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轨道洞膜血管瘤的低分离与单次射线手术:系统性审查,元分析和机构病例系列
Victor Goulenko1, Sarthak Sinha2, Venkatesh Shankar Madhugiri1
1Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA; Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
对于轨道洞膜血管瘤 (OCH) 的玛刀放射手术 (GKRS) 显示单次治疗与低分泌治疗的结果相似. 这两种方法都是有效和安全的,低分离可能有利于临床关键结构附近的特定患者.
科学领域:
- 神经外科
- 辐射瘤学
- 眼科 眼科
背景情况:
- 轨道腔瘤 (OCH) 是一种罕见的良性血管瘤,由于它们靠近重要视觉结构,因此具有治疗挑战.
- 手术切除是标准的治疗方法,但Gamma Knife放射性手术 (GKRS) 提供了一个微创的替代方法.
- 对于OCH,最佳的GKRS分离策略 (单次 vs. 低分离) 仍未确定.
研究的目的:
- 系统地审查和对OCH单次治疗和低分泌GKRS的临床和放射性结果进行元分析.
- 将两种GKRS分成方法之间的瘤体积减少和视觉症状改善进行比较.
- 用临床背景的机构病例系列来补充发现.
主要方法:
- 在PROSPERO注册 (注册代码:1061256).
- 从开始到2025年4月对OCH的GKRS进行的数据库搜索.
- 分析比较了瘤体积的减少 (比例和百分比) 和视觉症状的改善;评估了偏差风险和出版偏差.
主要成果:
- 分析了11项研究 (117名患者) 以及3个机构病例.
- 在100%的低分量病例和89%的单次治疗病例中观察到瘤体积的减少 (p=0. 0853).
- 视觉症状改善发生在80%的低分量病例和69%的单次治疗病例中 (p=0. 4763),平均体积减少率相似.
结论:
- 单一疗程和低分量的GKRS对OCH有效和安全,产生类似的临床结果.
- 低分化可能对视神经附近的OCH有好处,但在本次审查中没有统计学意义.
- 需要进行更多的前性多中心研究,以确定OCH的最佳GKRS分离策略.
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