Department of Neurosurgery, The Uni-versity of Tokyo Hospital, Tokyo, Japan.
Department of Radiation Oncology, The University of Tokyo Hospital, Tokyo, Japan.
Oper Neurosurg (Hagerstown). 2018 Apr 1;14(4):341-350. doi: 10.1093/ons/opx109.
Stereotactic radiosurgery (SRS) has been accepted as a therapeutic option for intracranial meningiomas; however, the detailed data on outcomes in elderly patients remain unclear.
To delineate the efficacy of SRS for meningiomas in elderly patients.
The outcomes of 67 patients aged ≥65 yr who underwent SRS for benign intracranial meningioma (World Health Organization grade I) between 1990 and 2014 at our institution were retrospectively analyzed. The median age was 71 yr (range, 65-83 yr), and the mean and median follow-up were 62 and 52 mo (range, 7-195 mo), respectively. Tumor margins were irradiated with a median dose of 16 Gy, and the median tumor volume was 4.9 cm3 (range, 0.7-22.9 cm3).
Actuarial local tumor control rates at 3, 5, and 10 yr after SRS were 92%, 86%, and 72%, respectively. Previous surgery and parasagittal/falcine location were statistically significant predictive factors for failed tumor control. Mild or moderate adverse events were noted in 9 patients. No severe adverse event was observed. A higher margin dose was significantly associated with adverse events by univariate analysis.
SRS is one of the standard therapies for meningiomas in elderly patients, providing both favorable tumor control and a low risk of adverse events under minimum invasiveness.
立体定向放射外科（SRS）已被接受为颅内脑膜瘤的治疗选择；然而，关于老年患者的详细结果数据仍不清楚。
阐明 SRS 治疗老年脑膜瘤患者的疗效。
回顾性分析了 1990 年至 2014 年间在我院接受 SRS 治疗的 67 例年龄≥65 岁的良性颅内脑膜瘤（世界卫生组织分级 I）患者的结果。患者的中位年龄为 71 岁（范围 65-83 岁），平均和中位随访时间分别为 62 个月和 52 个月（范围 7-195 个月）。肿瘤边缘接受了 16Gy 的中位剂量照射，肿瘤体积中位数为 4.9cm3（范围 0.7-22.9cm3）。
SRS 后 3、5 和 10 年的肿瘤局部控制率分别为 92%、86%和 72%。先前的手术和矢状窦旁/蝶骨嵴位置是肿瘤控制失败的统计学显著预测因素。9 例患者出现轻度或中度不良反应，无严重不良事件。单因素分析显示，较高的边缘剂量与不良反应显著相关。
SRS 是老年脑膜瘤患者的标准治疗方法之一，在微创的前提下既能提供良好的肿瘤控制，又能降低不良反应的风险。
