Lee Grace, Lamba Nayan, Niemierko Andrzej, Kim Daniel W, Chapman Paul H, Loeffler Jay S, Curry William T, Martuza Robert L, Oh Kevin S, Barker Fred G, Shih Helen A
Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Int J Radiat Oncol Biol Phys. 2021 Jan 1;109(1):252-266. doi: 10.1016/j.ijrobp.2020.08.015. Epub 2020 Aug 8.
The optimal timing of adjuvant radiation therapy (RT) in the management of atypical meningiomas remains controversial. We compared the outcomes of atypical meningiomas managed with upfront adjuvant RT versus postoperative surveillance.
Patients with intracranial atypical meningiomas who underwent resection between 2000 and 2015 at a single institution were identified. Patients receiving adjuvant RT (n = 51), defined as RT within the first year of surgery before tumor progression/recurrence (P/R), were compared with those undergoing initial surveillance (n = 179). The primary endpoints were radiographic evidence of P/R and time to P/R from surgery.
A total of 230 patients were identified. Fifty-one (22%) patients received upfront adjuvant RT, and 179 (78%) underwent surveillance. Compared with the surveillance group, patients who received adjuvant RT had larger tumors (5.2 cm vs 4.6 cm; P = .04), were more likely to have undergone subtotal resection (65% vs 26%; P < . 01), and more often had bone invasion (18% vs 7%; P = .02). On multivariable analysis, receipt of adjuvant RT was associated with a lower risk of P/R compared with surveillance (hazard ratio, 0.21; 95% confidence interval, 0.11-0.41; P < .01). Patients who initially underwent surveillance and then received salvage RT at time of P/R had a shorter median time to local progression after RT compared with patients who developed local P/R after upfront adjuvant RT (19 vs 64 months, respectively; P < . 01).
Upfront adjuvant RT was associated with improved local control in atypical meningiomas irrespective of extent of initial resection compared with surveillance. Early adjuvant RT should be strongly considered after gross total resection of atypical meningiomas.
非典型脑膜瘤治疗中辅助放疗（RT）的最佳时机仍存在争议。我们比较了采用 upfront 辅助放疗与术后监测治疗非典型脑膜瘤的疗效。
确定了 2000 年至 2015 年在单一机构接受颅内非典型脑膜瘤切除术的患者。将接受辅助放疗（n = 51）的患者（定义为在肿瘤进展/复发（P/R）前手术的第一年内接受放疗）与接受初始监测的患者（n = 179）进行比较。主要终点是 P/R 的影像学证据以及从手术到 P/R 的时间。
共确定了 230 例患者。51 例（22%）患者接受了 upfront 辅助放疗，179 例（78%）接受了监测。与监测组相比，接受辅助放疗的患者肿瘤更大（5.2 cm 对 4.6 cm；P = 0.04），更可能接受了次全切除（65%对 26%；P < 0.01），且骨侵犯更常见（18%对 7%；P = 0.02）。多变量分析显示，与监测相比，接受辅助放疗与 P/R 风险较低相关（风险比，0.21；95%置信区间，0.11 - 0.41；P < 0.01）。与 upfront 辅助放疗后发生局部 P/R 的患者相比，最初接受监测然后在 P/R 时接受挽救性放疗的患者放疗后局部进展的中位时间更短（分别为 19 个月和 64 个月；P < 0.01）。
与监测相比，无论初始切除范围如何，upfront 辅助放疗与非典型脑膜瘤局部控制的改善相关。非典型脑膜瘤全切术后应强烈考虑早期辅助放疗。
