Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Germany.
Acta Neurochir (Wien). 2011 Sep;153(9):1761-7. doi: 10.1007/s00701-011-1073-7. Epub 2011 Jun 25.
The optimal management of subtotally resected or recurrent malignant meningiomas remains controversial. We evaluated the efficacy of linear accelerator (LINAC) radiosurgery for atypical and anaplastic meningiomas after incomplete resection or treatment of recurrences.
Between August 1990 and December 2003, 16 patients with 28 meningiomas WHO II and III were treated by stereotactic LINAC radiosurgery at our institution. The median radiological follow-up was 60.3 months, respectively (range: 7.2-173.9 months). Fourteen tumors in nine patients were classified as WHO II and 14 tumors in seven patients as WHO III. The median surface dose was 14 Gy (range: 10-15 Gy) with a median tumor volume of 4.8 ml (range: 0.51-51.4 ml).
Clinical condition improved in four patients, remained unchanged in nine and deteriorated in one. Tumor shrinkage was seen in eight of 28 meningiomas and a stable disease in 12. Eight of 28 meningiomas showed local tumor progression. The overall tumor control rate (TCR) was 84%, 70%, 70% after 3, 5, 10 years. According to grading the corresponding TCR after 3, 5, 10 years was 91%, 81%, 81% for grade II and 77%, 60%, 60% for grade III meningiomas. Overall progression-free survival (PFS) was 74%, 67%, 58% after 3, 5, 10 years. According to grading the PFS after 3, 5, 10 years was 88%, 75%, 75% for grade II meningiomas and 57%, 57%, 43% for grade III meningiomas.
Our results show the efficacy and safety of LINAC radiosurgery for incompletely resected or recurrent malignant meningiomas with a relatively high local tumor control and low morbidity.
对于次全切除或复发的恶性脑膜瘤，其最佳治疗方法仍存在争议。我们评估了直线加速器（LINAC）立体定向放射外科治疗不完全切除或复发后的非典型性和间变性脑膜瘤的疗效。
1990 年 8 月至 2003 年 12 月，我们机构对 16 例 28 个脑膜瘤患者（WHO II 和 III 级）进行了立体定向 LINAC 放射外科治疗。中位影像学随访时间分别为 60.3 个月（范围：7.2-173.9 个月）。9 例患者中有 14 个肿瘤被归类为 WHO II 级，7 例患者中有 14 个肿瘤被归类为 WHO III 级。中位表面剂量为 14 Gy（范围：10-15 Gy），肿瘤体积中位数为 4.8 ml（范围：0.51-51.4 ml）。
4 例患者临床状况改善，9 例患者无变化，1 例患者恶化。28 个脑膜瘤中有 8 个肿瘤缩小，12 个肿瘤稳定。28 个脑膜瘤中有 8 个出现局部肿瘤进展。3、5、10 年的总体肿瘤控制率（TCR）分别为 84%、70%、70%。按分级，3、5、10 年后的 TCR 分别为 II 级 91%、81%、81%，III 级 77%、60%、60%。3、5、10 年的无进展生存率（PFS）分别为 74%、67%、58%。按分级，3、5、10 年后的 PFS 分别为 II 级 88%、75%、75%，III 级 57%、57%、43%。
我们的结果表明，LINAC 立体定向放射外科治疗不完全切除或复发的恶性脑膜瘤是有效且安全的，具有较高的局部肿瘤控制率和较低的发病率。
