Department of Stereotactic and Functional Neurosurgery, Centre for Neurosurgery, Medical Faculty of the University of Cologne, Kerpener Strasse 62, LFI Gebäude Ebene 2, 50937, Cologne, Germany.
Department of Radiation Oncology and Cyberknife Centre, Medical Faculty of the University of Cologne, Cologne, Germany.
Radiat Oncol. 2021 Jan 28;16(1):22. doi: 10.1186/s13014-021-01748-y.
For meningiomas, complete resection is recommended as first-line treatment while stereotactic radiosurgery (SRS) is established for meningiomas of smaller size considered inoperable. If the patient´s medical condition or preference excludes surgery, SRS remains a treatment option. We evaluated the efficacy and safety of SRS in a cohort comprising these cases.
In this retrospective single-centre analysis we included patients receiving single fraction SRS either by modified LINAC or robotic guidance by Cyberknife for potentially resectable intracranial meningiomas. Treatment-related adverse events as well as local and regional control rates were determined from follow-up imaging and estimated by the Kaplan-Meier method.
We analyzed 188 patients with 218 meningiomas. The median radiological, and clinical follow-up periods were 51.4 (6.2-289.6) and 55.8 (6.2-300.9) months. The median tumor volume was 4.2 ml (0.1-22), and the mean marginal radiation dose was 13.0 ± 3.1 Gy, with reference to the 80.0 ± 11.2% isodose level. Local recurrence was observed in one case (0.5%) after 239 months. The estimated 2-, 5-, 10- and 15-year regional recurrence rates were 1.5%, 3.0%, 6.6% and 6.6%, respectively. Early adverse events (≤ 6 months after SRS) occurred in 11.2% (CTCEA grade 1-2) and resolved during follow-up in 7.4% of patients, while late adverse events were documented in 14.4% (grade 1-2; one case grade 3). Adverse effects (early and late) were associated with the presence of symptoms or neurological deficits prior to SRS (p < 0.03) and correlated with the treatment volume (p < 0.02).
In this analysis SRS appears to be an effective treatment for patients with meningiomas eligible for complete resection and provides reliable long-term local tumor control with low rates of mild morbidity.
对于脑膜瘤，推荐完全切除作为一线治疗方法，而立体定向放射外科（SRS）则适用于体积较小、认为无法手术的脑膜瘤。如果患者的身体状况或偏好排除手术，SRS 仍然是一种治疗选择。我们评估了 SRS 在一组符合这些条件的患者中的疗效和安全性。
在这项回顾性单中心分析中，我们纳入了接受单次分割 SRS 治疗的患者，这些患者的颅内脑膜瘤可能适合手术切除，治疗方式为改良 LINAC 或机器人引导的 Cyberknife。通过随访影像学确定治疗相关不良事件以及局部和区域控制率，并通过 Kaplan-Meier 方法进行估计。
我们分析了 188 例 218 个脑膜瘤患者。影像学和临床随访的中位数分别为 51.4（6.2-289.6）和 55.8（6.2-300.9）个月。肿瘤体积中位数为 4.2ml（0.1-22），边缘照射剂量的平均值为 13.0±3.1Gy，参考 80.0±11.2%等剂量曲线。239 个月后，1 例（0.5%）出现局部复发。2、5、10 和 15 年区域复发率估计分别为 1.5%、3.0%、6.6%和 6.6%。SRS 后 6 个月内发生早期不良事件（CTCEA 1-2 级）占 11.2%，7.4%的患者在随访期间得到缓解，而晚期不良事件占 14.4%（1-2 级；1 例 3 级）。不良事件（早期和晚期）与 SRS 前存在症状或神经功能缺损有关（p<0.03），与治疗体积相关（p<0.02）。
在这项分析中，SRS 似乎是一种有效的治疗方法，适用于适合完全切除的脑膜瘤患者，并提供可靠的长期局部肿瘤控制，轻度发病率低。
