FRACTIONATED STEREOTACTIC RADIOTHERAPY IN THE TREATMENT OF VESTIBULAR SCHWANNOMA (ACOUSTIC NEUROMA): PREDICTING THE RISK OF HYDROCEPHALUS
FRACTIONATED STEREOTACTIC RADIOTHERAPY IN THE TREATMENT OF VESTIBULAR SCHWANNOMA (ACOUSTIC NEUROMA): PREDICTING THE RISK OF HYDROCEPHALUS
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DOI：
10.1016/j.ijrobp.2010.04.019
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发表时间：
2011-07-15
影响因子：
7
通讯作者：
Brada, Michael
中科院分区：
文献类型：
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作者：
Powell, Ceri;Micallef, Caroline;Brada, Michael
目的：为了确定脑积水的发病率和预测因素与听神经瘤（AN）治疗与分割立体定向radiotherapy.Patients和方法：72例患者与AN进行了治疗与分割立体定向放射治疗1998年和2007年（45-50戈伊，25-30分数超过5至6周）。预处理MRI扫描评估肿瘤的特点和解剖结构的扭曲独立的后续outcome.Results的风险：在平均随访49个月（范围，1-120个月），5年无事件生存率为95%。8名患者（11%）在放疗后19个月内出现脑积水，并得到成功治疗。在单变量分析中，预测脑积水的治疗前因素为最大直径（p = 0.005）、接近中线（p = 0.009）、第四脑室移位（p = 0.02）、第四脑室部分消失（p < 0.001）、接触延髓（p = 0.005）和更多脑干结构（p = 0.004）。在多变量分析中，调整后的第四脑室消失，没有其他变量仍然独立相关脑积水formation.Conclusions：分割立体定向放射治疗的结果在良好的肿瘤控制AN，虽然有发展脑积水的风险。高风险患者，即治疗前肿瘤较大且第四脑室部分消失的患者，应在随访期间进行更密切的监测。在肿瘤直径显著超过2 cm之前，在第四脑室发生显著变形之前，在脑积水风险较低的情况下，对进行性AN患者进行治疗也是优选的。(C)2011 Elsevier Inc.
Purpose: To determine the incidence and predictive factors for the development of hydrocephalus in patients with acoustic neuromas (AN) treated with fractionated stereotactic radiotherapy.Patients and Methods: Seventy-two patients with AN were treated with fractionated stereotactic radiotherapy between 1998 and 2007 (45-50 Gy in 25-30 fractions over 5 to 6 weeks). The pretreatment MRI scan was assessed for tumor characteristics and anatomic distortion independently of subsequent outcome and correlated with the risk of hydrocephalus.Results: At a median follow-up of 49 months (range, 1-120 months), 5-year event-free survival was 95%. Eight patients (11%) developed hydrocephalus within :19 months of radiotherapy, which was successfully treated. On univariate analysis, pretreatment factors predictive of hydrocephalus were maximum diameter (p = 0.005), proximity to midline (p = 0.009), displacement of the fourth ventricle (p = 0.02), partial effacement of the fourth ventricle (p < 0.001), contact with the medulla (p = 0.005), and more brainstem structures (p = 0.004). On multivariate analysis, after adjusting for fourth ventricular effacement, no other variables remained independently associated with hydrocephalus formation.Conclusions: Fractionated stereotactic radiotherapy results in excellent tumor control of AN, albeit with a risk of developing hydrocephalus. Patients at high risk, identified as those with larger tumors with partial effacement of the fourth ventricle before treatment, should be monitored more closely during follow-up. It would also be preferable to offer treatment to patients with progressive AN while the risk of hydrocephalus is low, before the development of marked distortion of fourth ventricle before tumor diameter significantly exceeds 2 cm. (C) 2011 Elsevier Inc.