分期伽玛刀放射外科联合贝伐珠单抗治疗散发性前庭神经鞘瘤后的纵向肿瘤反应动态
Longitudinal tumor response dynamics after staged gamma knife radiosurgery combined with bevacizumab in sporadic vestibular schwannoma.
文献信息
| PMID | 42936495 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2027 |
| 作者 | Zeyu Peng |
| 作者单位 | Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. |
| 期刊 | Clinical and translational radiation oncology |
| SCI 分区 | Q1 |
| IF | 3.4 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 前庭神经鞘瘤（VS）是第八颅神经的良性肿瘤。尽管伽玛刀放射外科（GKRS）可实现持久的肿瘤控制，但延迟退缩和假性进展仍是临床挑战。分期GKRS联合贝伐珠单抗可能改变放射外科术后的肿瘤反应模式。
目的： 比较分期GKRS联合贝伐珠单抗与单次GKRS单独治疗散发性VS的纵向肿瘤反应、假性进展和临床结局。
方法： 我们回顾性审查了72例散发性VS患者：49例接受分期GKRS联合贝伐珠单抗治疗，23例接受单次GKRS单独治疗。使用多变量线性混合效应模型分析纵向肿瘤体积变化，同时使用Kaplan-Meier估计和Cox比例风险模型评估早期体积增大。
结果： 与单独GKRS相比，分期GKRS联合贝伐珠单抗显示出显著不同的反应轨迹（治疗-by-时间交互作用，P < 0.001），表现为更早且持续的退缩。在3至36个月观察到更大的肿瘤缩小（所有校正P < 0.05）。早期体积增大（>10%）分别发生于14.3%对60.9%的患者（HR，0.16；95% CI，0.06-0.40；P < 0.001）。假性进展分别发生于4.1%对17.4%的患者，无统计学显著性（P = 0.078）。囊性肿瘤成分与更大的退缩独立相关。BEV相关不良事件轻微且可控。
结论： 在散发性VS中，分期GKRS联合贝伐珠单抗与更早、更持续的肿瘤退缩以及较低的早期治疗后增大风险相关。较大的基线肿瘤体积和囊性成分与更大的退缩相关。假性进展在数值上较少见，尽管差异无统计学显著性。
试验注册： ChiCTR2600131856（中国临床试验注册中心）。
英文摘要
BACKGROUND: Vestibular schwannomas (VSs) are benign tumors of the eighth cranial nerve. Although Gamma Knife radiosurgery (GKRS) achieves durable tumor control, delayed regression and pseudoprogression remain clinical challenges. Staged GKRS combined with bevacizumab may alter post-radiosurgical tumor response patterns.
AIM: To compare longitudinal tumor response, pseudoprogression, and clinical outcomes between staged GKRS combined with bevacizumab and single-session GKRS alone in sporadic VSs.
METHODS: We retrospectively reviewed 72 patients with sporadic VSs: 49 treated with staged GKRS plus bevacizumab and 23 with single-session GKRS alone. Longitudinal tumor volume changes were analyzed using multivariable linear mixed-effects models, while early volumetric enlargement was evaluated using Kaplan-Meier estimates and Cox proportional hazards models.
RESULTS: Compared with GKRS alone, staged GKRS plus bevacizumab showed significantly different response trajectories (treatment-by-time interaction, P < 0.001), with earlier and sustained regression. Greater tumor reduction was observed from 3 to 36 months (all adjusted P < 0.05). Early volumetric enlargement (>10%) occurred in 14.3% versus 60.9% of patients (HR, 0.16; 95% CI, 0.06-0.40; P < 0.001). Pseudoprogression occurred in 4.1% versus 17.4% of patients, without statistical significance (P = 0.078). Cystic tumor composition was independently associated with greater regression. BEV-related adverse events were mild and manageable.
CONCLUSION: Staged GKRS combined with bevacizumab was associated with earlier, more sustained tumor regression and a lower risk of early post-treatment enlargement in sporadic VSs. Larger baseline tumor volume and cystic composition were associated with greater regression. Pseudoprogression was numerically less frequent, although the difference was not statistically significant.
TRIAL REGISTRATION: ChiCTR2600131856 (Chinese Clinical Trial Registry).