Gamma Knife surgery for patients with jugular foramen schwannomas: a multiinstitutional retrospective study in Japan
Gamma Knife surgery for patients with jugular foramen schwannomas: a multiinstitutional retrospective study in Japan
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DOI：
10.3171/2015.8.jns151156
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发表时间：
2016-10-01
影响因子：
4.1
通讯作者：
Inoue, Akira
中科院分区：
文献类型：
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作者：
Hasegawa, Toshinori;Kato, Takenori;Inoue, Akira
目的 本研究旨在探讨立体定向放射外科治疗颈静脉孔神经鞘瘤 (JFSs) 患者的疗效和安全性。 方法 本研究对在日本 Leksell 伽玛刀协会 18 个医疗中心接受伽玛刀手术 (GKS) 的 117 例 JFS 患者进行多机构回顾性分析。患者的中位年龄为 53 岁。 56 名患者接受了 GKS 作为初始治疗，而 61 名患者之前接受过切除术。在 GKS 时，46 名患者（39%）出现声音嘶哑，45 名患者（38%）出现听力障碍，43 名患者（36%）出现吞咽障碍。 85 个肿瘤 (73%) 为实性肿瘤，32 个肿瘤 (27%) 具有囊性成分。中位肿瘤体积为 4.9 cm(3)，对肿瘤边缘施用的中位处方剂量为 12 Gy。 5 名患者接受分次 GKS 治疗，最大剂量和边际剂量分别为 42 Gy 和 21 Gy，采用 3 分次方案。 结果 中位随访期为 52 个月。最后的随访图像显示，62 名患者（53%）部分缓解，42 名患者（36%）肿瘤稳定，13 名患者（11%）肿瘤进展。精算3年和5年无进展生存率（PFS）分别为91%和89%。多变量分析显示，GKS前脑干水肿和哑铃形肿瘤显着影响PFS。在随访期间，20名患者（17%）出现了一定程度的症状恶化。其中 12 名患者 (10%) 的这种情况是短暂的，8 名患者 (7%) 的这种情况持续存在。持续恶化的原因是4名患者（3%）的肿瘤进展和4名患者（3%）的不良放射反应，其中2名患者听力恶化，1名患者吞咽障碍，以及1名听力恶化和舌下神经麻痹患者。然而，先前存在的声音嘶哑和吞咽障碍分别在 66% 和 63% 的患者中得到改善。 结论 GKS 对原发性 JFS 或残留 JFS 患者的肿瘤控制效果良好。尽管一些患者在治疗后出现了一定程度的症状恶化，但在最后一次随访时，整个系列中只有 3% 的患者出现了持续的放射不良反应。下颅神经缺陷是极其罕见的放射不良反应，三分之二的患者先前存在的声音嘶哑和吞咽障碍得到改善。这些结果表明，对于选定的 JFS 患者，GKS 是手术切除的安全合理的替代方案。
OBJECTIVE This study aimed to explore the efficacy and safety of stereotactic radiosurgery in patients with jugular foramen schwannomas (JFSs).METHODS This study was a multiinstitutional retrospective analysis of 117 patients with JFSs who were treated with Gamma Knife surgery (GKS) at 18 medical centers of the Japan Leksell Gamma Knife Society. The median age of the patients was 53 years. Fifty-six patients underwent GKS as their initial treatment, while 61 patients had previously undergone resection. At the time of GKS, 46 patients (39%) had hoarseness, 45 (38%) had hearing disturbances, and 43 (36%) had swallowing disturbances. Eighty-five tumors (73%) were solid, and 32 (27%) had cystic components. The median tumor volume was 4.9 cm(3), and the median prescription dose administered to the tumor margin was 12 Gy. Five patients were treated with fractionated GKS and maximum and marginal doses of 42 and 21 Gy, respectively, using a 3 -fraction schedule.RESULTS The median follow-up period was 52 months. The last follow-up images showed partial remission in 62 patients (53%), stable tumors in 42 patients (36%), and tumor progression in 13 patients (11%). The actuarial 3- and 5-year progression-free survival (PFS) rates were 91% and 89%, respectively. The multivariate analysis showed that pre-GKS brainstem edema and dumbbell-shaped tumors significantly affected PFS. During the follow-up period, 20 patients (17%) developed some degree of symptomatic deterioration. This condition was transient in 12 (10%) of these patients and persistent in 8 patients (7%). The cause of the persistent deterioration was tumor progression in 4 patients (3%) and adverse radiation effects in 4 patients (3%), including 2 patients with hearing deterioration, 1 patient with swallowing disturbance, and 1 patient with hearing deterioration and hypoglossal nerve palsy. However, the preexisting hoarseness and swallowing disturbances improved in 66% and 63% of the patients, respectively.CONCLUSIONS GKS resulted in good tumor control in patients with either primary or residual JFSs. Although some patients experienced some degree of symptomatic deterioration after treatment, persistent adverse radiation effects were seen in only 3% of the entire series at the last follow-up. Lower cranial nerve deficits were extremely rare adverse radiation effects, and preexisting hoarseness and swallowing disturbances improved in two-thirds of patients. These results indicated that GKS was a safe and reasonable alternative to surgical resection in selected patients with JFSs.