Jenkinson Michael D, Waqar Mueez, Farah Jibril Osman, Farrell Michael, Barbagallo Giuseppe M V, McManus Robin, Looby Seamus, Hussey Deirdre, Fitzpatrick David, Certo Francesco, Javadpour Mohsen
Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Lower Lane, Liverpool L9 7LJ, UK; Institute of Translational Medicine and School of Medicine, University of Liverpool, Liverpool, UK.
Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Lower Lane, Liverpool L9 7LJ, UK; Institute of Translational Medicine and School of Medicine, University of Liverpool, Liverpool, UK.
J Clin Neurosci. 2016 Jun;28:87-92. doi: 10.1016/j.jocn.2015.09.021. Epub 2016 Jan 8.
Atypical meningiomas have a greater propensity to recur than benign meningiomas and the benefits of early adjuvant radiotherapy are unclear. Existing studies report conflicting results. This retrospective cohort study evaluated the role of early adjuvant radiotherapy following surgical resection of atypical meningioma. A triple center case-note review of adults with newly-diagnosed atypical meningiomas between 2001 and 2010 was performed. Pathology diagnosis was made according to the World Health Organization classification in use at the time of surgery. Patients with multiple meningiomas, neurofibromatosis type 2 and radiation-induced meningiomas were excluded. Extent of resection was defined as gross total resection (GTR; Simpson Grade I-III) or subtotal resection (STR; Simpson Grade IV-V). Survival analysis was performed using the Kaplan-Meier method. One hundred thirty-three patients were identified with a median age of 62years (range 22-86years) and median follow-up of 57.4months (range 0.1-152.2months). Tumors were mostly located in the convexity (50.4%) or falcine/parasagittal regions (27.1%). GTR (achieved in 85%) was associated with longer progression free survival (PFS) (5year PFS 81.2% versus 40.08%, log-rank=11.117, p=0.001) but not overall survival (OS) (5year OS 76.6% versus 39.7%, log-rank=3.652, p=0.056). Following GTR, early adjuvant radiotherapy was administered to 28.3% of patients and did not influence OS (5year OS 77.0% versus 75.7%, log-rank=0.075, p=0.784) or PFS (5year PFS 82.0% versus 79.3%, log-rank=0.059, p=0.808). Although extent of resection emerged as an important prognostic variable, early adjuvant radiotherapy did not influence outcome following GTR of atypical meningiomas. Prospective randomized controlled trials are planned.
非典型脑膜瘤比良性脑膜瘤更易复发，早期辅助放疗的益处尚不清楚。现有研究报告的结果相互矛盾。这项回顾性队列研究评估了非典型脑膜瘤手术切除后早期辅助放疗的作用。对2001年至2010年间新诊断为非典型脑膜瘤的成年人进行了三中心病例记录回顾。病理诊断根据手术时使用的世界卫生组织分类标准进行。排除患有多发性脑膜瘤、2型神经纤维瘤病和放射性脑膜瘤的患者。切除范围定义为全切除（GTR；辛普森分级I-III级）或次全切除（STR；辛普森分级IV-V级）。采用Kaplan-Meier方法进行生存分析。共确定了133例患者，中位年龄为62岁（范围22-86岁），中位随访时间为57.4个月（范围0.1-152.2个月）。肿瘤大多位于凸面（50.4%）或镰状/矢状旁区域（27.1%）。GTR（85%的患者实现）与更长的无进展生存期（PFS）相关（5年PFS为81.2%对40.08%，对数秩检验=11.117，p=0.001），但与总生存期（OS）无关（5年OS为76.6%对39.7%，对数秩检验=3.652，p=0.056）。在GTR后，28.3%的患者接受了早期辅助放疗，这并未影响OS（5年OS为77.0%对75.7%，对数秩检验=0.075，p=0.784）或PFS（5年PFS为82.0%对79.3%，对数秩检验=0.059，p=0.808）。尽管切除范围是一个重要的预后变量，但早期辅助放疗并未影响非典型脑膜瘤GTR后的预后。计划进行前瞻性随机对照试验。
