Choi Yunseon, Lim Do Hoon, Jo Kyungil, Nam Do-Hyun, Seol Ho Jun, Lee Jung-Il
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
J Neurooncol. 2014 Sep;119(2):405-12. doi: 10.1007/s11060-014-1507-1. Epub 2014 Jun 26.
The necessity of postoperative radiotherapy (PORT) for meningiomas remains contentious. Here, the role of PORT in patients who underwent surgical resection for WHO grade II and III meningiomas was assessed. The record of 114 patients with WHO grade II (n = 72) and III (n = 42) meningiomas treated at Samsung Medical Center between March 1995 and April 2013 were reviewed and classified according to the extent of surgical resection and implementation of PORT. Median follow-up was 55.9 months. Simpson grade (SG) I, II, III, and IV resections were achieved in 29, 56, 9 and 20 patients, respectively. The 5-year local control (LC) and overall survival rate was 65.8 and 84.2 %, respectively. Thirty patients (26.3 %) developed local failure and five patients (4.4 %) developed distant metastases. The extent of surgical resection (SG I-II vs. III-IV) was influenced by tumor location (orbital and skull base lesions vs. others, p = 0.001) and the surgeons' experience (>10 operations, p = 0.044). Extent of surgical resection was also associated with local failure, overall progression, and overall survival (p = 0.001, p < 0.001, and p < 0.001, respectively). PORT improved LC in patients with incomplete surgical resection (SG III-IV, p = 0.049). Complete resection (SG I-II) is an important prognostic factor for LC and survival, and the extent of surgical resection (SG I-II vs. III-IV) is influenced by tumor location. PORT could improve the LC in WHO grade II-III meningioma patients who underwent incomplete surgical resection (SG III-IV).
脑膜瘤术后放疗（PORT）的必要性仍存在争议。在此，评估了PORT在接受WHO二级和三级脑膜瘤手术切除患者中的作用。回顾了1995年3月至2013年4月在三星医疗中心接受治疗的114例WHO二级（n = 72）和三级（n = 42）脑膜瘤患者的记录，并根据手术切除范围和PORT的实施情况进行分类。中位随访时间为55.9个月。分别有29、56、9和20例患者实现了辛普森分级（SG）I、II、III和IV级切除。5年局部控制（LC）率和总生存率分别为65.8%和84.2%。30例患者（26.3%）出现局部复发，5例患者（4.4%）出现远处转移。手术切除范围（SG I-II级与III-IV级）受肿瘤位置（眼眶和颅底病变与其他部位，p = 0.001）和外科医生经验（>10次手术，p = 0.044）影响。手术切除范围还与局部复发、总体进展和总生存相关（分别为p = 0.001、p < 0.001和p < 0.001）。PORT改善了手术切除不完全患者（SG III-IV级）的LC（p = 0.049）。完全切除（SG I-II级）是LC和生存的重要预后因素，手术切除范围（SG I-II级与III-IV级）受肿瘤位置影响。PORT可改善接受手术切除不完全（SG III-IV级）的WHO二级至三级脑膜瘤患者的LC。
