Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital Tuebingen, Calwerstr. 3, 72076, Tuebingen, Germany.
Radiat Oncol. 2019 Jul 29;14(1):132. doi: 10.1186/s13014-019-1341-x.
Various prognostic factors have been suggested in meningioma patients including WHO grading, brain invasion and bone involvement, for instance. Brain invasion was included as an independent criterion in the recent WHO classification. However, assessability of brain or bone involvement is often limited or varies between histopathologic, operative and imaging reports. Objective of our study was to investigate prognostic values including brain and bone involvement according to different clinical approaches.
A cohort of 111 patients was treated with primary, adjuvant or salvage irradiation between 2008 and 2017 using intensity-modulated radiotherapy. Positron-emission tomography (PET) was available for treatment planning in 81% of patients. Clinical data were extracted from the medical reports. Brain and bone involvement were stratified separately according to histopathologic, operative and imaging reports as well as judged in synopsis.
WHO grade I tumours, lower estimated proliferation index, primary versus recurrence treatment and localization (i.e. skull base, optic nerve sheath) were beneficial prognostic factors for local control. Judgement of brain and bone invasion partly differed between diagnostic modalities. In synopsis, brain or bone invasion did not show a significant influence on local control rates.
Several previously described prognostic factors could be reproduced. However, partly divergent histopathological, surgical and image-based judgements could be found in regard to brain and bone invasion and all methods imply limitations. Therefore, we suggest a particular, complemental synopsis judgement. In synopsis, brain or bone involvement did not coherently impair local control in our irradiated patients. This might be explained by elaborate radiation techniques and PET-based treatment planning.
在脑膜瘤患者中，已经提出了各种预后因素，包括世界卫生组织（WHO）分级、脑侵犯和骨侵犯等。脑侵犯已被纳入最近的 WHO 分类的独立标准。然而，脑或骨侵犯的可评估性通常受到限制，或者在组织病理学、手术和影像学报告之间存在差异。我们研究的目的是根据不同的临床方法，研究包括脑和骨侵犯在内的预后价值。
我们对 2008 年至 2017 年间使用调强放疗治疗的 111 名患者进行了原发性、辅助性或挽救性放疗。81%的患者使用正电子发射断层扫描（PET）进行治疗计划。临床数据从病历中提取。脑和骨侵犯根据组织病理学、手术和影像学报告以及综合判断进行分层。
WHO 分级 I 肿瘤、较低的增殖指数估计值、原发性与复发治疗以及定位（即颅底、视神经鞘）是局部控制的有利预后因素。诊断方式之间对脑和骨侵犯的判断存在部分差异。综合判断中，脑或骨侵犯与局部控制率无显著相关性。
可以重现一些以前描述的预后因素。然而，在脑和骨侵犯方面，组织病理学、手术和影像学之间的判断存在部分分歧，所有方法都存在局限性。因此，我们建议采用一种特殊的、互补的综合判断。在综合判断中，脑或骨侵犯并未在我们接受放疗的患者中一致影响局部控制率。这可能是由于采用了精细的放疗技术和基于 PET 的治疗计划。
