Interdisciplinary Centre for Radiosurgery (ICERA), Radiological Alliance Hamburg, Mörkenstr.47, 22767, Hamburg, Germany.
Department of Clinical Neuroscience, Karolinska Institute, Centre for Molecular Medicine L8:04, Karolinska University Hospital, S-17176, Stockholm, Sweden.
Acta Neurochir (Wien). 2020 Sep;162(9):2183-2196. doi: 10.1007/s00701-020-04350-5. Epub 2020 Jun 26.
With regard to the generally slow growth of meningioma, it is essential to analyse clinical treatment results in a long-term perspective. The purpose of the present analysis is to provide clinical data after Gamma Knife radiosurgery of meningioma in a 10-year perspective together with a review of the current literature.
The current study is a retrospective analysis of 86 consecutive Swedish patients with meningiomas treated using Gamma Knife radiosurgery at the Karolinska Hospital Stockholm between March 1991 and May 2001. A total of 130 tumours were treated in 115 treatment sessions. The median radiological follow-up was 10 years (1.8-16.5 years), and the median clinical follow-up was 9.4 years (2.1-17.4 years).
After a median follow-up period of 10 years, local tumour control was achieved in 87.8% of meningiomas (108/123 tumours). The median latency between initial treatment and local (in-field) recurrence (n = 15) was 5.8 years (1.9-11.5). Recurrences adjacent but outside the initial radiation field occurred in 15.1% of patients (13/86) at a median of 7.5 years (1.3-15.7). New meningiomas were seen in 10.5% after a median of 5.4 years (0.9-10.8). In 72% of patients, no further treatment was required, 17.4% (15/86) underwent a second Gamma Knife treatment, 4.7% (4/86) required later open surgery and 5.8% (5/86) required both secondary treatments. Eighty-six percent of patients were neurologically unchanged or improved. A significantly lower rate of local (in-field) recurrences was seen in meningiomas treated with a prescription dose of > 13.4 Gy (7.1% vs. 24%, p = 0.02).
The current retrospective analysis provides a 10-year follow-up and comprises one of the longest available follow-up studies of radiosurgically treated meningiomas. The current series documents a persistent high local tumour control after Gamma Knife treatment, while providing an estimation of a necessary minimum dose for long-term tumour control in meningiomas. The study confirms the validity of previous short-term data in a long-term perspective.
鉴于脑膜瘤的生长通常较为缓慢，从长远角度分析临床治疗结果至关重要。本分析的目的是提供 10 年伽玛刀放射外科治疗脑膜瘤的临床数据，并结合当前文献进行回顾。
本研究是对在斯德哥尔摩卡罗林斯卡医院于 1991 年 3 月至 2001 年 5 月期间使用伽玛刀放射外科治疗的 86 例瑞典连续脑膜瘤患者的回顾性分析。共有 130 个肿瘤在 115 次治疗中接受了治疗。中位影像学随访时间为 10 年（1.8-16.5 年），中位临床随访时间为 9.4 年（2.1-17.4 年）。
中位随访 10 年后，87.8%（108/123 个肿瘤）的脑膜瘤实现了局部肿瘤控制。最初治疗后至局部（靶区内）复发（n=15）的中位潜伏期为 5.8 年（1.9-11.5 年）。15.1%（13/86）的患者在初始放射野外相邻部位出现复发，中位时间为 7.5 年（1.3-15.7 年）。10.5%的患者在中位时间 5.4 年后（0.9-10.8 年）出现新的脑膜瘤。72%的患者无需进一步治疗，17.4%（15/86）的患者接受了第二次伽玛刀治疗，4.7%（4/86）需要进一步开放手术，5.8%（5/86）需要进行二次治疗。86%的患者神经功能保持不变或改善。处方剂量>13.4Gy 的脑膜瘤局部（靶区内）复发率显著降低（7.1% vs. 24%，p=0.02）。
本次回顾性分析提供了 10 年的随访结果，是目前可获得的最长时间内伽玛刀治疗脑膜瘤随访研究之一。本系列研究记录了伽玛刀治疗后持续高的局部肿瘤控制率，同时估计了脑膜瘤长期肿瘤控制所需的最小剂量。该研究从长远角度证实了以往短期数据的有效性。
