Clinical analysis of spinal stereotactic radiosurgery in the treatment of neurogenic tumors

作者：Shin Dong Won; Sohn Moon Jun^*; Kim Han Seong; Lee Dong Joon; Jeon Sang Ryong; Hwang Yoon Joon; Jho Eek Hoon

来源：Journal of Neurosurgery-Spine, 2015, 23(4): 429-437.

DOI：10.3171/2015.1.SPINE14910

• stereotactic spinal radiosurgery
• spinal neurogenic tumors
• malignant peripheral nerve sheath tumor
• neurofibromatosis
• immunohistochemical staining
• oncology

OBJECT In this study the authors sought to evaluate clinical outcomes after using stereotactic radiosurgery (SRS) to treat benign and malignant spinal neurogenic tumors.
METHODS The authors reviewed a total of 66 procedures of spinal SRS performed between 2001 and 2013 for 110 tumors in 58 patients with spinal neurogenic tumors, which included schwannomas, neurofibromas, and malignant peripheral nerve sheath tumors (MPNSTs). The cliriical and radiological findings were evaluated in patients with benign neurogenic tumors. For the 4 patients with MPNSTs, the authors reported overall survival and results of additional immunohistochemical staining to predict the survival difference among the patients.
RESULTS Of the 92 benign neurogenic tumors, 65 tumors that were serially followed up using MRI after SRS showed significant change in mean tumor volume, from a mean of 12.0 +/- 2.6 cm(3) pre-SRS to 10.8 +/- 2.5 cm(3) post-SRS = 0.027), over an average of 44 months. The local control rate of benign neurogenic tumors was 95.4%. The 34 patients who presented with clinical symptoms of pain showed a significant symptomatic improvement. The initial mean visual analog scale (VAS) score was 6.0 and decreased dramatically to 1.0 after SRS during an average follow-up period of 10.9 months (median of 8.1 months). Although the proportions of transient swelling and loss of intramural enhancement were significantly different among the groups, there was no statistically significant correlation between those 2 factors and local tumor control (p = 0.253 and 0.067, respectively; Fisher's exact text). Cross-table analysis also indicated that there was no statistically significant relationship between groups with loss of intramural enhancement and transient swelling. The median survival of neurofibromatosis Type 1 (NF1)-related and sporadic MPNSTs was 1.13 and 5.8 years, respectively. lmmunohistochemical results showed that S100 was expressed in a sporadic MPNST or neurofibroma,. whereas topoisomerase-Ila was expressed in NF1-related MPNSTs.
CONCLUSIONS SRS is an effective treatment modality for benign neurogenic tumors, while MPNSTs showed heterogeneity in their responses to SRS.

• 出版日期2015-10