Zhi Ming, Girvigian Michael R, Miller Michael J, Chen Joseph C, Schumacher Andrew J, Rahimian Javad, Lodin Kenneth
Department of Radiation Oncology, Kaiser Permanente-Los Angeles Medical Center, Los Angeles, California, USA.
Department of Radiation Oncology, Kaiser Permanente-Los Angeles Medical Center, Los Angeles, California, USA.
World Neurosurg. 2019 Feb;122:e1153-e1161. doi: 10.1016/j.wneu.2018.11.006. Epub 2018 Nov 14.
The role of adjuvant radiotherapy (ART) in patients with World Health Organization Grade II atypical meningiomas (AMs) remains controversial.
We retrospectively reviewed 149 patients with newly diagnosed resected AMs from 2000 to 2012. Gross total resection (GTR) was defined as Simpson Grades I-III and subtotal resection (STR) as Grades IV and V. Kaplan-Meier analyses of local control (LC), progression-free survival (PFS), and overall survival were performed with the log-rank test, and risk factors for progression/recurrence (P/R) were analyzed with multivariate Cox regression.
Median follow-up was 74.2 months. GTR was achieved in 98 patients and STR in 51 patients. Fifty-three (35%) patients received ART. Overall, 46 patients (31%) experienced P/R with a median time to P/R of 32.4 months. ART was associated with a trend toward improved PFS (P = 0.0669) in the GTR subset but significantly improved LC (P = 0.0183) and PFS (P = 0.0034) in the STR subset. Age, tumor size, and STR were significant risk factors for worse PFS, whereas receiving ART was associated with improved PFS on multivariate analyses. Thirty-nine of the 46 progressive/recurrent patients underwent salvage therapy with only 22 patients experiencing long-term control. Five patients experienced transformation to World Health Organization Grade III malignant meningioma.
Patients who undergo STR for newly diagnosed AM should receive ART based on improvements in LC and PFS. GTR patients should be considered for ART, but active surveillance is a reasonable management approach with the recognition that progressive/recurrent disease can act aggressively. Prospective, randomized trials are currently underway to evaluate the role of ART.
辅助放疗（ART）在世界卫生组织II级非典型脑膜瘤（AMs）患者中的作用仍存在争议。
我们回顾性分析了2000年至2012年149例新诊断为切除性AMs的患者。将大体全切（GTR）定义为辛普森分级I - III级，次全切除（STR）定义为IV级和V级。采用对数秩检验进行局部控制（LC）、无进展生存期（PFS）和总生存期的Kaplan - Meier分析，并通过多变量Cox回归分析进展/复发（P/R）的危险因素。
中位随访时间为74.2个月。98例患者实现了GTR，51例患者为STR。53例（35%）患者接受了ART。总体而言，46例（31%）患者出现P/R，P/R的中位时间为32.4个月。在GTR亚组中，ART与PFS改善趋势相关（P = 0.0669），但在STR亚组中显著改善了LC（P = 0.0183）和PFS（P = 0.0034）。年龄、肿瘤大小和STR是PFS较差的显著危险因素，而在多变量分析中接受ART与PFS改善相关。46例进展/复发患者中有39例接受了挽救治疗，只有22例患者实现了长期控制。5例患者发生了向世界卫生组织III级恶性脑膜瘤的转变。
新诊断为AMs且接受STR的患者应基于LC和PFS的改善接受ART。GTR患者应考虑接受ART，但鉴于进展/复发性疾病可能具有侵袭性，积极监测是一种合理的管理方法。目前正在进行前瞻性随机试验以评估ART的作用。
