Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Germany.
Acta Neurochir (Wien). 2012 Apr;154(4):599-604. doi: 10.1007/s00701-012-1278-4.
We present the long-term results of a consecutive series of patients with meningiomas treated by LINAC-radiosurgery using the micro-multi-leaf collimator technique (μMLC).
Between May 2001 and July 2009, 78 patients (m: f = 024:54; median age, 56.8 years; range, 20.1-81 years) with 87 intracranial meningiomas (78 WHO I, seven WHO II, two WHO III) were treated with μMLC-LINAC radiosurgery at our institution, either as a primary or salvage treatment following one or more microsurgical procedures. Fifty-eight of 87 tumors (66.7%) were located in the skull base. The remaining 29 meningiomas (33.3%) were located in the convexity of the brain. The median tumor volume was 4.8 ml (range, 0.2-18.3 ml). The median tumor surface dose, maximal dose, and therapeutic isodose were 12 Gy, 16 Gy, and 75%, respectively.
For retrospective evaluation, we included 70 patients (78 tumors) with a minimum radiological follow-up of 24 months. After a median follow-up of 79.7 months (range, 24.2-109.1 months), 24 patients (34.3%) improved in their clinical status (paresis of N. abducens 18/48, facial paresis 4/8, and hemiparesis 2/9), 41 patients remained stable (58.6%), three patients had treatment-related temporary complaints (4.3%); two patients developed vertigo, and one had a left-sided hemihypesthesia. All complaints recovered completely after steroid medication within 2 weeks. Two patients (2.8%) developed permanent trigeminal neuralgia. Follow-up MR images showed a partial remission in 21 tumors (26.9%) and a stable tumor size in 55 cases (70.5%). Two patients with high-grade meningiomas showed a tumor progression (one WHO II and one WHO III meningioma). At the end of follow-up (July 2010), the actuarial 5- and 9-year progression-free survival after radiosurgery were 98 and 96%, respectively. There was no treatment-related mortality.
LINAC radiosurgery using a micro multi-leaf collimator for complex shaped intracranial meningiomas is effective yielding a high local tumor control, whereas the treatment-related morbidity remains low.
我们报告了一系列连续接受 LINAC 放射外科治疗的脑膜瘤患者的长期结果，该治疗采用微多叶准直器技术（μMLC）。
在 2001 年 5 月至 2009 年 7 月期间，78 名患者（男性：女性=024:54；中位年龄 56.8 岁；范围 20.1-81 岁）的 87 个颅内脑膜瘤（78 例 WHO I 级，7 例 WHO II 级，2 例 WHO III 级）在我院接受了 μMLC-LINAC 放射外科治疗，这些患者要么是在一次或多次显微手术后作为原发性治疗，要么是作为挽救性治疗。87 个肿瘤中有 58 个（66.7%）位于颅底。其余 29 个脑膜瘤（33.3%）位于大脑凸面。肿瘤中位体积为 4.8ml（范围 0.2-18.3ml）。肿瘤表面中位剂量、最大剂量和治疗等剂量分别为 12Gy、16Gy 和 75%。
为了进行回顾性评估，我们纳入了 70 名患者（78 个肿瘤），这些患者的影像学随访时间均至少为 24 个月。在中位随访时间 79.7 个月（范围 24.2-109.1 个月）后，24 名患者（34.3%）的临床状况有所改善（8 例展神经麻痹、4 例面肌麻痹、2 例偏瘫），41 名患者病情稳定（58.6%），3 名患者出现与治疗相关的暂时性并发症（4.3%）；2 名患者出现眩晕，1 名患者出现左侧半身感觉减退。所有的症状在 2 周内通过类固醇药物治疗完全恢复。2 名患者（2.8%）出现永久性三叉神经痛。随访 MRI 显示 21 个肿瘤（26.9%）部分缓解，55 个肿瘤（70.5%）肿瘤大小稳定。2 名高级别脑膜瘤患者出现肿瘤进展（1 例 WHO II 级脑膜瘤和 1 例 WHO III 级脑膜瘤）。随访结束时（2010 年 7 月），放射外科治疗后 5 年和 9 年的无进展生存率分别为 98%和 96%。无治疗相关死亡。
采用微多叶准直器的 LINAC 放射外科治疗复杂形状的颅内脑膜瘤是有效的，能获得较高的局部肿瘤控制率，而治疗相关的发病率仍然较低。
