Cohen-Inbar Or, Lee Cheng-chia, Schlesinger David, Xu Zhiyuan, Sheehan Jason P
Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan; National Yang-Ming University, Taipei, Taiwan.
World Neurosurg. 2016 Mar;87:431-8. doi: 10.1016/j.wneu.2015.10.081. Epub 2015 Nov 5.
Meningiomas are the most common primary benign brain tumor. Radiosurgery (primary or adjuvant) allows excellent local control. The Geriatric Scoring System (GSS) for preoperative risk stratification and outcome prediction of patients with meningiomas has been reported previously. The GSS incorporates 8 tumor and patient parameters on admission. A GSS score greater than 16 was reported previously to be associated with a more favorable outcome. We assessed the validity of the GSS score and its influence on outcome in patients treated with Gamma-Knife radiosurgery (GKRS).
Patients treated with single-session GKRS for World Health Organization grade I meningioma during 1989-2013 at the University of Virginia were reviewed. The cohort comprised 323 patients, 50.2% (n = 162) male. Median age was 56 years (29-84 years), and median follow-up was 53.6 months (6-235 months). Median tumor volume was 4.5 cm(3) (0.2-23). Median margin and maximal doses were 15 Gy (8-36) and 32.3 Gy (20-65), respectively.
Tumor volume control was achieved in 87% (n = 281), and post-GKRS clinical neurologic improvement was reported in 66.3% (n = 214). The median change in KPS was +10 (range -30 to +40). The most common complication was intermittent headaches (34.1%, n = 110) and cranial nerve deficits (14.2%, n = 46). The GSS (calculated and grouped as GSS > 16 and GSS ≤ 16) was found to correlate with different post-GKRS functional status (P < 0.0001) and tumor control (P = 0.028).
The GSS, used for risk stratification and outcome prediction in patients with meningiomas, seems valid for patients undergoing single-session GRKS. A GSS score greater than 16 is associated with a better long-term functional status and tumor control.
脑膜瘤是最常见的原发性良性脑肿瘤。放射外科手术（原发性或辅助性）可实现出色的局部控制。先前已报道了用于脑膜瘤患者术前风险分层和预后预测的老年评分系统（GSS）。GSS纳入了入院时的8个肿瘤和患者参数。先前报道GSS评分大于16与更有利的预后相关。我们评估了GSS评分的有效性及其对接受伽玛刀放射外科手术（GKRS）治疗的患者预后的影响。
回顾了1989年至2013年在弗吉尼亚大学接受单疗程GKRS治疗世界卫生组织I级脑膜瘤的患者。该队列包括323例患者，其中50.2%（n = 162）为男性。中位年龄为56岁（29 - 84岁），中位随访时间为53.6个月（6 - 235个月）。中位肿瘤体积为4.5 cm³（0.2 - 23）。中位边缘剂量和最大剂量分别为15 Gy（8 - 36）和32.3 Gy（20 - 65）。
87%（n = 281）的患者实现了肿瘤体积控制，66.3%（n = 214）的患者报告GKRS术后临床神经功能改善。KPS的中位变化为+10（范围 - 30至+40）。最常见的并发症是间歇性头痛（34.1%，n = 110）和脑神经功能缺损（14.2%，n = 46）。发现GSS（计算并分组为GSS > 16和GSS ≤ 16）与GKRS术后不同的功能状态（P < 0.0001）和肿瘤控制情况（P = 0.028）相关。
用于脑膜瘤患者风险分层和预后预测的GSS，对于接受单疗程GRKS的患者似乎是有效的。GSS评分大于16与更好的长期功能状态和肿瘤控制相关。
