Gamma Knife Center Cairo, Nasser Institute for Research and Treatment, Cairo, Egypt; Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Gamma Knife Center Cairo, Nasser Institute for Research and Treatment, Cairo, Egypt; Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
World Neurosurg. 2021 Jun;150:e324-e336. doi: 10.1016/j.wneu.2021.03.003. Epub 2021 Mar 13.
The use of stereotactic radiosurgery for the treatment of intracranial meningiomas has been established as an effective and safe treatment modality. Larger meningiomas typically are managed by surgery followed by radiosurgery. Treatment of large meningiomas (usually defined as >10 cc) by stereotactic radiosurgery has been investigated in some recent reports, either by single-session, volume-staged, or the hypofractionation technique. We sought to assess the long-term efficacy and safety of single-session stereotactic radiosurgery for large (10 cc or more) intracranial benign meningiomas.
In this retrospective study, we included 273 patients with large benign meningiomas (≥10 cc) who were treated by single-session SRS and followed up for more than 2 years. Tumors were in a basal location in 228 patients (84%). There were 161 tumors (59%) in the perioptic location. The median tumor volume was 15.5 (10-57.3 cc [interquartile range {IQR} 12.3 cc]). The median prescription dose was 12 Gy (9-15 Gy [IQR 1 Gy]).
The median follow-up period was 6.1 years (2-18 years [IQR 5.5 years]). The tumor control rate was 90%. The progression-free survival at 5 and 10 years was 96% and 81%, respectively, for the whole cohort. Among 161 patients with perioptic meningiomas, favorable (better/stable) visual outcome was reported in 155 patients (96%) and unfavorable (worse) outcome in 6 patients (4%). Temporary adverse radiation effects were observed in 41 patients (15%) but only 16 (6%) were symptomatic.
Stereotactic radiosurgery provides an effective and safe treatment option for large meningiomas.
立体定向放射外科治疗颅内脑膜瘤已被确立为一种有效且安全的治疗方式。较大的脑膜瘤通常通过手术切除后再进行放射外科治疗。一些近期的报告研究了立体定向放射外科治疗大型脑膜瘤（通常定义为> 10cc）的方法，包括单次分割、体积分期或分次治疗技术。我们旨在评估单次分割立体定向放射外科治疗大型（≥ 10cc）颅内良性脑膜瘤的长期疗效和安全性。
在这项回顾性研究中，我们纳入了 273 例接受单次分割立体定向放射外科治疗且随访时间超过 2 年的大型良性脑膜瘤（≥ 10cc）患者。228 例（84%）患者肿瘤位于基底部位，161 例（59%）患者肿瘤位于视路部位。肿瘤体积中位数为 15.5cc（10-57.3cc[四分位距12.3cc]）。处方剂量中位数为 12Gy（9-15Gy[四分位距 1Gy]）。
中位随访时间为 6.1 年（2-18 年[四分位距 5.5 年]）。肿瘤控制率为 90%。全队列的无进展生存率在 5 年和 10 年时分别为 96%和 81%。在 161 例视路脑膜瘤患者中，155 例（96%）报告了良好（改善/稳定）的视力结果，6 例（4%）报告了不良（恶化）的视力结果。41 例（15%）患者出现暂时的放射性不良反应，但仅有 16 例（6%）患者出现症状。
立体定向放射外科为大型脑膜瘤提供了一种有效且安全的治疗选择。
