Long-term Outcomes of Gamma Knife Radiosurgery for Treating Vestibular Schwannoma With a Lower Prescription Dose of 12 Gy Compared With Higher Dose Treatment
Long-term Outcomes of Gamma Knife Radiosurgery for Treating Vestibular Schwannoma With a Lower Prescription Dose of 12 Gy Compared With Higher Dose Treatment
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DOI：
10.1097/mao.0000000000002885
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发表时间：
2020-12-01
影响因子：
2.1
通讯作者：
Saito, Nobuhito
中科院分区：
文献类型：
--
作者：
Kawashima, Mariko;Hasegawa, Hirotaka;Saito, Nobuhito
目的：伽玛刀治疗前庭神经鞘瘤是目前治疗前庭神经鞘瘤的常用方法。GKRS并发症的风险在较低剂量下降低，但尚不清楚长期肿瘤控制是否受到剂量降低的负面影响。研究设计：这是一项回顾性病例审查和患者数据分析。设置：三级转诊中心。患者：1990年至2007年在作者所在机构接受GKRS的VS患者。干预措施：受试者根据接受的处方放射剂量分为两个队列：12戈伊队列（96例患者），随访期为124个月;>12戈伊队列（118例患者），随访期为143个月。主要观察指标：10 - 15年的肿瘤控制率，面神经和三叉神经并发症的频率，以及听力功能。结果：10 ~ 15年肿瘤控制率，12戈伊组为95%，> 12戈伊组为88%，但差异无统计学意义。与>12戈伊队列相比，12戈伊队列中面神经和三叉神经缺损的发生率显著降低，10年累积永久无缺损率分别为2%和0%。多变量分析显示，治疗剂量超过12戈伊与颅神经缺损的风险显著升高相关。平均12戈伊队列中保留纯音的受试者百分比为33%; p = 0.823）。结论：GKRS治疗VS的剂量减少至12戈伊可减少面神经和三叉神经并发症，而不会恶化肿瘤控制率。
Objective: Gamma knife radiosurgery (GKRS) is commonly used to treat vestibular schwannomas (VSs). The risk of complications from GKRS decreases at lower doses, but it is unknown if long-term tumor control is negatively affected by dose reduction. Study Design: This was a retrospective case review and analysis of patient data. Setting: Tertiary referral center. Patients: Patients with VSs who underwent GKRS between 1990 and 2007 at the authors' institution. Intervention(s): The subjects were divided into two cohorts based on the prescribed doses of radiation received: a 12 Gy cohort (96 patients) with a follow-up period of 124 months and a >12 Gy cohort (118 patients) with a follow-up period of 143 months. Main Outcome Measures: Tumor control rates at 10 to 15 years, frequency of facial and trigeminal nerve complications, and hearing function. Results: The 10 to 15-year tumor control rates were 95% in the 12 Gy cohort and 88% in the > 12 Gy cohort, but the differences were not significant. Compared with the >12 Gy cohort, facial and trigeminal nerve deficits occurred significantly less frequently in the 12 Gy cohort, with the 10-year cumulative, permanent deficit-free rates being 2% and 0%, respectively. Multivariate analyses revealed that treatment doses exceeding 12 Gy were associated with a significantly higher risk for cranial nerve deficits. The percentage of subjects retaining pure-tone average 12 Gy cohort, 33%; p = 0.823). Conclusions: Dose reduction to 12 Gy for GKRS to treat VSs decreased facial and trigeminal nerve complications without worsening tumor control rates.