Science in published English language was conducted. We included studies with radiosurgery for benign ET and in patients with malignant transformation of ET (MTET). All studies were evaluated for tumor characteristics, pattern of treatment, dosimetric profile, outcome, and complications. We included all studies with at least one outcome of interest i.e. local control (LC); progression-free survival (PFS); symptomatic toxicity; disease progression; retreatment; and overall survival (OS); and cause-specific mortality.
The search revealed 403 articles, of which 6 and 8 studies with patients of benign ET and MTET respectively were included. 25 (65.7%) patients received primary SRS. 27 patients presented with hyperactive cranial nerve syndromes; 77.7% gained complete improvement. The overall median age was 46.7 years (22-67) and the median tumor volume ranged from 0.38 to 6.2cc in benign ET. Volumetric reduction was seen in 6 cases; progression was seen in 2 cases while ET remained stable in the rest. Mean follow-up duration ranged from 33.7 to 60 months, and no recurrence was reported at the latest follow-up in any case of benign ET. 9.5% of patients suffered from transient cranial nerve deficits with no prolonged adverse radiation effect. OS in the MTET group was 6 to 60 months following GKRS with 50% of patients alive at the latest follow-up.
SRS may be a promising treatment option for a conventionally benign and radioresistant ET making a meaningful change in the natural history of the disease. It is a valuable adjuvant technique in patients with MTET.
即使对良性表皮样囊肿（ET）进行全切除，其复发风险仍然很高。治疗策略主要包括再次手术切除，但会带来较高的发病率和死亡率。在这种情况下，辅助放疗的作用仍不明确。
在已发表的文献中评估立体定向放射外科作为颅内表皮样囊肿的独立或辅助治疗的可行性、安全性、有效性和并发症情况。
按照PRISMA指南，对PubMed、Embase、Scopus和Web of Science数据库进行全面检索，检索发表的英文文献。我们纳入了对良性ET进行立体定向放射外科治疗以及表皮样囊肿恶变（MTET）患者的研究。对所有研究的肿瘤特征、治疗模式、剂量学特征、结果和并发症进行评估。我们纳入了至少有一项感兴趣的结果的所有研究，即局部控制（LC）；无进展生存期（PFS）；症状性毒性；疾病进展；再次治疗；总生存期（OS）；以及特定病因死亡率。
检索共发现403篇文章，其中分别纳入了6项针对良性ET患者和8项针对MTET患者的研究。25例（占65.7%）患者接受了初次立体定向放射外科治疗。27例患者出现颅神经功能亢进综合征；77.7%的患者完全改善。总体中位年龄为46.7岁（22 - 67岁），良性ET患者的中位肿瘤体积在0.38至6.2立方厘米之间。6例患者肿瘤体积缩小；2例患者病情进展，其余患者病情稳定。平均随访时间为33.7至60个月，在任何良性ET病例的最新随访中均未报告复发。9.5%的患者出现短暂性颅神经功能缺损，无长期不良放射效应。MTET组在伽玛刀放射外科治疗后的总生存期为6至60个月，最新随访时有50%的患者存活。
立体定向放射外科可能是治疗传统上良性且对放疗抵抗的ET的一种有前景的治疗选择，能对该疾病的自然病程产生有意义的改变。对于MTET患者，它是一种有价值的辅助技术。
