Boulle Geoffroy, Bracci Stefano, Hitchcock Kathryn, Jacob Julian, Clausse Emmanuelle, Halley Amandine, Belghith Bacem, Kamsu Kom Leopold, Canova Charles-Henri, Bielle Franck, Chevalier Antoine, Peyre Matthieu, Mazeron Jean-Jacques, Maingon Philippe, Feuvret Loïc
Department of Radiation Oncology, Hôpital Pitié-Salpêtrière Charles Foix, APHP, Paris, France.
Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Roma, Italy.
J Clin Neurosci. 2019 Jan;59:190-196. doi: 10.1016/j.jocn.2018.10.073. Epub 2018 Oct 24.
Meningiomas account for 30-35% of intracranial tumors. Grade I meningiomas are most common and carry the best prognosis. Grade II and III meningiomas are more aggressive and the outcomes after surgical resection alone remain unsatisfactory. The main objective of this retrospective, single-center study was to assess our results of treatment of grade II-III intracranial meningioma with helical tomotherapy (HT). We retrospectively reviewed patients with histologically proven (WHO 2007) grade II-III meningioma irradiated with HT. Patients were treated one session a day, 5 days a week, to a total dose of 59.4 Gy and 68.4 Gy delivered in 33 and 38 fractions of 1.8 Gy each to the LR PTV and HR PTV, with or without simultaneous integrated boost. From May 2011 to January 2015, 19 patients (15 with grade II and 4 with grade III meningiomas) were treated. Median follow-up for patients with Grade II or Grade III meningiomas, was 29.2 months (range, 10.7-52.4) and 21.3 months (range, 2.4-51.3), respectively. Disease free survival at 1, 2 and 3 years was 89.2%, 83.6% and 56.3% respectively. Overall survival at 1, 2 and 3 years was 94.7%, 94.7% and 78.9%, respectively. No patient had neurological toxicity greater than grade 2 in the acute period. During follow-up, only one patient had neurological toxicity greater than or equal to grade 3. The management of grade II to III meningiomas using HT with doses exceeding 60 Gy is associated with good local control and acceptable survival results.
脑膜瘤占颅内肿瘤的30% - 35%。I级脑膜瘤最为常见，预后最佳。II级和III级脑膜瘤侵袭性更强，单纯手术切除后的效果仍不尽人意。这项回顾性单中心研究的主要目的是评估我们采用螺旋断层放射治疗（HT）治疗II - III级颅内脑膜瘤的结果。我们回顾性分析了经组织学证实（WHO 2007）接受HT照射的II - III级脑膜瘤患者。患者每天接受一次治疗，每周5天，LR PTV和HR PTV的总剂量分别为59.4 Gy和68.4 Gy，分33次和38次给予，每次1.8 Gy，有或无同步整合加量。2011年5月至2015年1月，共治疗了19例患者（15例II级脑膜瘤和4例III级脑膜瘤）。II级或III级脑膜瘤患者的中位随访时间分别为29.2个月（范围10.7 - 52.4个月）和21.3个月（范围2.4 - 51.3个月）。1年、2年和3年的无病生存率分别为89.2%、83.6%和56.3%。1年、2年和3年的总生存率分别为94.7%、94.7%和78.9%。急性期无患者出现大于2级的神经毒性。随访期间，只有1例患者出现大于或等于3级的神经毒性。使用HT且剂量超过60 Gy治疗II至III级脑膜瘤可实现良好的局部控制并获得可接受的生存结果。
