Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, 3-6-28 Okinogami, Fukuyama 720-0825, Japan.
Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan.
J Clin Neurosci. 2020 Mar;73:24-30. doi: 10.1016/j.jocn.2020.02.019. Epub 2020 Feb 15.
The use of gamma knife radiosurgery (GKS) for meningiomas after cranial surgery has been extensively evaluated; however, studies on tumor progression, including recurrence out of the margin dose line, are scarce. Hence, we aimed to evaluate the meningioma recurrence after GKS within and out of the margin dose. We included 37 consecutive patients with World Health Organization (WHO) grade 1 meningiomas who were treated with GKS following cranial surgery. Radiologically indicated recurrences were classified into three patterns by their relationship to the margin dose and tumor. The median follow-up was 58.9 months; 2 (5.4%) patients died. Only 2 (5.4%) patients did not keep active daily lives because of tumor progression. Cumulative local control at 5 years was 85.2%. Local recurrence and recurrence out of the margin dose occurred in 5 (13.5%) and 13 (35.1%) patients, respectively. A larger preoperative maximum diameter was a risk factor for local recurrence (hazard ratio [HR]: 2.118; P = 0.033), adjacent progression (HR: 1.633; P = 0.015), and remote progression (HR: 2.016; P = 0.003). Symptomatic adverse radiation effects occurred in 1 patient. Salvage GKS and cranial surgery were performed in 9 (24.3%) and 8 (21.6%) patients, respectively. Progression to WHO grade 2-3 occurred in 5 (13.5%) patients. A larger preoperative maximum diameter was a risk factor for progression of WHO grade (HR: 2.016, P = 0.033). Progression out of the margin dose was associated with a larger preoperative tumor size.
伽玛刀放射外科（GKS）在颅后手术治疗脑膜瘤中的应用已得到广泛评估；然而，关于肿瘤进展的研究，包括超出边缘剂量线的复发，却很少见。因此，我们旨在评估 GKS 治疗后脑膜瘤的边缘剂量内和边缘剂量外的复发情况。我们纳入了 37 例连续的颅后手术治疗后接受 GKS 治疗的世界卫生组织（WHO）分级 1 脑膜瘤患者。根据肿瘤与边缘剂量的关系，影像学提示的复发分为三种模式。中位随访时间为 58.9 个月；2 例（5.4%）患者死亡。仅有 2 例（5.4%）患者因肿瘤进展而无法保持正常的日常生活。5 年局部控制率为 85.2%。局部复发和边缘剂量外复发分别发生在 5 例（13.5%）和 13 例（35.1%）患者中。较大的术前最大直径是局部复发的危险因素（风险比[HR]：2.118；P=0.033）、邻近进展（HR：1.633；P=0.015）和远处进展（HR：2.016；P=0.003）。1 例出现症状性放射性不良反应。9 例（24.3%）患者进行了挽救性 GKS 治疗，8 例（21.6%）患者进行了颅后手术治疗。5 例（13.5%）患者进展为 WHO 分级 2-3。较大的术前最大直径是进展为 WHO 分级的危险因素（HR：2.016，P=0.033）。边缘剂量外的进展与术前较大的肿瘤大小有关。
