Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA.
David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA.
J Neurooncol. 2021 Apr;152(2):205-216. doi: 10.1007/s11060-020-03674-7. Epub 2021 Feb 26.
Meningiomas comprise 33% of all CNS tumors. The World Health Organization (WHO) describes meningiomas as benign (BM), atypical (AM), and malignant/anaplastic (MM). High-grade meningiomas such as AMs and MMs are more aggressive, recur more frequently, and portend a worse prognosis than BMs. Currently, the standard treatment for high-grade meningiomas, especially AMs, is ill-defined. In particular, the benefit to survival outcomes of adjuvant radiotherapy post-surgical resection remains unclear. In this study, we investigated the effect of adjuvant radiotherapy (ART) post-surgery on survival outcomes compared to surgery alone for high-grade meningiomas.
PRISMA guidelines were a foundation for our literature review. We screened the PubMed database for studies reporting overall survival (OS), progression free survival (PFS), and tumor recurrence for intracranial, primary AM and MMs treated with surgery+ART or surgery alone. Fixed and random effect models compared tumor control rate for AM aforementioned groups.
Mean 5-year PFS was 76.9% for AM (surgery+ART) and 55.9% for AM (surgery alone) patients. Mean 5-year OS was 81.3% and 74% for AM (surgery+ART) and AM (surgery alone) groups, respectively. Overall, the mean 5-year PFS for aggregated high-grade meningiomas AM+MM (surgery+ART) was 67.6%. Fixed effect models revealed tumor control rate as 76% for AM (surgery+ART) and 69% for AM (surgery alone) groups. ART induced toxicity incidence ranged from 12.0% to 35.5% for AM and MM patients.
Our analysis suggests that (surgery+ART) may increase PFS, OS, and tumor control rates in high-grade meningiomas. However, further studies involving surgery+ ART should be conducted to fully evaluate the ideal radiosurgical candidate, modality, and dosage.
脑膜瘤占中枢神经系统肿瘤的 33%。世界卫生组织（WHO）将脑膜瘤描述为良性（BM）、非典型（AM）和恶性/间变（MM）。高级别脑膜瘤，如 AM 和 MM，侵袭性更强，复发更频繁，预后比 BM 更差。目前，高级别脑膜瘤的标准治疗方法，特别是 AM，仍不明确。特别是手术切除后辅助放疗对生存结果的益处尚不清楚。在这项研究中，我们研究了与单独手术相比，手术后辅助放疗（ART）对高级别脑膜瘤的生存结果的影响。
PRISMA 指南是我们文献回顾的基础。我们筛选了 PubMed 数据库，以获取报告颅内、原发性 AM 和 MM 接受手术+ART 或单独手术治疗的总生存率（OS）、无进展生存率（PFS）和肿瘤复发的研究。固定和随机效应模型比较了上述 AM 组的肿瘤控制率。
AM（手术+ART）的平均 5 年 PFS 为 76.9%，AM（手术单独）为 55.9%。AM（手术+ART）和 AM（手术单独）组的平均 5 年 OS 分别为 81.3%和 74%。总体而言，高级别脑膜瘤 AM+MM 的平均 5 年 PFS 为 67.6%。固定效应模型显示，AM（手术+ART）和 AM（手术单独）组的肿瘤控制率分别为 76%和 69%。ART 诱导的毒性发生率在 AM 和 MM 患者中为 12.0%至 35.5%。
我们的分析表明，（手术+ART）可能提高高级别脑膜瘤的 PFS、OS 和肿瘤控制率。然而，应进行更多涉及手术+ART 的研究，以充分评估理想的放射外科候选者、方式和剂量。
