Frameless Fractionated Stereotactic Radiosurgery for Acoustic Neuromas: A Single-Institution Experience

以無框式分次立體定位放射手術治療聽神經瘤：單一機構之經驗

黃仲儀(Chung-I Huang) ； 林裕為(Yu-Wei Lin) ； 楊清傑(Ching-Chieh Yang) ； 林立青(Li-Ching Lin)

《放射治療與腫瘤學》 22卷2期 (2015/06) Pp. 103-111

https://doi.org/10.6316/TRO/201522(2)103

摘要

目的：評估聽神經瘤的病人接受無框式分次立體定位放射手術治療後的腫瘤控制率、聽力保存率、及副作用。材料與方法：回溯性分析從2009年到2012年期間，57位罹患聽神經瘤總共63處病灶，接受無框式分次立體定位放射手術治療的病例紀錄。總治療劑量各別為18 Gy至30 Gy，分成3次至5次療程。我們利用核磁共振顯影影像定期追蹤以評估腫瘤局部控制率，並利用Gardner-Robertson scale來追蹤聽力。此外亦於病患回診時由病患主觀判斷其聽力及其他症狀的變化。結果：經過中位值29.1個月的追蹤時間，二年及三年的局部控制率分別為94.8%及89.3%。其中13位病患於治療前保有有用聽力且治療後有定期接受聽力測驗，經過中位值30.8個月追蹤，其結果顯示治療後聽力保留率為88.2%。而57位病患中僅有6位於治療後發生3至4度的水腦症、腦水腫，及頭痛等副作用需接受藥物或手術處理。結論：與過去有關聽神經瘤接受手術、傳統立體放射線治療，或伽傌刀為基礎的立體放射手術治療的文獻比較，使用無框式分次立體定位放射手術治療聽神經瘤可以獲得良好的腫瘤局部控制率及聽力保留率，且治療相關的副作用發生率亦在可接受的範圍內。

關鍵字

聽神經瘤 ； 立體定位放射手術 ； 放射線治療

並列摘要

Objective: To evaluate tumor control, hearing preservation, and complication rates after frameless fractionated stereotactic radiosurgery (FSRS) in patients with acoustic neuromas (ANs). Methods: Fifty-seven patients with 63 ANs treated with FSRS at Chi-Mei Medical Center from 2009 to 2012 were retrospectively analyzed. The radiation dose ranged from 18 Gy to 30 Gy in 3 to 5 fractions. To evaluate local control rate, we arranged brain MRI with contrast enhancement at regular intervals. Hearing ability was also assessed using the Gardner-Robertson scale. Additionally, subjective change of hearing was rated at regular OPD follow-ups. Results: With a median follow-up of 29.1 months (range 3.6-54.1), actuarial local control rate was 94.8% after 2 years and 89.3% after 3 years. Of the 13 patients with serviceable hearing and with audiograms, the hearing preservation rate was 88.2% at a median follow-up of 30.8 months. Among the 57 treated patients, 6 developed complications including grade 3 to 4 hydrocephalus, perifocal edema, and headache that needed medical or surgical intervention after treatment. Conclusion: Frameless fractionated SRS treatment of AN demonstrates good results for tumor control, hearing preservation rate, and acceptable rates of radiation related toxicity as compared to literature on study series on surgery, conventional stereotactic radiotherapy, and Gamma-knife based stereotactic radiosurgery, yet longer follow-up will be needed.

並列關鍵字

Acoustic neuroma ； Stereotactic radiosurgery ； Radiotherapy