Sun Sam Q, Cai Chunyu, Murphy Rory K J, DeWees Todd, Dacey Ralph G, Grubb Robert L, Rich Keith M, Zipfel Gregory J, Dowling Joshua L, Leuthardt Eric C, Simpson Joseph R, Robinson Clifford G, Chicoine Michael R, Perrin Richard J, Huang Jiayi, Kim Albert H
‡Washington University School of Medicine, St. Louis, Missouri; §Department of Pathology and Immunology, Washington University, St. Louis, Missouri; ¶Department of Neurosurgery, Washington University, St. Louis, Missouri; ‖Department of Radiation Oncology, Washington University, St. Louis, Missouri.
Neurosurgery. 2016 Jul;79(1):23-32. doi: 10.1227/NEU.0000000000001160.
Optimal use of stereotactic radiosurgery (SRS) vs external beam radiation therapy (EBRT) for treatment of residual/recurrent atypical meningioma is unclear.
To analyze features associated with progression after radiation therapy.
Fifty radiation-naive patients who received SRS or EBRT for residual and/or recurrent atypical meningioma were examined for predictors of progression using Cox regression and Kaplan-Meier analyses.
Thirty-two patients (64%) received adjuvant radiation after subtotal resection, 12 patients (24%) received salvage radiation after progression following subtotal resection, and 6 patients (12%) received salvage radiation after recurrence following gross total resection. Twenty-one patients (42%) received SRS (median 18 Gy), and 7 (33%) had tumor progression. Twenty-nine patients (58%) received EBRT (median 54 Gy), and 13 (45%) had tumor progression. Whereas tumor volume (P = .53), SRS vs EBRT (P = .45), and adjuvant vs salvage (P = .34) were not associated with progression after radiation therapy, spontaneous necrosis (hazard ratio [HR] = 82.3, P < .001), embolization necrosis (HR = 15.6, P = .03), and brain invasion (HR = 3.8, P = .008) predicted progression in univariate and multivariate analyses. Tumors treated with SRS/EBRT had 2- and 5-year actuarial locoregional control rates of 91%/88% and 71%/69%, respectively. Tumors with spontaneous necrosis, embolization necrosis, and no necrosis had 2- and 5-year locoregional control rates of 76%, 92%, and 100% and 36%, 73%, and 100%, respectively (P < .001).
This study suggests that necrosis may be a negative predictor of radiation response regardless of radiation timing or modality.
AM, atypical meningiomaEBRT, external beam radiation therapyGTR, gross total resectionLC, locoregional controlOS, overall survivalPOE, preoperative embolizationRT, radiation therapySRS, stereotactic radiosurgerySTR, subtotal resection.
立体定向放射外科（SRS）与外照射放疗（EBRT）在治疗残留/复发性非典型脑膜瘤时的最佳应用尚不清楚。
分析放疗后与疾病进展相关的特征。
对50例接受SRS或EBRT治疗残留和/或复发性非典型脑膜瘤的初治放疗患者，采用Cox回归和Kaplan-Meier分析来检测疾病进展的预测因素。
32例患者（64%）在次全切除术后接受辅助放疗，12例患者（24%）在次全切除术后病情进展后接受挽救性放疗，6例患者（12%）在全切术后复发后接受挽救性放疗。21例患者（42%）接受SRS（中位剂量18 Gy），其中7例（33%）出现肿瘤进展。29例患者（58%）接受EBRT（中位剂量54 Gy），其中13例（45%）出现肿瘤进展。放疗后，肿瘤体积（P = 0.53）、SRS与EBRT（P = 0.45）以及辅助放疗与挽救性放疗（P = 0.34）均与疾病进展无关，但在单因素和多因素分析中，自发坏死（风险比[HR]=82.3，P < 0.001）、栓塞后坏死（HR = 15.6，P = 0.03）和脑侵犯（HR = 3.8，P = 0.008）可预测疾病进展。接受SRS/EBRT治疗的肿瘤2年和5年局部区域控制率分别为91%/88%和71%/69%。有自发坏死、栓塞后坏死和无坏死的肿瘤2年和5年局部区域控制率分别为76%、92%和100%以及36%、73%和100%（P < 0.001）。
本研究提示，无论放疗时机或方式如何，坏死可能是放疗反应的负性预测因素。
AM，非典型脑膜瘤；EBRT，外照射放疗；GTR，全切；LC，局部区域控制；OS，总生存；POE，术前栓塞；RT，放疗；SRS，立体定向放射外科；STR，次全切除
