Dufour H, Métellus P, Fuentes S, Murracciole X, Régis J, Figarella-Branger D, Grisoli F
Department of Neurosurgery, H pital de la Timone Adultes, Marseille, France.
Neurosurgery. 2001 Apr;48(4):756-62; discussion 762-3. doi: 10.1097/00006123-200104000-00011.
To specify that postoperative radiotherapy is useful for preventing local recurrence and neuraxis recurrence of surgically treated meningeal hemangiopericytomas.
We retrospectively studied 21 patients with meningeal hemangiopericytoma who were followed in our department during a 34-year period. In 17 patients, the meningeal hemangiopericytoma was intracranial, and in 4 there was an intradural extramedullary localization. These groups were studied separately.
Of the 17 patients with intracranial hemangiopericytoma, all underwent surgery; 8 also underwent radiotherapy (5,000-6,400 rads) (Group I), and 9 did not (Group II). The mortality rate was zero for Group I patients and 55% for Group II. The mean local recurrence rate was 52% (12.5% in Group I and 88% in Group II; P < 0.05). Neuraxis recurrences occurred in two patients in Group II, and none occurred in Group I (P = 0.4). Peripheral metastasis took place in two patients (22%) in Group II and in one patient (12.5%) in Group I (P = 0.5). Of the four patients with intradural extramedullary hemangiopericytoma, all underwent surgery. Two patients received 4000 rads of radiotherapy after intervention. No patient in this group had a recurrence.
For patients with intracranial meningeal hemangiopericytoma, surgical removal followed by external radiotherapy reduced the risk of local recurrence. It was not demonstrated that postoperative radiotherapy protected against neuraxis metastasis. Radiotherapy did not protect against peripheral metastasis, which can occur up to several years after the first operation. It appears that radiotherapy after surgery for local or neuraxis recurrence did not avoid further recurrence. Radiosurgery is indicated for recurrent tumors measuring less than 25 mm in greatest diameter. For intradural extramedullary localizations, the value of postoperative radiotherapy is more questionable.
明确术后放疗对预防手术治疗的脑膜血管外皮细胞瘤的局部复发和神经轴复发是否有用。
我们回顾性研究了在34年期间在我科随访的21例脑膜血管外皮细胞瘤患者。17例患者的脑膜血管外皮细胞瘤位于颅内，4例为硬脊膜外髓外定位。这些组分别进行研究。
17例颅内血管外皮细胞瘤患者均接受了手术；8例还接受了放疗（5000 - 6400拉德）（第一组），9例未接受放疗（第二组）。第一组患者的死亡率为零，第二组为55%。平均局部复发率为52%（第一组为12.5%，第二组为88%；P < 0.05）。第二组有2例患者发生神经轴复发，第一组无患者发生（P = 0.4）。第二组有2例患者（22%）发生远处转移，第一组有1例患者（12.5%）发生远处转移（P = 0.5）。4例硬脊膜外髓外血管外皮细胞瘤患者均接受了手术。2例患者在干预后接受了4000拉德的放疗。该组无患者复发。
对于颅内脑膜血管外皮细胞瘤患者，手术切除后进行外照射放疗可降低局部复发风险。未证明术后放疗可预防神经轴转移。放疗不能预防远处转移，远处转移可在首次手术后数年发生。似乎手术后针对局部或神经轴复发进行放疗并不能避免进一步复发。对于最大直径小于25 mm的复发性肿瘤，建议采用放射外科治疗。对于硬脊膜外髓外定位，术后放疗的价值更值得怀疑。
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