Purpose

Clival metastatic cancer is rare and has limited literature to guide management. We describe management of clival metastasis with Gamma Knife radiosurgery (GKRS). We augment our findings with a systematic review of all forms of radiation therapy for clival metastasis.

Methods

Records of 14 patients with clival metastasis who underwent GKRS at the University of Pittsburgh Medical Center from 2002 to 2023 were reviewed. Treatment parameters and clinical outcomes were assessed. A systematic review was conducted using evidence-based guidelines.

Results

The average age was 61 years with male predominance (n = 10) and average follow-up of 12.4 months. The most common primary cancers were prostate (n = 3) and lung (n = 3). The average time from cancer diagnosis to clival metastasis was 34 months. The most common presenting symptoms were headache (n = 9) and diplopia (n = 7). Five patients presented with abducens nerve palsies, and two presented with oculomotor nerve palsies. The median tumor volume was 9.3 cc, and the median margin dose was 15 Gy. Eleven patients achieved tumor control after one procedure, and three with progression obtained tumor control after repeat GKRS. One patient recovered abducens nerve function. The median survival from cancer diagnosis and GKRS were 49.7 and 15.3 months, respectively. The cause of death was progression of systemic cancer in six patients, clival metastasis in one, and unknown in four. The systematic review included 31 studies with heterogeneous descriptions of treatment and outcomes.

Conclusion

Clival metastasis is rare and associated with poor prognosis. GKRS is a safe, effective treatment for clival metastasis.

中文翻译：

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伽玛刀放射外科治疗斜坡转移：病例系列和系统评价

目的

斜坡转移癌很少见，指导治疗的文献有限。我们描述了用伽玛刀放射外科（GKRS）治疗斜坡转移的方法。我们通过对所有形式的斜坡转移放射治疗进行系统评价来增强我们的发现。

方法

回顾了 2002 年至 2023 年在匹兹堡大学医学中心接受 GKRS 的 14 名斜坡转移患者的记录。评估治疗参数和临床结果。使用基于证据的指南进行了系统审查。

结果

平均年龄为 61 岁，男性占主导地位 (n = 10)，平均随访时间为 12.4 个月。最常见的原发性癌症是前列腺癌 (n = 3) 和肺癌 (n = 3)。从癌症诊断到斜坡转移的平均时间为34个月。最常见的症状是头痛 (n = 9) 和复视 (n = 7)。五名患者出现外展神经麻痹，两名患者出现动眼神经麻痹。中位肿瘤体积为 9.3 cc，中位边缘剂量为 15 Gy。 11 名患者在一次手术后实现了肿瘤控制，3 名病情进展的患者在重复 GKRS 后获得了肿瘤控制。一名患者恢复了外展神经功能。癌症诊断和 GKRS 的中位生存期分别为 49.7 个月和 15.3 个月。六名患者的死亡原因是全身癌症进展，一名患者是斜坡转移，四名患者死亡原因不明。系统评价包括 31 项研究，这些研究对治疗和结果的描述各异。

结论

斜坡转移很少见，且预后不良。 GKRS 是一种安全、有效的治疗斜坡转移的方法。