PDF(Pubmed)
Abstract：
BACKGROUND: Paragangliomas (PG) are rare neoplasms of neuroendocrine origin that tend to be highly vascularized, slow-growing, and usually sporadic. To date, common treatment options are surgical resection (SR), with or without radiation therapy (RT), and a watch-and-wait approach.
OBJECTIVE: To evaluate the local control and effectiveness of exclusive fractionated stereotactic RT (FSRT) treatment in unresectable PG (uPG).
METHODS: We retrospectively evaluated patients with uPG (medically inoperable or refused SR) treated with FSRT with a Cyberknife System (Accuray Incorporated, Sunnyvale, California). Toxicity and initial efficacy were evaluated.
RESULTS: From May 2009 to January 2023, 6 patients with a median age of 68 (range 20-84) were treated with FSRT. The median delivered dose was 21 Gy (range 20-30 Gy) at a median isodose line of 75.5% (range 70%-76%) in 4 fractions (range 3-5 fractions). The median volume was 13.6 mL (range 12.4-65.24 mL). The median cumulative biological effective dose and equivalent dose in 2-Gy fractions were 70 Gy and 37.10 Gy respectively. Site of origin involved were the timpa-nojugular glomus (4/6), temporal bone, and cervical spine. In 1 of the 6 patients, the follow-up was insufficient; 5 of 6 patients showed a 5-year overall survival and 5-year progression-free survival of 100%. We observed negligible toxicities during and after RT. The majority of patients showed stable symptoms during follow-up. Only 1 patient developed spine metastases.
CONCLUSIONS: Our preliminary results on this small cohort of patients suggest that FSRT could be an effective and safe alternative to SR.
OBJECTIVE: To evaluate the local control and effectiveness of exclusive fractionated stereotactic RT (FSRT) treatment in unresectable PG (uPG).
METHODS: We retrospectively evaluated patients with uPG (medically inoperable or refused SR) treated with FSRT with a Cyberknife System (Accuray Incorporated, Sunnyvale, California). Toxicity and initial efficacy were evaluated.
RESULTS: From May 2009 to January 2023, 6 patients with a median age of 68 (range 20-84) were treated with FSRT. The median delivered dose was 21 Gy (range 20-30 Gy) at a median isodose line of 75.5% (range 70%-76%) in 4 fractions (range 3-5 fractions). The median volume was 13.6 mL (range 12.4-65.24 mL). The median cumulative biological effective dose and equivalent dose in 2-Gy fractions were 70 Gy and 37.10 Gy respectively. Site of origin involved were the timpa-nojugular glomus (4/6), temporal bone, and cervical spine. In 1 of the 6 patients, the follow-up was insufficient; 5 of 6 patients showed a 5-year overall survival and 5-year progression-free survival of 100%. We observed negligible toxicities during and after RT. The majority of patients showed stable symptoms during follow-up. Only 1 patient developed spine metastases.
CONCLUSIONS: Our preliminary results on this small cohort of patients suggest that FSRT could be an effective and safe alternative to SR.
摘要：
背景：副神经节瘤（PG）是神经内分泌起源的罕见肿瘤，倾向于高度血管化，生长缓慢,通常是零星的。迄今为止,常见的治疗选择是手术切除(SR)，有或没有放射治疗（RT），和观望的方法。
目的：评估不可切除的PG（uPG）的独家分割立体定向RT（FSRT）治疗的局部控制和有效性。
方法：我们回顾性评估了使用Cyberknife系统（AccurayIncorporated，桑尼维尔,California).评估毒性和初始疗效。
结果：从2009年5月到2023年1月，对6名中位年龄为68岁（范围20-84）的患者进行了FSRT治疗。在4个部分(范围3-5个部分)的75.5%(范围70%-76%)的中值等剂量线处的中值递送剂量为21Gy(范围20-30Gy)。中位体积为13.6mL(范围12.4-65.24mL)。2-Gy部分的中位累积生物有效剂量和等效剂量分别为70Gy和37.10Gy。涉及的起源部位是蒂颈-颈静脉球球（4/6），颞骨,和颈椎。在6名患者中，有1名随访时间不足;6例患者中有5例的5年总生存率和5年无进展生存率为100%.我们观察到RT期间和之后的毒性可以忽略不计。大多数患者在随访期间表现出稳定的症状。仅1例患者出现脊柱转移。
结论：我们对这一小群患者的初步结果表明，FSRT可能是SR的有效和安全的替代方案。
目的：评估不可切除的PG（uPG）的独家分割立体定向RT（FSRT）治疗的局部控制和有效性。
方法：我们回顾性评估了使用Cyberknife系统（AccurayIncorporated，桑尼维尔,California).评估毒性和初始疗效。
结果：从2009年5月到2023年1月，对6名中位年龄为68岁（范围20-84）的患者进行了FSRT治疗。在4个部分(范围3-5个部分)的75.5%(范围70%-76%)的中值等剂量线处的中值递送剂量为21Gy(范围20-30Gy)。中位体积为13.6mL(范围12.4-65.24mL)。2-Gy部分的中位累积生物有效剂量和等效剂量分别为70Gy和37.10Gy。涉及的起源部位是蒂颈-颈静脉球球（4/6），颞骨,和颈椎。在6名患者中，有1名随访时间不足;6例患者中有5例的5年总生存率和5年无进展生存率为100%.我们观察到RT期间和之后的毒性可以忽略不计。大多数患者在随访期间表现出稳定的症状。仅1例患者出现脊柱转移。
结论：我们对这一小群患者的初步结果表明，FSRT可能是SR的有效和安全的替代方案。
