伽玛刀治疗151例涉窦脑膜瘤的长期随访研究

Long-term follow-up study of gamma knife radiosurgery in the treatment of 151 patients with meningiomas involving the major dural sinuses

目的评价伽玛刀治疗涉窦脑膜瘤(MIMDS)的远期疗效。方法回顾性分析华中科技大学同济医学院附属协和医院神经外科2006年1月至2016年12月行伽玛刀治疗的151例MIMDS患者的临床资料。151例患者中, 原发性中、小型MIMDS 100例, 术后残余MIMDS 51例;病变直径均<5 cm。脑膜瘤主要位于海绵窦(50.3%, 76/151), 其次为矢状窦(29.8%, 45/151), 其余部位包括窦汇区(8.6%, 13/151)、乙状窦(6.0%, 9/151)、横窦(5.3%, 8/151)。151例患者行伽玛刀治疗前肿瘤的中位体积为3.2 cm3(0.1~48.9 cm3), 伽玛刀治疗的中位边缘剂量为14.5 Gy(5~42 Gy), 中位等剂量曲线为50%(33%~70%)。治疗后行临床和影像学随访, 评估治疗后并发症和肿瘤复发情况。采用Kaplan-Meier生存分析法确定患者的无进展生存率(PFS)。通过单因素和多因素Cox回归分析方法探讨影响MIMDS患者伽玛刀治疗后复发的相关因素。结果所有患者均获随访, 随访时间为(70.9±33.6)个月(36~172个月)。151例MIMDS患者中, 9例(6.0%)治疗后出现并发症, 其中视力下降3例(2.0%)、放射性脑水肿3例(2.0%)、脑积水2例(1.3%)、眼球突出伴溃疡1例(0.7%)。151例患者行伽玛刀治疗后的总体5年、10年PFS分别为87.6%和78.8%。Log-rank结果表明, <60岁患者的PFS明显高于≥60岁患者, 术后行伽玛刀治疗患者的PFS总体高于单纯行伽玛刀治疗的患者(均P<0.05)。随访期间肿瘤复发22例(14.6%)。多因素Cox分析结果表明, 年龄(P=0.028)和治疗方式(P=0.032)为MIMDS患者肿瘤复发的独立影响因素。结论伽玛刀是针对中、小型MIMDS及MIMDS术后残余肿瘤的一种有效的治疗方法, 可长期控制肿瘤的生长, 且治疗后并发症少。

Objective To evaluate the long-term outcomes of gamma knife radiosurgery(GKRS)for meningiomas involving the major dural sinuses(MIMDS).Methods A retrospective analysis was conducted on the clinical data of 151 patients with MIMDS who underwent gamma knife treatment from January 2006 to December 2016 at the Department of Neurosurgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology.Among the 151 patients,100 cases were primary medium and small MIMDS,and 51 cases were residual MIMDS after operation;the diameter of the lesions was less than 5 cm.Meningiomas were mainly located in the cavernous sinus(50.3%,76/151),followed by the sagittal sinus(29.8%,45/151),the confluence area(8.6%,13/151),the sigmoid sinus(6.0%,9/151)and transverse sinus(5.3%,8/151).The median tumor volume before gamma knife treatment in 151 patients was 3.2 cm^(3)(0.1-48.9 cm^(3)),the median marginal dose of gamma knife treatment was 14.5 Gy(5-42 Gy),and the median isodose curve was 50%(33%-70%).Clinical and imaging follow-ups were performed after treatment to evaluate post-treatment complications and tumor recurrence.The Kaplan-Meier survival analysis method was used to determine the progression-free survival(PFS).Through univariate and multivariate Cox regression analysis methods,we explored the related factors affecting PFS in MIMDS patients.Results All patients were follow edup for70.9±33.6months(36-172 months).Among 151 patients with MIMDS,9 cases(6.0%)developed complications after treatment,including 3 cases of vision impairment(2.0%),3 cases(2.0%)of radiation-induced cerebral edema,2 cases(1.3%)of hydrocephalus,and 1 case(0.7%)of exophthalmos combined wth ulcer.The overall 5-year and 10-year PFS of 151 patients after GKRS were 87.6%and 78.8%,respectively.Log-rank results showed that the PFS of<60 years old patients was significantly higher than that of patients≥60 years old,and the PFS of patients who underwent GKRS after surgeiy was generally higher than that of patients who underwent GKRS alone(both P<0.05).During the follow-up period,the tumor recurred in 22 cases(14.6%).The results of multivariate Cox analysis showed that age(P=0.028)and treatment method(P=0.032)were prognostic factors for tumor recurrence in MIMDS patients.Conclusions Gamma knife is a safe and ejffective treatment method for small and medium-sized MIMDS and postoperative residual MIMDS.It can control tumor growth for a long time and has few complications after treatment.