Navarria Pierina, Pessina Federico, Cozzi Luca, Clerici Elena, Villa Elisa, Ascolese Anna Maria, De Rose Fiorenza, Comito Tiziana, Franzese Ciro, D'Agostino Giuseppe, Lobefalo Francesca, Fogliata Antonella, Reggiori Giacomo, Fornari Maurizio, Tomatis Stefano, Bello Lorenzo, Scorsetti Marta
Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center Rozzano Milano, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
Neurosurgery Department, Humanitas Research Hospital, Milan, Italy.
J Neurooncol. 2015 Sep;124(2):283-9. doi: 10.1007/s11060-015-1838-6. Epub 2015 Jun 4.
To investigate the role of hypo-fractionated stereotactic radiation treatment (HSRT) in the management of skull base meningioma. Twenty-six patients were included in the study and treated with a dose of 30 Gy in 5 fractions with volumetric modulated arc therapy (RapidArc). Eighteen patients were symptomatic before treatment. Endpoints were local toxicity and relief from symptoms. Tumors were located in anterior skull base in 4/27 cases, in middle skull base in 12/27 and in posterior skull base in 11/27. HSRT was performed as first treatment in 17 (65 %) patients, in 9 (35 %) patients it followed a previous partial resection. Median follow up was 24.5 months (range 5-57 months). clinical remission of symptoms, complete or partial, was obtained in the vast majority of patients after treatment. Out of the 18 symptomatic patients, partial remission occurred in 9 (50 %) patients and complete remission in 9 (50 %). All asymptomatic patients retained their status after treatment. No severe neurologic toxicity grade III-IV was recorded. No increase of meningioma in the same site of treatment occurred; 16 (62 %) patients had stable disease and 9 (38 %) patients had tumor reduction. The mean tumor volume after treatment was 10.8 ± 17.8 cm(3) compared with 13.0 ± 19.1 cm(3) before treatment (p = 0.02). The mean actuarial OS was 54.4 ± 2.8 months. The 1- and 2-years OS was 92.9 ± 0.7 %. HSRT proved to be feasible for these patients not eligible to full surgery or to ablative radiation therapy. Local control and durability of results suggest for a routine application of this approach in properly selected cases.
探讨低分割立体定向放射治疗（HSRT）在颅底脑膜瘤治疗中的作用。本研究纳入26例患者，采用容积调强弧形放疗（RapidArc）分5次给予30 Gy剂量进行治疗。18例患者治疗前有症状。观察终点为局部毒性和症状缓解情况。肿瘤位于前颅底4/27例，中颅底12/27例，后颅底11/27例。17例（65%）患者将HSRT作为首次治疗，9例（35%）患者此前接受过部分切除术，之后进行HSRT。中位随访时间为24.5个月（范围5 - 57个月）。绝大多数患者治疗后症状获得临床缓解，完全或部分缓解。18例有症状的患者中，9例（50%）部分缓解,9例（50%）完全缓解。所有无症状患者治疗后维持无症状状态。未记录到III - IV级严重神经毒性。治疗部位未出现脑膜瘤增大；16例（62%）患者病情稳定，9例（38%）患者肿瘤缩小。治疗后平均肿瘤体积为10.8±17.8 cm³，治疗前为13.0±19.1 cm³（p = 0.02）。平均精算总生存期为54.4±2.8个月。1年和2年总生存率为92.9±0.7%。对于不适合进行全手术或消融性放射治疗的患者，HSRT被证明是可行的。局部控制和结果的持久性表明，在适当选择的病例中可常规应用这种方法。
