Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina, USA.
Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina, USA.
World Neurosurg. 2020 Dec;144:e53-e61. doi: 10.1016/j.wneu.2020.07.211. Epub 2020 Aug 3.
Although most meningiomas will be benign, a small proportion will have atypical or anaplastic histologic features and will exhibit more aggressive behavior. The treatment of these tumors has been controversial, especially for patients with recurrence after resection and radiotherapy. We have presented a large series of atypical and anaplastic meningiomas treated with stereotactic radiosurgery (SRS).
We performed a retrospective review of a single-institution radiosurgery database and identified 48 patients with 183 lesions who had undergone 99 SRS sessions from 1999 to 2019. The median dose was 15 Gy prescribed to the 50% isodose line. The center of the failures was plotted, and the distance from the treated tumor to the center of the failure was measured. Simulated treatment volumes for external beam radiotherapy were generated according to the target, and failures were characterized as local, marginal, or distant according to the simulated volume.
The 5-year disease-free and overall survival rate measured from the initial SRS session was 45.8% and 74.7%, respectively. The 5-year lesional control rate was 68.9%. The most common pattern of first failure was isolated distant failure, followed by isolated local or marginal failure. The incidence of distant failure was significantly greater after treatment of >2 lesions in a single SRS session. Isolated local/marginal failure was associated with grade III tumors and an increasing tumor size.
High-risk meningiomas are a heterogeneous group of tumors with a propensity for multiple failures. The most common pattern of relapse after SRS was distant. However, local control remains an issue. Further studies evaluating dose-escalation strategies are warranted.
尽管大多数脑膜瘤为良性，但一小部分脑膜瘤具有非典型或间变的组织学特征，并表现出更具侵袭性的行为。这些肿瘤的治疗一直存在争议，尤其是对于接受过切除和放疗后复发的患者。我们报告了一组采用立体定向放射外科（SRS）治疗的非典型和间变脑膜瘤的大型系列病例。
我们对一家机构的放射外科数据库进行了回顾性分析，确定了 1999 年至 2019 年间，48 例患者的 183 个病灶接受了 99 次 SRS 治疗。中位剂量为 15Gy，规定为 50%等剂量线。绘制了失败中心，并测量了治疗肿瘤到失败中心的距离。根据靶区生成外照射放疗的模拟治疗体积，并根据模拟体积将失败特征化为局部、边缘或远处。
从初始 SRS 治疗开始，5 年无疾病生存率和总生存率分别为 45.8%和 74.7%。5 年病灶控制率为 68.9%。首次失败的最常见模式是孤立的远处失败，其次是孤立的局部或边缘失败。单次 SRS 治疗中治疗 2 个以上病灶后，远处失败的发生率明显更高。孤立的局部/边缘失败与 3 级肿瘤和肿瘤大小增加有关。
高危脑膜瘤是一组具有多发性失败倾向的异质性肿瘤。SRS 后复发最常见的模式是远处复发。然而，局部控制仍然是一个问题。需要进一步研究评估剂量递增策略。
