Chia‑Hui Chewa†, Jin‑Cherng Chenb†, Shih‑Kai Hunga, c, Tsung‑Hsien Wub, Moon‑Sing Leea, c, Wen‑Yen Chioua, c, Liang‑Cheng Chena, c, Hon‑Yi Lina, c, d*
aDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, bDepartment of Neurosurgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, cSchool of Medicine, Tzu Chi University, Hualien, Taiwan, dInstitute of Molecular Biology, National Chung Cheng University, Chiayi, Taiwan
†Both authors contributed equally to this work.
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
Abstract
Objectives: Accelerator‑based stereotactic radiosurgery (SRS) is a noninvasive and effective treatment modality widely used for benign brain tumors. This study aims to report 20‑year treatment outcomes in our institute. Materials and Methods: From May 2001 to December 2020, 127 patients treated with LINAC‑based single‑fraction SRS for their benign brain lesions were included. A neurosurgeon and two radiation oncologists retrospectively reviewed all data. Computed tomography (CT) simulation was performed after head‑frame fixation under local anesthesia. All planning CT images were co‑registered and fused with gadolinium‑enhanced magnetic resonance imaging taken within 3 months for lesions targeting and critical organs delineation. The marginal dose was prescribed at 60%–90% isodose lines, respectively, to cover ≥95% planning target volume. Outcome evaluations included clinical tumor control rate (TCR), defined as the need for salvage therapy, and radiological response, defined as no enlargement of >2 cm in the maximal diameter. Overall survival (OS) and adverse reaction (defined according to CTCAE 5.0) were also analyzed. Results: The present study included 76 female and 51 male patients for analysis. The median age was 59 years (range, 20–88 years). Their diagnoses were vestibular schwannoma (VS, n = 54), nonvestibular cranial nerve schwannoma (n = 6), meningioma (n = 50), and pituitary adenoma (n = 17). Totally 136 lesions were treated in a single fraction, predominantly skull base tumors, accounting for 69.1%. Median and mean follow‑up duration was 49 and 61 months (range, 1–214 months), Overall TCR was 92.9%. The 5‑year disease‑specific TCR for VS, nonvestibular schwannoma, meningioma, and pituitary adenoma were 97.4%, 91.7%, 93.8%, and 83.3%. Salvage therapy was indicated for eight patients at 4–110 months after SRS. Among symptomatic patients, post‑SRS symptom(s) was improved, stable, and worse in 68.2%, 24.3%, and 3.6%, respectively. Radiological response rate for 111 evaluable patients was 94.6% (shrinkage, 28.8%; stable, 65.8%). OS was 96.1% without treatment‑related mortality. One patient with post‑SRS cranial nerve injury (0.8%, involving the trigeminal nerve, grade 2 toxicities). No grade 3–4 acute or late toxicity was found. Conclusion: Our results suggested that LINAC‑based SRS effectively controls tumor growth and tumor‑related neurological symptoms for patients with benign brain tumors. SRS is less aggressive, associated with low neurological morbidity and no mortality. Continuous follow‑up is indicated to conclude longer outcomes.
Keywords: Benign brain tumor, LINAC, Stereotactic radiosurgery, Tumor control rate
