van Nieuwenhuizen David, Klein Martin, Stalpers Lukas J A, Leenstra Sieger, Heimans Jan J, Reijneveld Jaap C
Department of Neurology, VU University Medical Center, De Boelelaan 1117-1118, 1081 HV, Amsterdam, The Netherlands.
J Neurooncol. 2007 Sep;84(3):271-8. doi: 10.1007/s11060-007-9366-7. Epub 2007 Apr 13.
Potential treatment-related neurotoxicity and the indolent course of the disease mainly feed the controversy concerning the optimal timing of surgery and radiotherapy in meningioma patients.
To quantify the additional negative effects of conventional radiotherapy compared to surgery alone on neurocognitive functioning and health-related quality of life (HRQOL) in patients with WHO grade I meningiomas.
Neurocognitive functioning and HRQOL (SF36, EORTC-BCM20) were assessed in consecutive patients (1999-2005) with WHO grade I meningiomas at least 1 year after surgical treatment in two centers for brain tumor patients. Subsequently, we selected all patients who underwent surgery and conformal external beam fractioned radiotherapy (n=18) and matched these patients for age, sex, and educational level with the same number of patients who had had surgery only (n=18), as well as with the same number of healthy controls.
No significant differences in neurocognitive functioning were found between the two meningioma patient groups; however, even meningioma patients who were treated with surgery only had a significantly lower neurocognitive functioning than healthy controls. Meningioma patients who were treated with surgery and radiotherapy had significantly lower HRQOL scores than meningioma patients who were treated with surgery only, who had HRQOL ratings comparable with healthy controls; these differences, however, disappeared after correction for the duration of disease.
In contrast with conventional thinking, long-term neurocognitive functioning was significantly impaired in our meningioma patients. Additional radiotherapy following surgery, however, does not have additional deleterious effects on neurocognitive outcome in these patients.
潜在的治疗相关神经毒性以及疾病的惰性病程,主要引发了关于脑膜瘤患者手术和放疗最佳时机的争议。
量化与单纯手术相比,常规放疗对世界卫生组织(WHO)I级脑膜瘤患者神经认知功能和健康相关生活质量(HRQOL)的额外负面影响。
在两个脑肿瘤患者中心,对1999年至2005年接受手术治疗至少1年后的连续WHO I级脑膜瘤患者的神经认知功能和HRQOL(SF36、欧洲癌症研究与治疗组织-脑肿瘤生活质量量表20项版,EORTC-BCM20)进行评估。随后,我们选取了所有接受手术和适形外照射分割放疗的患者(n = 18),并将这些患者与相同数量的仅接受手术的患者(n = 18)以及相同数量的健康对照在年龄、性别和教育水平上进行匹配。
两组脑膜瘤患者的神经认知功能未发现显著差异;然而,即使是仅接受手术治疗的脑膜瘤患者,其神经认知功能也显著低于健康对照。接受手术和放疗的脑膜瘤患者的HRQOL得分显著低于仅接受手术治疗的脑膜瘤患者,后者的HRQOL评分与健康对照相当;然而,在校正疾病持续时间后,这些差异消失。
与传统观念相反,我们的脑膜瘤患者的长期神经认知功能显著受损。然而,手术后额外的放疗对这些患者的神经认知结果没有额外的有害影响。