Patrice S J, Sneed P K, Flickinger J C, Shrieve D C, Pollock B E, Alexander E, Larson D A, Kondziolka D S, Gutin P H, Wara W M, McDermott M W, Lunsford L D, Loeffler J S
Harvard Joint Center for Radiation Therapy, Brigham and Women's Hospital, Boston, MA, USA.
Int J Radiat Oncol Biol Phys. 1996 Jun 1;35(3):493-9. doi: 10.1016/s0360-3016(96)80011-3.
Between June 1988 and June 1994. 38 hemangioblastomas were treated with stereotactic radiosurgery (SR) at three SR centers to evaluate the efficacy and potential toxicity of this therapeutic modality as an adjuvant or alternative treatment to surgical resection.
SR was performed using either a 201-cobalt source unit or a dedicated SR linear accelerator. Of the 18 primary tumors treated, 16 had no prior history of surgical resection and were treated definitively with SR and two primary lesions were subtotally resected and subsequently treated with SR. Twenty lesions were treated with SR after prior surgical failure (17 tumors) or failure after prior surgery and conventional radiotherapy (three tumors). Eight patients were treated with SR for multifocal disease (total, 24 known tumors). SR tumor volumes measured 0.05 to 12 cc (median: 0.97 cc). Minimum tumor doses ranged from 12 to 20 Gy (median: 15.5 Gy).
Median follow-up from the time of SR was 24.5 months (range: 6-77 months). The 2-year actuarial over-all survival was 88 +/- 15% (95% confidence interval). Two-year actuarial freedom from progression was 86 +/- 12% (95% confidence interval). The median tumor volume of the lesions that failed to be controlled by SR was 7.85 cc (range: 3.20-10.53 cc) compared to 0.67 cc (range: 0.05-12 cc) for controlled lesions (p - 0.0023). The lesions that failed to be controlled by SR received a median minimum tumor dose of 14 Gy (range: 13-17 Gy) compared to 16 Gy (range: 12-20 Gy) for controlled lesions (p = 0.0239). Seventy-eight percent of the surviving patients remained neurologically stable or clinically improved. There were no significant permanent complications directly attributable to SR.
This report documents the largest experience in the literature of the use of SR in the treatment of hemangioblastoma. We conclude that SR: (a) controls the majority of primary and recurrent hemangioblastomas; (b) offers the ability to treat multiple lesions in a single treatment session, which is particularly important for patients with Von Hippel-Lindau Syndrome; and that (c) better control rates are associated with higher doses and smaller tumor volumes.
1988年6月至1994年6月期间，三个立体定向放射外科（SR）中心对38例血管母细胞瘤进行了SR治疗，以评估这种治疗方式作为手术切除辅助或替代治疗的疗效和潜在毒性。
使用201钴源装置或专用SR直线加速器进行SR治疗。在接受治疗的18例原发性肿瘤中，16例既往无手术切除史，接受了SR根治性治疗，2例原发性病变进行了次全切除，随后接受了SR治疗。20个病变在先前手术失败（17个肿瘤）或先前手术及传统放疗失败后（3个肿瘤）接受了SR治疗。8例患者因多灶性疾病接受了SR治疗（共24个已知肿瘤）。SR治疗的肿瘤体积为0.05至12立方厘米（中位数：0.97立方厘米）。最小肿瘤剂量范围为12至20 Gy（中位数：15.5 Gy）。
从SR治疗时起的中位随访时间为24.5个月（范围：6至77个月）。2年实际总生存率为88±15%（95%置信区间）。2年实际无进展生存率为86±12%（95%置信区间）。SR未能控制的病变的中位肿瘤体积为7.85立方厘米（范围：3.20至10.53立方厘米），而得到控制的病变为0.67立方厘米（范围：0.05至12立方厘米）（p = 0.0023）。SR未能控制的病变接受的中位最小肿瘤剂量为14 Gy（范围：13至17 Gy），而得到控制的病变为16 Gy（范围：12至20 Gy）（p = 0.0239）。78%的存活患者神经功能保持稳定或临床症状改善。没有直接归因于SR的明显永久性并发症。
本报告记录了文献中使用SR治疗血管母细胞瘤的最大规模经验。我们得出结论，SR：（a）可控制大多数原发性和复发性血管母细胞瘤；（b）能够在单次治疗中治疗多个病变，这对患有冯·希佩尔－林道综合征的患者尤为重要；并且（c）更高的控制率与更高的剂量和更小的肿瘤体积相关。
