世界卫生组织II级和III级脑膜瘤的立体定向放射外科治疗：长期临床和影像学结果分析
Stereotactic radiosurgery for WHO II and III meningiomas: analysis of long-term clinical and radiographic outcomes.
作者信息
Williams Brian J, Salvetti David J, Starke Robert M, Yen Chun Po, Sheehan Jason P
机构信息
Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
出版信息
J Radiosurg SBRT. 2013;2(3):183-191.
BACKGROUND/AIM: WHO grade II and III meningiomas are challenging tumors to treat, and the role of stereotactic radiosurgery (SRS) in their treatment is not well defined. We evaluate our experience to better define its role and assess for clinical and radiographic predictors of failure.
METHODS
This is a retrospective analysis of all patients with histological diagnosis of WHO II or III meningioma. Thirteen patients were included. The mean dose to the periphery was 16 Gy (12-20), the mean maximum dose was 31 Gy (13-40), and the mean isodose line was 49% (35-50).
RESULTS
The median age was 48 years. The median follow up was 50 months (7-67). All cases had undergone at least one previous resection, and six patients had undergone external beam radiation (EBRT). The median pre SRS Karnofsky performance score (KPS) was 90. The progression free survival (PFS) was 92% and 31% at 1 and 4 years, respectively. Eleven patients required further treatment after SRS. The final tumor volume was decreased in 7 patients, stable in 1, and increased in 6.
CONCLUSIONS
WHO grade II and III meningiomas are aggressive tumors that will require multiple treatments. SRS may be a useful as an adjuvant treatment or for recurrence.
背景/目的：世界卫生组织（WHO）二级和三级脑膜瘤是具有挑战性的肿瘤，立体定向放射外科（SRS）在其治疗中的作用尚未明确界定。我们评估自身经验以更好地明确其作用，并评估失败的临床和影像学预测因素。
方法
这是一项对所有经组织学诊断为WHO二级或三级脑膜瘤患者的回顾性分析。共纳入13例患者。周边平均剂量为16 Gy（12 - 20），平均最大剂量为31 Gy（13 - 40），平均等剂量线为49%（35 - 50）。
结果
中位年龄为48岁。中位随访时间为50个月（7 - 67）。所有病例此前至少接受过一次手术切除，6例患者接受过外照射放疗（EBRT）。SRS前中位卡诺夫斯基表现评分（KPS）为90。1年和4年的无进展生存期（PFS）分别为92%和31%。11例患者在SRS后需要进一步治疗。7例患者最终肿瘤体积减小，1例稳定，6例增大。
结论
WHO二级和三级脑膜瘤是侵袭性肿瘤，需要多种治疗方法。SRS作为辅助治疗或用于复发情况可能有用。
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