分形适形放疗在海绵窦脑膜瘤治疗中的应用：单中心的长期功能预后和肿瘤控制效果。
Fractionated conformal radiotherapy in the management of cavernous sinus meningiomas: long-term functional outcome and tumor control at a single institution.
机构信息
Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
出版信息
Int J Radiat Oncol Biol Phys. 2010 Nov 1;78(3):836-43. doi: 10.1016/j.ijrobp.2009.08.006. Epub 2010 Feb 3.
PURPOSE
To evaluate long-term outcome of cavernous sinus meningioma (CSM) treated with fractionated conformal radiotherapy (FCR).
PATIENTS AND METHODS
Fifty-three patients with CSMs (16 men [30.2%], 37 women [69.8%], aged 53 ± 13.0 years [mean ± SD]) were treated by FCR. In 28 patients (52.8%) FCR was performed as first-line treatment and in 25 patients (47.2%) as adjuvant treatment. All patients received FCR with a dose of 52.9 ± 1.8 Gy in 29.4 ± 1.0 fractions over 6 weeks. Dose per fraction was 1.9 ± 0.1 Gy. Radiotherapy was delivered stereotactically in 47 cases (88.7%) and conformally in 6 (11.3%)
RESULTS
The median follow-up was 6.9 years (range, 3-19 years). According to Sekhar's classification, 19 patients (35.8%) were Grade 1-2, 30 patients (56.6%) were Grade 3-4, and 4 patients (7.6%) were Grade 5. Pretreatment tumor volume was determined in 46 patients, and tumor volume was 12.6 ± 8.2 cm(3). In these patients, the distance between tumor and optic apparatus was 1.62 ± 1.2 mm. Actuarial 5- and 10-year progression-free survival rates were 98.1% and 95.8%, respectively. Clinical improvement was observed in 31 patients (58.5%), and 20 patients (37.7%) remained unchanged. Radiologic response was observed in 18 patients (30.2%), and 35 patients (66.0%) showed stable lesions. Two patients (3.8%) showed tumor progression during follow-up. Transient morbidity was observed in 3 patients (5.7%) and permanent morbidity in 1 (1.9%).
CONCLUSION
Fractionated conformal radiotherapy affords satisfactory long-term tumor control and low treatment morbidity.
目的
评估采用分次适形放疗（FCR）治疗海绵窦脑膜瘤（CSM）的长期疗效。
方法
53 例 CSM 患者（男 16 例[30.2%]，女 37 例[69.8%]，年龄 53±13.0 岁[均值±标准差]）接受 FCR 治疗。28 例（52.8%）患者行 FCR 作为一线治疗，25 例（47.2%）作为辅助治疗。所有患者接受 52.9±1.8 Gy 的 FCR 治疗，29.4±1.0 次分割，6 周完成。单次剂量 1.9±0.1 Gy。47 例（88.7%）采用立体定向放疗，6 例（11.3%）采用适形放疗。
结果
中位随访时间 6.9 年（范围 3-19 年）。根据 Sekhar 分级，19 例（35.8%）为 1-2 级，30 例（56.6%）为 3-4 级，4 例（7.6%）为 5 级。46 例患者测定了治疗前肿瘤体积，肿瘤体积为 12.6±8.2 cm3。这些患者肿瘤与视神经之间的距离为 1.62±1.2 mm。5 年和 10 年无进展生存率分别为 98.1%和 95.8%。31 例（58.5%）患者临床症状改善，20 例（37.7%）无变化。18 例（30.2%）患者影像学反应，35 例（66.0%）病变稳定。2 例（3.8%）患者在随访期间肿瘤进展。3 例（5.7%）患者出现短暂并发症，1 例（1.9%）患者出现永久性并发症。
结论
分次适形放疗可获得满意的长期肿瘤控制和低治疗并发症发生率。
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