Integrating gamma knife radiosurgery into multimodal treatment of advanced juvenile nasopharyngeal angiofibroma.
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Juvenile nasopharyngeal angiofibroma (JNA) is a benign, highly vascular tumor affecting adolescent males. While early-stage disease is primarily managed surgically, advanced stages (Fisch III-IV) often require adjunctive therapy. Gamma Knife radiosurgery (GKRS) offers a targeted, minimally invasive option with low morbidity. This study assesses the efficacy and safety of GKRS in treating residual or unresectable intracranial JNA. A retrospective study involving 14 patients with histopathologically confirmed JNA was performed, treated with Gamma Knife Perfexion (mean marginal dose: 16.13 Gy, range: 12-25 Gy) between January 2011 and December 2019. Patients underwent clinical follow-up at six months, then annually with MRI for four years, and biennially thereafter. GKRS was used as primary therapy in 50% and as adjuvant post-surgical therapy in the remaining 50%. Of the 15 intracranial lesions treated, 60% were Fisch grade IVb, 33.3% grade IIIb, and 6.6% grade II. The mean pre-treatment tumor volume was 22.29 cm³. At the first follow-up (mean: 25 months), the average tumor volume had reduced by 52.2%, with no post-radiation imaging changes. At the last follow-up (mean: 53.4 months), the mean volume reduction reached 76.8%. Clinically, 11 patients improved, and 3 remained stable. No new complications were observed. None of the patients required repeat GKRS or any other form of salvage intervention. GKRS appears to be a safe and effective treatment for advanced or residual JNA, providing precise radiation with high tumor control, significant volume reduction, and minimal complications. As part of a multimodal approach, it ensures long-term tumor regression and maintains a favorable safety profile.Clinical trial registration number and date of registration: Not applicable.