Department of Neurological Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
Int J Radiat Oncol Biol Phys. 2012 Aug 1;83(5):1414-8. doi: 10.1016/j.ijrobp.2011.10.033. Epub 2011 Dec 29.
To define the rate of tumor control and factors associated with radiation-related complications after single-fraction radiosurgery (SRS) for patients with imaging defined intracranial meningiomas.
Retrospective review of 251 patients (192 women, 59 men) having SRS for imaging-defined intracranial meningiomas between 1990 and 2008. Excluded were patients with radiation-induced tumors, meningiomatosis, or neurofibromatosis. The mean patient age was 58.6 ± 13.4 years. The majority of tumors involved the skull base/tentorium (n = 210, 83.7%). The mean treatment volume was 7.7 ± 6.2 cm(3); the mean tumor margin dose was 15.8 ± 2.0 Gy. Follow-up (mean, 62.9 ± 43.9 months) was censored at last evaluation (n = 224), death (n = 22), or tumor resection (n = 5).
No patient died from tumor progression or radiation-related complications. Tumor size decreased in 181 patients (72.1%) and was unchanged in 67 patients (26.7%). Three patients (1.2%) had in-field tumor progression noted at 28, 145, and 150 months, respectively. No patient had a marginal tumor progression. The 3- and 10-year local control rate was 99.4%. One patient had distant tumor progression at 105 months and underwent repeat SRS. Thirty-one patients (12.4%) had either temporary (n = 8, 3.2%) or permanent (n = 23, 9.2%) symptomatic radiation-related complications including cranial nerve deficits (n = 14), headaches (n = 5), hemiparesis (n = 5), new/worsened seizure (n = 4), cyst-formation (n = 1), hemifacial spasm (n = 1), and stroke (n = 1). The 1- and 5-year complication rates were 8.3% and 11.5%, respectively. Radiation-related complications were associated with convexity/falx tumors (HR = 2.8, 95% CI 1.3-6.1, p = 0.009) and increasing tumor volume (HR = 1.05, 95% CI 1.0-1.1, p = 0.04) on multivariate analysis. No patient developed a radiation-induced tumor.
Single-fraction SRS at the used dose range provides a high rate of tumor control for patients with imaging defined intracranial meningiomas. However, treatment failures were noted after 10 years emphasizing the need for long-term imaging follow-up after meningioma SRS.
定义单次分割放射外科（SRS）治疗影像学定义的颅内脑膜瘤后肿瘤控制率及与放射相关并发症相关的因素。
回顾性分析 1990 年至 2008 年间 251 例（192 例女性，59 例男性）接受 SRS 治疗的影像学定义颅内脑膜瘤患者。排除因放射诱导肿瘤、脑膜瘤病或神经纤维瘤病而接受治疗的患者。患者平均年龄为 58.6±13.4 岁。大多数肿瘤累及颅底/天幕（n=210，83.7%）。平均治疗体积为 7.7±6.2cm³；平均肿瘤边缘剂量为 15.8±2.0Gy。中位随访时间为 62.9±43.9 个月，随访截止于末次评估（n=224）、死亡（n=22）或肿瘤切除术（n=5）。
无患者死于肿瘤进展或放射相关并发症。181 例（72.1%）患者肿瘤缩小，67 例（26.7%）肿瘤大小无变化。3 例（1.2%）患者分别在 28、145 和 150 个月时出现肿瘤进展。无患者出现边缘性肿瘤进展。3 年和 10 年局部控制率分别为 99.4%。1 例患者在 105 个月时出现远处肿瘤进展，并接受再次 SRS 治疗。31 例（12.4%）患者出现暂时性（n=8，3.2%）或永久性（n=23，9.2%）症状性放射相关并发症，包括颅神经损伤（n=14）、头痛（n=5）、偏瘫（n=5）、新发/恶化癫痫（n=4）、囊肿形成（n=1）、面肌痉挛（n=1）和卒中（n=1）。1 年和 5 年并发症发生率分别为 8.3%和 11.5%。多因素分析显示，凸面/镰旁肿瘤（HR=2.8，95%CI 1.3-6.1，p=0.009）和肿瘤体积增加（HR=1.05，95%CI 1.0-1.1，p=0.04）与放射相关并发症相关。无患者发生放射性肿瘤。
在使用的剂量范围内，单次分割 SRS 为影像学定义的颅内脑膜瘤患者提供了较高的肿瘤控制率。然而，在 10 年后仍出现治疗失败，强调脑膜瘤 SRS 后需要长期影像学随访。
