Copeland William R, Link Michael J, Stafford Scott L, Pollock Bruce E
Department of Neurological Surgery, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA.
J Neurooncol. 2014 Oct;120(1):95-102. doi: 10.1007/s11060-014-1521-3. Epub 2014 Jul 9.
Meningeal hemangiopericytomas (M-HPC) are challenging tumors with a high rate of recurrence despite surgical resection and external beam radiotherapy (EBRT). To better understand the role of single-fraction stereotactic radiosurgery (SRS) for patients with M-HPC, we reviewed our experience with 22 patients (12 men, 10 women) from 1990 until 2010. Twelve patients (55%) underwent a single SRS procedure, whereas 10 patients (45%) had more than one SRS procedure (range 2-6). In total, 47 SRS procedures were performed to treat 64 tumors. Fourteen patients (64%) had undergone prior EBRT (median dose, 56.0 Gy). Follow-up after the initial SRS (median, 66 months) was censored at the time of death (n = 15) or last clinical evaluation (n = 7). Eleven patients (50 %) died of intracranial tumor progression (n = 10) or treatment-related complications (n = 1). One patient (5%) died of systemic disease progression. Disease-specific survival (DSS) at 1-, 3- and 5-years after SRS was 96, 82, and 61%, respectively. Prior EBRT (HR 9.0, 95% CI 1.1-78.1, p < 0.05) and larger initial tumor volume (HR 1.09, 95% CI 1.02-1.2, p = 0.02) were associated with worse DSS. Local tumor control (LTC) after SRS at 1-, 3-, and 5-years was 89, 68, and 59%, respectively. Improved LTC was noted in patients who had not undergone prior EBRT (HR 6.3, 95% CI 2.1-19.5, p = 0.001). One patient (5%) had symptomatic radiation-relation complications after SRS. Overall, single-fraction SRS was effective in providing LTC for more than half of recurrent or residual M-HPC at 5-years after the procedure. Repeat SRS is often required secondary to either distant or local tumor progression.
脑膜血管外皮细胞瘤（M-HPC）是具有挑战性的肿瘤，尽管进行了手术切除和外照射放疗（EBRT），其复发率仍很高。为了更好地了解单次分割立体定向放射外科治疗（SRS）对M-HPC患者的作用，我们回顾了1990年至2010年期间22例患者（12例男性，10例女性）的治疗经验。12例患者（55%）接受了单次SRS治疗，而10例患者（45%）接受了不止一次SRS治疗（范围为2-6次）。总共进行了47次SRS治疗以治疗64个肿瘤。14例患者（64%）曾接受过EBRT（中位剂量为56.0 Gy）。初始SRS后的随访（中位时间为66个月）在死亡时（n = 15）或最后一次临床评估时（n = 7）进行了截尾。11例患者（50%）死于颅内肿瘤进展（n = 10）或治疗相关并发症（n = 1）。1例患者（5%）死于全身疾病进展。SRS后1年、3年和5年的疾病特异性生存率（DSS）分别为96%、82%和61%。既往接受EBRT（风险比9.0，95%置信区间1.1-78.1，p < 0.05）和初始肿瘤体积较大（风险比1.09，95%置信区间1.02-1.2，p = 0.02）与较差的DSS相关。SRS后1年、3年和5年的局部肿瘤控制率（LTC）分别为89%、68%和59%。未接受过既往EBRT的患者LTC有所改善（风险比6.3，95%置信区间2.1-19.5，p = 0.001）。1例患者（5%）在SRS后出现有症状的放射性相关并发症。总体而言，单次分割SRS在治疗后5年为超过一半的复发性或残留M-HPC提供LTC方面是有效的。由于远处或局部肿瘤进展，通常需要重复SRS。
