Stereotactic Radiosurgery of Cranial Nonvestibular Schwannomas: Results of Single- and Multisession Radiosurgery

被引:25
作者
Choi, Clara Y. H. [1 ]
Soltys, Scott G. [2 ]
Gibbs, Iris C. [2 ]
Harsh, Griffith R. [1 ]
Sakamoto, Gordon T. [1 ]
Patel, Deep A. [2 ]
Lieberson, Robert E. [1 ]
Chang, Steven D. [1 ]
Adler, John R. [1 ]
机构
[1] Stanford Univ, Med Ctr, Dept Neurosurg, Stanford, CA 94305 USA
[2] Stanford Univ, Med Ctr, Dept Radiat Oncol, Stanford, CA 94305 USA
关键词
CyberKnife; Multisession; Nonvestibular schwannoma; Radiation; Stereotactic radiosurgery; JUGULAR FORAMEN SCHWANNOMAS; LINEAR-QUADRATIC MODEL; GAMMA-KNIFE SURGERY; UNIFIED SURVIVAL-CURVE; LONG-TERM OUTCOMES; OF-THE-LITERATURE; TRIGEMINAL-SCHWANNOMAS; VESTIBULAR SCHWANNOMAS; NONACOUSTIC SCHWANNOMAS; SURGICAL-MANAGEMENT;
D O I
10.1227/NEU.0b013e31820c0474
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: Surgical resection of nonvestibular cranial schwannomas carries a considerable risk of postoperative complications. Stereotactic radiosurgery (SRS) offers a non-invasive treatment alternative. The efficacy and safety of multi-session SRS of nonvestibular cranial schwannomas has not been well studied. OBJECTIVE: To analyze the results of single- and multi-session SRS of nonvestibular cranial schwannomas. METHODS: From 2001 to 2007, 42 lesions in 40 patients were treated with SRS at Stanford University Medical Center, targeting schwannomas of cranial nerves IV (n = 1), V (n = 18), VII (n = 6), X (n = 5), XII (n = 2), jugular foramen (n = 8), and cavernous sinus (n = 2). SRS was delivered to a median marginal dose of 18 Gy (range, 15-33 Gy) in 1 to 3 sessions, targeting a median tumor volume of 3.2 cm(3) (range, 0.1-23.7 cm 3). The median doses for treatments in 1 (n = 18), 2 (n = 9), and 3 (n = 15) sessions were 17.5, 20, and 18 Gy, respectively. RESULTS: With a median follow-up of 29 months (range, 6-84 months), tumor control was achieved in 41 of the 42 lesions. Eighteen of 42 lesions (43%) decreased in size; 23 tumors (55%) remained stable. There were 2 cases of new or worsening cranial nerve deficits in patients treated in single session; no patient treated with multi-session SRS experienced any cranial nerve toxicity (P = 0.18). CONCLUSION: SRS of nonvestibular cranial schwannomas provides excellent tumor control with minimal risk of complications. There was a trend towards decreased complications with multi-session SRS.
引用
收藏
页码:1200 / 1208
页数:9
相关论文
共 60 条
[1]  
Adler JR, 2008, NEUROSURGERY, V62, P733, DOI [10.1227/01.neu.0000316277.14748.63, 10.1227/01.NEU.0000223512.09115.3E]
[2]   Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function [J].
Al-Mefty, O ;
Ayoubi, S ;
Gaber, E .
JOURNAL OF NEUROSURGERY, 2002, 96 (03) :453-463
[3]   Some implications of linear-quadratic-linear radiation dose-response with regard to hypofractionation [J].
Astrahan, Melvin .
MEDICAL PHYSICS, 2008, 35 (09) :4161-4172
[4]  
Astrahan M, 2008, INT J RADIAT ONCOL, V71, P963, DOI 10.1016/j.ijrobp.2008.02.050
[5]   The linear-quadratic model is an appropriate methodology for determining isoeffective doses at large doses per fraction [J].
Brenner, David J. .
SEMINARS IN RADIATION ONCOLOGY, 2008, 18 (04) :234-239
[6]   Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system [J].
Bulsara, Ketan R. ;
Sameshima, Tetsuro ;
Friedman, Allan H. ;
Fukushima, Takanori .
JOURNAL OF NEUROSURGERY, 2008, 109 (05) :794-803
[7]   Stereotactic radiotherapy for vestibular schwannomas: Favorable outcome with minimal toxicity [J].
Chan, AW ;
Black, PM ;
Ojemann, RG ;
Barker, FG ;
Kooy, HM ;
Lopes, VV ;
McKenna, MJ ;
Shrieve, DC ;
Martuza, RL ;
Loeffler, JS .
NEUROSURGERY, 2005, 57 (01) :60-69
[8]   Staged stereotactic irradiation for acoustic neuroma [J].
Chang, SD ;
Gibbs, IC ;
Sakamoto, GT ;
Lee, E ;
Oyelese, A ;
Adler, JR .
NEUROSURGERY, 2005, 56 (06) :1254-1261
[9]   Long-term follow-up of acoustic schwannoma radiosurgery with marginal tumor doses of 12 to 13 Gy [J].
Chopra, Rahul ;
Kondziolka, Douglas ;
Niranjan, Ajay ;
Lunsford, L. Dade ;
Flickinger, John C. .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2007, 68 (03) :845-851
[10]   Management of acoustic neuromas with fractionated stereotactic radiotherapy (FSRT): Long-term results in 106 patients treated in a single institution [J].
Combs, SE ;
Volk, S ;
Schulz-Ertner, D ;
Huber, PE ;
Thilmann, C ;
Debus, J .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2005, 63 (01) :75-81