Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, USA.
J Neurosurg. 2011 Oct;115(4):811-9. doi: 10.3171/2011.5.JNS11112. Epub 2011 Jun 24.
The role of postoperative radiotherapy in patients undergoing first-time resection of WHO Grade II meningioma remains unclear as reflected by varied practices in published clinical studies and national professional surveys. Much of the relevant literature is based on pre-2000 WHO grading criteria for atypical meningiomas. Authors in this study set out to explore the role of postoperative radiotherapy in patients undergoing first-time surgery for WHO Grade II meningiomas diagnosed using revised WHO 2000 criteria, against a background of otherwise limited published literature on this issue.
The authors retrospectively collected data on 114 consecutive patients who underwent first-time resection of WHO Grade II atypical meningiomas diagnosed using 2000 WHO criteria, and who variably underwent postoperative radiotherapy according to individual surgeon practices. Outcomes, including radiological recurrence, were submitted to Kaplan-Meier and Cox regression analyses.
Postoperative radiotherapy demonstrated a significant benefit only when patients who had undergone gross-total tumor resection and those who had undergone subtotal resection along with postoperative radiosurgery to the tumor remnant were excluded from analysis.
The authors have performed the largest study in the literature to examine the use of radiotherapy for WHO Grade II, atypical, meningiomas following a first-time resection. They suggest that radiotherapy is not appropriate after first-time resection of those lesions in which a gross-total resection (Simpson Grade 1 or 2) has been achieved. They also advise that any tumor remnant radiologically demonstrated on postoperative imaging should be treated with radiosurgery and that postoperative radiotherapy after a first-time resection should be reserved for tumor remnants too large for radiosurgery and for which a second staged operation is not planned.
在发表的临床研究和国家专业调查中，不同的实践反映出术后放疗在首次切除 WHO 分级 II 脑膜瘤患者中的作用仍不明确。相关文献中的很大一部分基于前 2000 年 WHO 分级标准的非典型脑膜瘤。本研究的作者旨在探索在使用修订后的 2000 年 WHO 分级标准诊断为 WHO 分级 II 脑膜瘤的患者中，首次手术切除后放疗的作用，同时考虑到该问题的相关文献有限。
作者回顾性收集了 114 例连续患者的数据，这些患者首次接受了使用 2000 年 WHO 标准诊断的 WHO 分级 II 非典型脑膜瘤切除术，并且根据个别外科医生的实践接受了不同的术后放疗。包括影像学复发在内的结果进行了 Kaplan-Meier 和 Cox 回归分析。
只有当排除了接受大体全切除肿瘤的患者和接受肿瘤残部术后放射外科手术的患者后，术后放疗才显示出显著获益。
作者进行了文献中最大规模的研究，以检查在首次切除后使用放疗治疗 WHO 分级 II、非典型脑膜瘤的情况。他们建议，对于那些达到大体全切除（Simpson 分级 1 或 2）的病变，首次切除后不适合进行放疗。他们还建议，对于影像学上显示的任何肿瘤残部，应采用放射外科手术治疗，对于太大而无法进行放射外科手术且未计划进行二次分期手术的肿瘤残部，应保留首次切除后进行放疗。
