Zhonghua yi xue za zhi · 2009
[Gamma knife for elderly patients with large vestibular schwannomas: 11-year follow-up].
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Wang En-Min, Pan Li, Wang Bin-Jiang, Zhang Nan, Dong Ya-Fei, Dai Jia-Zhong, Cai Pei-Wu
Аннотация
OBJECTIVE: To evaluate the effect of Leksell Gamma Knife (LGK) on elderly patients with large vestibular schwannomas (VS) and to summarize the indications for LGK in patients with large VS.
METHODS: From July 1994 to July 2000, 50 elderly patients (age range: 60.0 - 81.0 years) with large VS were treated by LGK as primary treatment modality. The maximal tumor diameter ranged from 31.0 to 61.0 mm [mean, (36.0 +/- 6.1) mm] and mean tumor volume was (14.8 +/- 8.0) cm(3) (range, 7.5 - 54.0 cm(3)). The maximal dose irradiated to tumor ranged from 22.0 to 28.0 Gy [mean: (25.0 +/- 1.6) Gy] and the mean tumor marginal dose was (12.3 +/- 0.9) Gy (range, 9.5 - 14.0 Gy). The mean follow-up duration was (86 +/- 12) months (range: 68 - 138 months).
RESULTS: Of the 50 patients with follow-up data, 4 were deceased and 46 survived. Two patients with giant VS died at 6 and 9 months post-LGK respectively because of tumor swelling. Another two patients died of stroke or heart attack at 3 years and 4 years after LGK respectively, but their tumors decreased in volume. Clinical response: hearing: 14 (28%) patients preserved useful hearing as pre-LGK; 32 patients had unchanged or deteriorated hearing. Facial palsy: two patients developed mild facial palsy at 4 and 8 months respectively, one of them recovered and another improved later. Seven patients developed hydrocephalus around 6 months post-LGK and had V-P shunt. Eighteen patients had deteriorated facial numbness because of tumor swelling, 15 of them improved 3 years later. Tumor response: in 46 surviving patients, 43 tumors decreased markedly in size, 2 tumors remained stable in volume, 1 tumor progressed at five years and had second LGK. In this series tumor control rate was 94% (47/50).
CONCLUSION: LGK provides an effective treatment for some selected large VS (maximal diameter <or= 40 mm) in elderly patients, especially when the brain stem compression was not obvious and VS had non-enhanced area or small cysts within the tumor on contrast MRI.
METHODS: From July 1994 to July 2000, 50 elderly patients (age range: 60.0 - 81.0 years) with large VS were treated by LGK as primary treatment modality. The maximal tumor diameter ranged from 31.0 to 61.0 mm [mean, (36.0 +/- 6.1) mm] and mean tumor volume was (14.8 +/- 8.0) cm(3) (range, 7.5 - 54.0 cm(3)). The maximal dose irradiated to tumor ranged from 22.0 to 28.0 Gy [mean: (25.0 +/- 1.6) Gy] and the mean tumor marginal dose was (12.3 +/- 0.9) Gy (range, 9.5 - 14.0 Gy). The mean follow-up duration was (86 +/- 12) months (range: 68 - 138 months).
RESULTS: Of the 50 patients with follow-up data, 4 were deceased and 46 survived. Two patients with giant VS died at 6 and 9 months post-LGK respectively because of tumor swelling. Another two patients died of stroke or heart attack at 3 years and 4 years after LGK respectively, but their tumors decreased in volume. Clinical response: hearing: 14 (28%) patients preserved useful hearing as pre-LGK; 32 patients had unchanged or deteriorated hearing. Facial palsy: two patients developed mild facial palsy at 4 and 8 months respectively, one of them recovered and another improved later. Seven patients developed hydrocephalus around 6 months post-LGK and had V-P shunt. Eighteen patients had deteriorated facial numbness because of tumor swelling, 15 of them improved 3 years later. Tumor response: in 46 surviving patients, 43 tumors decreased markedly in size, 2 tumors remained stable in volume, 1 tumor progressed at five years and had second LGK. In this series tumor control rate was 94% (47/50).
CONCLUSION: LGK provides an effective treatment for some selected large VS (maximal diameter <or= 40 mm) in elderly patients, especially when the brain stem compression was not obvious and VS had non-enhanced area or small cysts within the tumor on contrast MRI.