背景:最近,立体定向放射外科(SRS)已成为颈静脉孔神经鞘瘤(JFS)的替代治疗选择。虽然大多数报道的研究集中在SRS的长期疗效和安全性问题上,没有描述早发性不良事件(eAE)。我们的目的是调查发病率,临床特征,以及JFSSRS后六个月内发生的eAE的中期结果。
方法:在这篇回顾性综述中,在2008年7月至2019年11月期间在我们机构进行SRS的所有JFS患者中纳入了至少6个月随访的患者.eAE被定义为SRS后的前六个月内新出现的神经功能缺损或先前存在的症状加重。
结果:46例患者纳入分析。中位随访期为50个月(范围9-136)。总体肿瘤控制率为91.3%,精算3-,5-,10年无进展生存率为97.8%,93.8%,76.9%,分别。46名患者中,16有eAE,eAE的中位发病时间为1个月(范围1-6个月),主要症状是下颅神经功能障碍。16例患者中有13例在随访期间表现出改善的eAE症状,中位消退时间为6个月(范围1-52).在16例eAE患者中的11例(68.8%)中,在eAE发作后平均3.6个月观察到一过性扩张,在有eAE的患者中,初始肿瘤体积和瞬时扩张体积之间的平均差更为明显(3.2cm3与1.0cm3;p=0.057)。在单变量分析中,哑铃形肿瘤(OR10.56;p=0.004)和初始肿瘤体积(OR1.32;p=0.033)与eAE的发生显著相关.
结论:尽管JFSSRS后的急性不良事件并不罕见,这些急性效应不是永久性的,大部分通过类固醇治疗得到改善.Dumbell形和大体积肿瘤是eAE发生的重要预测因素。瞬时膨胀似乎也与eAE密切相关。因此,临床医师在治疗这些患者时需要更加谨慎,并密切监测eAE的发生.
BACKGROUND: Recently, stereotacitc radiosurgery (SRS) has been in the spotlight as an alternative therapeutic option for jugular foramen schwannomas (JFS). While most reported studies focus on the long-term efficacy and safety issues of SRS, none describe the early-onset adverse events (eAEs). We aimed to investigate the incidence, clinical characteristics, and mid-term outcomes of eAEs occurring within six months after SRS for JFS.
METHODS: In this retrospective
review, patients who underwent at least six months of follow-up were included among all patients with JFS who have performed SRS at our institution between July 2008 and November 2019. And eAEs were defined as a newly developed neurological deficit or aggravation of pre-existing symptoms during the first six months after SRS.
RESULTS: Forty-six patients were included in the analysis. The median follow-up period was 50 months (range 9-136). The overall tumor control rate was 91.3%, and the actuarial 3-, 5-, and 10-year progression-free survival rates were 97.8%, 93.8%, and 76.9%, respectively. Of the 46 patients, 16 had eAEs, and the median time to onset of eAEs was one month (range 1-6 months), and the predominant symptoms were lower cranial nerve dysfunctions. Thirteen of 16 patients showed improved eAE symptoms during the follow-up period, and the median resolution time was six months (range 1-52). In 11 (68.8%) of 16 patients with eAEs, transient expansions were observed with a mean of 3.6 months after the onset of eAEs, and the mean difference between the initial tumor volume and the transient expansion volume was more prominent in the patients with eAEs (3.2 cm3 vs. 1.0 cm3; p = 0.057). In univariate analysis, dumbbell-shaped tumors (OR 10.56; p = 0.004) and initial tumor volume (OR 1.32; p = 0.033) were significantly associated with the occurrence of eAEs.
CONCLUSIONS: Although acute adverse events after SRS for JFS are not rare, these acute effects were not permanent and mostly improved with the steroid treatment. Dumbell-shaped and large-volume tumors are significant predictive factors for the occurrence of eAEs. And the transient expansion also seems to be closely related to eAEs. Therefore, clinicians need to be more cautious when treating these patients and closely monitor the occurrence of eAEs.