Grabb P A, Lunsford L D, Albright A L, Kondziolka D, Flickinger J C
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Neurosurgery. 1996 Apr;38(4):696-701; discussion 701-2.
We evaluated the role of stereotactic radiosurgery (SRS) in 25 children with surgically incurable brain tumors of glial origin. Histological diagnoses were obtained at the time of craniotomy and attempted removal (n = 20) or by stereotactic biopsy (n = 5). Thirteen children had tumors with benign histological characteristics (pilocytic and low-grade astrocytomas), whereas 12 children had tumors with malignant characteristic (malignant astrocytomas and ependymomas). Eleven (10 with malignant tumors) of the 25 children had received fractionated irradiation before SRS. Radiosurgical doses (range to margin, 11-20 Gy) were calculated on the basis of tumor volume and location, with consideration given to prior radiation dose. Follow-up for the 13 children with benign tumors ranged from 6 to 48 months (median, 21 mo). Eleven of the 13 children with "benign" glial neoplasms had tumor control with SRS alone (no evidence of tumor, n = 4; decreased tumor, n = 5; and unchanged tumor, n = 2), and all 13 remain alive. Five children with malignant tumors are alive at 12, 45, 50, 72, and 72 months after radiosurgery. The other seven children with malignant tumors are dead, with a median survival of 6 months after radiosurgery. Three of 12 children with malignant glial neoplasms had tumor control after SRS. Two of these three children received fractionated irradiation as an adjunct to SRS. Complications occurring in four children were transient, associated with peritumoral edema, and responsive to oral glucocorticoids. There was no relationship between tumor volume and local control after radiosurgery. Radiosurgery alone is a safe and effective treatment modality for unresectable benign gliomas of childhood. Radiosurgery may have a role in the adjuvant management of unresectable malignant glial neoplasms of childhood if other therapies (irradiation or chemotherapy) are available.
我们评估了立体定向放射外科手术（SRS）在25例手术无法治愈的儿童胶质源性脑肿瘤中的作用。在开颅手术和尝试切除时（n = 20）或通过立体定向活检（n = 5）获得组织学诊断。13例儿童的肿瘤具有良性组织学特征（毛细胞型和低级别星形细胞瘤），而12例儿童的肿瘤具有恶性特征（恶性星形细胞瘤和室管膜瘤）。25例儿童中有11例（10例患有恶性肿瘤）在接受SRS之前接受过分次照射。根据肿瘤体积和位置计算放射外科手术剂量（至边缘范围，11 - 20 Gy），并考虑先前的放射剂量。13例患有良性肿瘤的儿童的随访时间为6至48个月（中位数，21个月）。13例患有“良性”胶质肿瘤的儿童中有11例仅通过SRS实现了肿瘤控制（无肿瘤证据，n = 4；肿瘤缩小，n = 5；肿瘤无变化，n = 2），并且所有13例均存活。5例患有恶性肿瘤的儿童在放射外科手术后12、45、50、72和72个月时存活。其他7例患有恶性肿瘤的儿童死亡，放射外科手术后的中位生存期为6个月。12例患有恶性胶质肿瘤的儿童中有3例在SRS后实现了肿瘤控制。这3例儿童中有2例接受了分次照射作为SRS的辅助治疗。4例儿童出现的并发症是短暂的，与瘤周水肿相关，并且对口服糖皮质激素有反应。放射外科手术后肿瘤体积与局部控制之间没有关系。单独的放射外科手术是治疗儿童不可切除的良性胶质瘤的一种安全有效的治疗方式。如果有其他治疗方法（照射或化疗），放射外科手术可能在儿童不可切除的恶性胶质肿瘤的辅助治疗中发挥作用。
