Dynamics of tumor evolution after Gammaknife radiosurgery for sporadic vestibular schwannoma: defining volumetric patterns characterizing individual trajectory.

IF 19.3 1区 材料科学 Q1 CHEMISTRY, PHYSICAL ACS Energy Letters Pub Date : 2024-09-16 DOI:10.1093/neuonc/noae187
Anne Balossier, Madalina Olteanu, Christine Delsanti, Lucas Troude, Jean-Marc Thomassin, Pierre-Hugues Roche, Marie Chavent, Jean Régis
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Abstract

Background: Definition of tumor control and treatment failure after Gammaknife radiosurgery (GKRS) for vestibular schwannoma (VS) is still debated. The lack of knowledge on the dynamics of tumor evolution can lead to misinterpretation and subsequent inappropriate second treatment. The aim of this study was to evaluate the post-GKRS dynamics of evolution of tumor volume, and characterize volumetric patterns.

Methods: We included patients with sporadic VS treated by GKRS with an MRI follow-up of minimum 3 years. A clustering in 2 steps was performed: definition of the patterns of evolution based on a subset of patients with the most comprehensive follow-up, then assignment of the remaining patients on a best fit basis. The minimum length of follow-up was assessed by measuring the consistency of the clusters over time (Adjusted Rand Index and Normalized Mutual Information). An analysis of the discriminant variables was finally performed.

Results: 1,607 patients were included (median follow-up: 67 months). Five patterns were defined with one pattern gathering almost all cases of treatment failure. The clustering at 5 years afforded the highest consistency with long-term follow-up. Discriminant variables for clusters were: sex, initial symptoms, delay of diagnosis, Koos grading, fundus invasion, and number of isocenters.

Conclusions: The definition of these robust distinct patterns is likely to help tremendously the physicians to distinguish tumor control from potential failure. We advocate for no retreatment decision before 5 years post-GKRS. Further investigations are required to decide if the dynamics of evolution can be predicted at GKRS on an individual basis.

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伽玛刀放射外科治疗散发性前庭裂隙瘤后肿瘤演变的动力学:确定个体轨迹的体积模式。
背景:前庭分裂瘤(VS)伽玛刀放射外科手术(GKRS)后肿瘤控制和治疗失败的定义仍存在争议。由于缺乏对肿瘤演变动态的了解,可能会导致误解和不恰当的二次治疗。本研究旨在评估 GKRS 术后肿瘤体积的动态演变,并描述肿瘤体积模式:我们纳入了接受 GKRS 治疗、磁共振成像随访至少 3 年的散发性 VS 患者。我们分两步进行了聚类:根据随访最全面的患者子集定义演变模式,然后根据最佳拟合原则分配其余患者。通过测量聚类随时间变化的一致性(调整后的兰德指数和归一化互信息)来评估随访的最短时间。最后进行了判别变量分析:共纳入 1,607 名患者(中位随访时间:67 个月)。共确定了五种模式,其中一种模式聚集了几乎所有的治疗失败病例。5 年的分组与长期随访的一致性最高。聚类的判别变量包括:性别、初始症状、诊断延迟、Koos分级、眼底侵犯和等中心数量:这些强大的独特模式的定义可能会极大地帮助医生区分肿瘤控制和潜在的失败。我们主张在 GKRS 术后 5 年前不做再治疗决定。我们还需要进一步的研究,以确定是否可以根据个体情况预测 GKRS 的演变动态。
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来源期刊
ACS Energy Letters
ACS Energy Letters Energy-Renewable Energy, Sustainability and the Environment
CiteScore
31.20
自引率
5.00%
发文量
469
审稿时长
1 months
期刊介绍: ACS Energy Letters is a monthly journal that publishes papers reporting new scientific advances in energy research. The journal focuses on topics that are of interest to scientists working in the fundamental and applied sciences. Rapid publication is a central criterion for acceptance, and the journal is known for its quick publication times, with an average of 4-6 weeks from submission to web publication in As Soon As Publishable format. ACS Energy Letters is ranked as the number one journal in the Web of Science Electrochemistry category. It also ranks within the top 10 journals for Physical Chemistry, Energy & Fuels, and Nanoscience & Nanotechnology. The journal offers several types of articles, including Letters, Energy Express, Perspectives, Reviews, Editorials, Viewpoints and Energy Focus. Additionally, authors have the option to submit videos that summarize or support the information presented in a Perspective or Review article, which can be highlighted on the journal's website. ACS Energy Letters is abstracted and indexed in Chemical Abstracts Service/SciFinder, EBSCO-summon, PubMed, Web of Science, Scopus and Portico.
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