Temporal Dynamics of Pseudoprogression After Gamma Knife Radiosurgery for Vestibular Schwannomas-A Retrospective Volumetric Study
Temporal Dynamics of Pseudoprogression After Gamma Knife Radiosurgery for Vestibular Schwannomas-A Retrospective Volumetric Study
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DOI：
10.1093/neuros/nyy019
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发表时间：
2019-01-01
期刊：
影响因子：
4.8
通讯作者：
Theodosopoulos, Philip V.
中科院分区：
文献类型：
--
作者：
Breshears, Jonathan D.;Chang, Joseph;Theodosopoulos, Philip V.
背景：散发性前庭神经鞘瘤放疗后的最佳观察间隔未知。目的：通过分析一系列的体积数据，确定鉴别假性进展和真实肿瘤生长的最佳放射外科治疗间隔。方法：这项单一机构的回顾性研究包括2002-2014年间所有接受伽玛刀放射外科治疗的散发性前庭神经鞘瘤(Eketa AB，瑞典斯德哥尔摩；12-13Gy)。对所有可用的治疗前和治疗后磁共振成像扫描进行体积分析。结果：共118例患者治疗后肿瘤体积中位数为0.74 cm(3)(四分位数范围[IQR]=0.34-1.77 cm(3))，中位随访期为4.1年(IQR=2.6-6.0年)。44%的患者观察到一过性肿瘤扩大，开始于治疗后1年的中位数(IQR=0.6-1.4年)，90%的患者在治疗后3.5年内达到峰值体积。体积扩大消失的时间中位数为2.4年(IQR 1.9-3.6年)，90%的病例在6.9年内消失。越来越多的随访显示，许多肿瘤在立体定向放射手术后1~3年开始增大，随着时间的延长，最终开始缩小(45%到4年，77%到6年)。结论：治疗后3.5年以内的肿瘤扩大不应作为抢救治疗的唯一标准。必须考虑患者的症状和肿瘤的大小，在选择挽救治疗之前给肿瘤一个消退的机会可能是值得的。
BACKGROUND: The optimal observation interval after the radiosurgical treatment of a sporadic vestibular schwannoma, prior to salvage intervention, is unknown.OBJECTIVE: To determine an optimal postradiosurgical treatment interval for differentiating between pseudoprogression and true tumor growth by analyzing serial volumetric data.METHODS: This single-institution retrospective study included all sporadic vestibular schwannomas treated with Gamma Knife radiosurgery (Eketa AB, Stockholm, Sweden; 12-13 Gy) from 2002 to 2014. Volumetric analysis was performed on all available pre- and posttreatment magnetic resonance imaging scans. Tumors were classified as "stable/decreasing," "transient enlargement", or "persistent growth" after treatment, based on incrementally increasing follow-up durations.RESULTS: A total of 118 patients included in the study had a median treatment tumor volume of 0.74 cm(3) (interquartile range [IQR] = 0.34-1.77 cm(3)) and a median follow-up of 4.1 yr (IQR = 2.6-6.0 yr). Transient tumor enlargement was observed in 44% of patients, beginning at a median of 1 yr (IQR = 0.6-1.4 yr) posttreatment, with 90% reaching peak volume within 3.5 yr, posttreatment. Volumetric enlargement resolved at a median of 2.4 yr (IQR 1.9-3.6 yr), with 90% of cases resolved at 6.9 yr. Increasing follow-up revealed that many of the tumors initially enlarging 1 to 3 yr after stereotactic radiosurgery ultimately begin to shrink on longer follow-up (45% by 4 yr, 77% by 6 yr).CONCLUSION: Tumor enlargement within similar to 3.5 yr of treatment should not be used as a sole criterion for salvage treatment. Patient symptoms and tumor size must be considered, and giving tumors a chance to regress before opting for salvage treatment may be worthwhile.