Marcus H J, Price S J, Wilby M, Santarius T, Kirollos R W
Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK.
Br J Neurosurg. 2008 Aug;22(4):520-8. doi: 10.1080/02688690802308687.
Although increasingly used, the precise role of radiotherapy in the management of meningiomas is still disputed. The objective of this study, therefore, was to appraise the evidence for adjuvant radiotherapy in benign and atypical intracranial meningiomas, and to compare and contrast it with the current opinion and practice of neurosurgeons in the United Kingdom and the Republic of Ireland. The use of radiotherapy as a primary treatment strategy or its use in the treatment of recurrence was not considered. We performed a systematic review of the evidence for adjuvant radiotherapy in benign and atypical intracranial meningiomas, surveyed current opinion amongst neurosurgeons involved in such cases and ascertained local practice using data from the regional cancer registry. Overall, 10 cohorts were identified that fulfilled our eligibility criteria. Four studies showed significantly improved local control in patients receiving adjuvant radiotherapy for incompletely resected grade I meningiomas. Our survey demonstrated that the vast majority (98%) of neurosurgeons would not recommend adjuvant radiotherapy in grade I meningioma. In grade II meningioma, most (80%) would not advocate adjuvant radiotherapy if completely excised, but the majority (59%) would recommend radiotherapy in cases of subtotal resection. Significant variation in opinion between centres exists, however, particularly in cases of completely resected atypical meningiomas (p = 0.02). Data from the Eastern Cancer Registration and Information Centre appears to be in line with these findings: less than 10% of patients with grade I meningiomas, but almost 30% of patients with grade II meningiomas received adjuvant radiotherapy in the Eastern region. In conclusion, our study has highlighted significant variation in opinion and practice, reflecting a lack of class 1 evidence to support the use of adjuvant radiotherapy in the treatment of meningiomas. Efforts are underway to address this with a randomized multicentre trial comparing a policy of watchful waiting versus adjuvant irradiation.
尽管放射治疗的应用越来越广泛，但它在脑膜瘤治疗中的具体作用仍存在争议。因此，本研究的目的是评估辅助放疗在良性和非典型颅内脑膜瘤中的证据，并将其与英国和爱尔兰共和国神经外科医生的当前观点和实践进行比较和对比。本研究未考虑将放射治疗作为主要治疗策略或用于复发性疾病的治疗。我们对良性和非典型颅内脑膜瘤辅助放疗的证据进行了系统综述，调查了参与此类病例的神经外科医生的当前观点，并利用区域癌症登记处的数据确定了当地的实践情况。总体而言，共确定了10个符合我们纳入标准的队列。四项研究表明，接受辅助放疗的I级脑膜瘤不完全切除患者的局部控制率显著提高。我们的调查显示，绝大多数（98%）神经外科医生不建议对I级脑膜瘤进行辅助放疗。在II级脑膜瘤中，如果完全切除，大多数（80%）医生不主张进行辅助放疗，但在次全切除的病例中，大多数（59%）医生会建议放疗。然而，各中心之间存在显著的观点差异，特别是在完全切除的非典型脑膜瘤病例中（p = 0.02）。东部癌症登记和信息中心的数据似乎与这些发现一致：在东部地区，I级脑膜瘤患者接受辅助放疗的比例不到10%，而II级脑膜瘤患者接受辅助放疗的比例近30%。总之，我们的研究突出了观点和实践中的显著差异，这反映出缺乏一级证据支持在脑膜瘤治疗中使用辅助放疗。目前正在努力通过一项随机多中心试验来解决这一问题，该试验比较观察等待策略与辅助放疗策略。
