Hug E B, Devries A, Thornton A F, Munzenride J E, Pardo F S, Hedley-Whyte E T, Bussiere M R, Ojemann R
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
J Neurooncol. 2000 Jun;48(2):151-60. doi: 10.1023/a:1006434124794.
Atypical and malignant meningiomas are at high risk for local failure. The role of radiation therapy (RT) and dose levels required to improve tumor control are poorly defined. This study reviews our experience with RT.
Thirty-one patients underwent fractionated RT for atypical (AM, 15 patients) or malignant meningioma (MM, 16 patients) of the cranium. Sixteen patients presented with primary and 15 with recurrent disease. Eight patients received RT following total resection, 21 patients after subtotal resection and 2 patient following biopsy only. RT was given using megavoltage photons in 15 patients and combined photons and 160 MeV protons in 16 patients. Total target doses ranged from 50 to 68 (AM, mean 62) and from 40 to 72 (MM, mean 58) Gy or CGE (= cobalt-gray-equivalent).
With mean observation time of 59 months (range: 7-155 months) actuarial local control rates at 5- and 8-years were similar for both histologies (38% and 19% for AM and 52 and 17% for MM). However, significantly improved local control was observed for proton versus photon RT (80% versus 17% at 5 years, p = 0.003) and target doses > or = 60 Gy for both, atypical (p = 0.025) and malignant meningioma (p = 0.0006). At time of analysis, 14/15 patients (93%) with AM and 6/16 (38%) with MM were alive. Three patients (19%) with MM developed distant metastasis. Actuarial 5- and 8-year survival rates for MM were significantly improved by use of proton over photon RT and radiation doses > 60 CGE. Three patients developed symptomatic radiation damage after 59.3, 68.4 and 72 Gy/CGE.
Conformal, high dose RT resulted in significant improvement of local control for atypical and malignant meningiomas. Increased local control resulted also in improved rates of survival for patients with malignant meningioma.
非典型和恶性脑膜瘤局部复发风险高。放射治疗（RT）的作用以及提高肿瘤控制所需的剂量水平尚不明确。本研究回顾了我们在放射治疗方面的经验。
31例患者接受了颅部非典型脑膜瘤（AM，15例）或恶性脑膜瘤（MM，16例）的分次放射治疗。16例为原发性疾病，15例为复发性疾病。8例患者在全切术后接受放射治疗，21例在次全切术后接受放射治疗，2例仅在活检后接受放射治疗。15例患者使用兆伏光子进行放射治疗，16例患者使用光子与160兆电子伏特质子联合治疗。总靶剂量范围为50至68（AM，平均62）和40至72（MM，平均58）Gy或CGE（=钴-灰当量）。
平均观察时间为59个月（范围：7至155个月），两种组织学类型的5年和8年精算局部控制率相似（AM分别为38%和19%，MM分别为52%和17%）。然而，质子放疗与光子放疗相比，局部控制显著改善（5年时分别为80%和17%，p = 0.003），非典型脑膜瘤（p = 0.025）和恶性脑膜瘤（p = 0.0006）的靶剂量均≥60 Gy。在分析时，15例AM患者中有14例（93%）存活，16例MM患者中有6例（38%）存活。3例MM患者（19%）发生远处转移。使用质子放疗和大于60 CGE的放射剂量可显著提高MM的5年和8年精算生存率。3例患者在接受59.3、68.4和72 Gy/CGE的放射治疗后出现放射性损伤症状。
适形高剂量放射治疗可显著提高非典型和恶性脑膜瘤的局部控制率。局部控制率的提高也改善了恶性脑膜瘤患者的生存率。
