Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany.
Neurosurgery. 2012 Jan;70(1):32-9; discussion 39. doi: 10.1227/NEU.0b013e31822d408a.
Radiosurgery is the main alternative to microsurgical resection for benign meningiomas.
To assess the long-term efficacy and safety of radiosurgery for meningiomas with respect to tumor growth and prevention of associated neurological deterioration. Medium- to long-term outcomes have been widely reported, but no large multicenter series with long-term follow-up have been published.
From 15 participating centers, we performed a retrospective observational analysis of 4565 consecutive patients harboring 5300 benign meningiomas. All were treated with Gamma Knife radiosurgery at least 5 years before assessment for this study. Clinical and imaging data were retrieved from each center and uniformly entered into a database by 1 author (A.S.).
Median tumor volume was 4.8 cm³, and median dose to tumor margin was 14 Gy. All tumors with imaging follow-up < 24 months were excluded. Detailed results from 3768 meningiomas (71%) were analyzed. Median imaging follow-up was 63 months. The volume of treated tumors decreased in 2187 lesions (58%), remained unchanged in 1300 lesions (34.5%), and increased in 281 lesions (7.5%), giving a control rate of 92.5%. Only 84 (2.2%) enlarging tumors required further treatment. Five- and 10-year progression-free survival rates were 95.2% and 88.6%, respectively. Tumor control was higher for imaging defined tumors vs grade I meningiomas (P < .001), for female vs male patients (P < .001), for sporadic vs multiple meningiomas (P < .001), and for skull base vs convexity tumors (P < .001). Permanent morbidity rate was 6.6% at the last follow-up.
Radiosurgery is a safe and effective method for treating benign meningiomas even in the medium to long term.
放射外科是治疗良性脑膜瘤的主要替代方法，优于显微手术切除。
评估放射外科治疗脑膜瘤的长期疗效和安全性，包括肿瘤生长和预防相关神经功能恶化。目前已经广泛报道了中期至长期的结果，但尚无发表大型多中心、长期随访的系列研究。
从 15 个参与中心回顾性分析了 4565 例连续的 5300 例良性脑膜瘤患者。所有患者均在该研究评估前至少 5 年接受伽玛刀放射外科治疗。由 1 位作者（A.S.）从各中心检索临床和影像学数据，并统一输入数据库。
肿瘤体积中位数为 4.8cm³，肿瘤边缘剂量中位数为 14Gy。所有影像学随访<24 个月的肿瘤均被排除。分析了 3768 例（71%）脑膜瘤的详细结果。影像学随访中位数为 63 个月。2187 例（58%）治疗肿瘤体积缩小，1300 例（34.5%）肿瘤体积无变化，281 例（7.5%）肿瘤体积增大，肿瘤控制率为 92.5%。仅 84 例（2.2%）增大肿瘤需要进一步治疗。5 年和 10 年无进展生存率分别为 95.2%和 88.6%。影像学定义的肿瘤、I 级脑膜瘤（P<0.001）、女性患者（P<0.001）、单发脑膜瘤（P<0.001）、颅底肿瘤（P<0.001）的肿瘤控制率更高。末次随访时永久性发病率为 6.6%。
放射外科治疗良性脑膜瘤即使在中期至长期也是一种安全有效的方法。
