Manabe Yoshihiko, Murai Taro, Ogino Hiroyuki, Tamura Takeshi, Iwabuchi Michio, Mori Yoshimasa, Iwata Hiromitsu, Suzuki Hirochika, Shibamoto Yuta
Department of Radiology, Nagoya City University Graduate School of Medical Sciences.
Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center.
Neurol Med Chir (Tokyo). 2017 Dec 15;57(12):627-633. doi: 10.2176/nmc.oa.2017-0115. Epub 2017 Oct 12.
Definitive radiotherapy is an important alternative treatment for meningioma patients who are inoperable or refuse surgery. We evaluated the efficacy and toxicity of CyberKnife-based stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (hSRT) as first-line treatments for intracranial meningiomas that were diagnosed using magnetic resonance imaging (MRI) and/or computed tomography (CT). Between February 2005 and September 2015, 41 patients with intracranial meningiomas were treated with CyberKnife-based SRS or hSRT. Eleven of those tumors were located in the skull base. The median tumor volume was 10.4 ml (range, 1.4-56.9 ml). The median prescribed radiation dose was 17 Gy (range, 13-20 Gy to the 61-88% isodose line) for SRS (n = 9) and 25 Gy (range, 14-38 Gy to the 44-83% isodose line) for hSRT (n = 32). The hSRT doses were delivered in 2 to 10 daily fractions. The median follow-up period was 49 months (range, 7-138). The 5-year progression-free survival rate (PFS) for all 41 patients was 86%. The 3-year PFS was 69% for the 14 patients with tumor volumes of ≥13.5 ml (30 mm in diameter) and 100% for the 27 patients with tumor volumes of <13.5 ml (P = 0.031). Grade >2 toxicities were observed in 5 patients (all of them had tumor volumes of ≥13.5 ml). SRS and hSRT are safe and effective against relatively small (<13.5 ml) meningiomas.
对于无法手术或拒绝手术的脑膜瘤患者，立体定向放射治疗是一种重要的替代治疗方法。我们评估了基于射波刀的立体定向放射外科治疗（SRS）和大分割立体定向放射治疗（hSRT）作为使用磁共振成像（MRI）和/或计算机断层扫描（CT）诊断的颅内脑膜瘤一线治疗方法的疗效和毒性。在2005年2月至2015年9月期间，41例颅内脑膜瘤患者接受了基于射波刀的SRS或hSRT治疗。其中11个肿瘤位于颅底。肿瘤体积中位数为10.4 ml（范围为1.4 - 56.9 ml）。SRS（n = 9）的中位处方剂量为17 Gy（范围为13 - 20 Gy至61 - 88%等剂量线），hSRT（n = 32）的中位处方剂量为25 Gy（范围为14 - 38 Gy至44 - 83%等剂量线）。hSRT剂量分2至10次每日给予。中位随访期为49个月（范围为7 - 138个月）。41例患者的5年无进展生存率（PFS）为86%。肿瘤体积≥13.5 ml（直径30 mm）的14例患者的3年PFS为69%，肿瘤体积<13.5 ml的27例患者的3年PFS为100%（P = 0.031）。5例患者出现>2级毒性反应（所有患者肿瘤体积均≥13.5 ml）。SRS和hSRT对于相对较小（<13.5 ml）的脑膜瘤是安全有效的。
