Peyre Matthieu, Zanello Marc, Mokhtari Karima, Boch Anne-Laure, Capelle Laurent, Carpentier Alexandre, Clemenceau Stephane, Karachi Carine, Navarro Soledad, Nouet Aurelien, Reina Vincent, Valery Charles-Ambroise, Sanson Marc, Cornu Philippe, Kalamarides Michel
Department of Neurosurgery, Service de Neurochirurgie, AP-HP, Hôpital Pitié Salpêtrière, 47-83 bvd de l'Hôpital, 75013, Paris, France.
J Neurooncol. 2015 May;123(1):151-60. doi: 10.1007/s11060-015-1778-1. Epub 2015 Apr 17.
Patients with surgery- and radiation-refractory meningiomas have a poor outcome. Due to our lack of knowledge concerning multi-recurrent meningioma natural history, their clinical course is poorly defined. This retrospective study aims at defining patterns of relapse in order to help in the definition of response criteria in future clinical trials. We performed a retrospective review of surgery- and radiotherapy-refractory meningioma cases with interpretable radiological follow-up treated in our department. Tumor volumes were measured on 3D T1 Gadolinium volumetric sequences using a semi-automated algorithm for tumor segmentation. Twenty nine patients with multi-treated meningioma (11 WHO Grade II, 5 de novo WHO Grade III and 13 transformed WHO Grade III), were evaluated. Median PFS was 16 months for patients with Grade II meningiomas. In patients with Grade III meningiomas, the de novo subgroup had a median PFS of 4 months compared with 7 months in patients with malignant transformation. Volumetric analysis of tumor growth concerned 95 tumor nodules in 50 relapses. The mean growth rate of tumor nodules was 10.4 cm(3)/year (95% CI 7.3-14.8 cm(3)/year). Three patterns of tumor growth were described: "classical" for 9 (31%) patients, "local multi-nodular" for 6 (21%) patients and "multi-nodular metastatic" for the last 14 (48%) patients. Considering all tumor nodules, median time to tumor progression (TTP) was 3.7 months. Progressing tumors represent the most frequent histological subgroup of surgery and radiation-refractory meningiomas while tumors with multi-nodular metastatic dissemination are the prominent radiological pattern of progression.
手术和放疗难治性脑膜瘤患者预后较差。由于我们对多次复发脑膜瘤的自然史缺乏了解，其临床病程尚不明确。这项回顾性研究旨在确定复发模式，以帮助定义未来临床试验中的反应标准。我们对在本部门接受治疗且有可解释放射学随访结果的手术和放疗难治性脑膜瘤病例进行了回顾性分析。使用半自动肿瘤分割算法在3D T1钆增强容积序列上测量肿瘤体积。对29例接受多次治疗的脑膜瘤患者（11例WHO二级，5例原发性WHO三级和13例转化型WHO三级）进行了评估。二级脑膜瘤患者的中位无进展生存期为16个月。在三级脑膜瘤患者中，原发性亚组的中位无进展生存期为4个月，而恶性转化患者为7个月。对50次复发中的95个肿瘤结节进行了肿瘤生长的容积分析。肿瘤结节的平均生长速率为10.4 cm³/年（95%CI 7.3 - 14.8 cm³/年）。描述了三种肿瘤生长模式：9例（31%）患者为“经典型”，6例（21%）患者为“局部多结节型”，最后14例（48%）患者为“多结节转移型”。考虑所有肿瘤结节，肿瘤进展的中位时间（TTP）为3.7个月。进展性肿瘤是手术和放疗难治性脑膜瘤中最常见的组织学亚组，而具有多结节转移播散的肿瘤是进展的主要放射学模式。
