Department of Neurological Surgery, University of Colorado School of Medicine, 1635 Aurora Ct, 4th floor, Aurora, CO, 80045, USA.
Department of Medicine, Concejo Latinoamericano de Neurointensivismo-CLaNi, Cartagena, Colombia.
J Neurooncol. 2021 May;152(3):439-449. doi: 10.1007/s11060-021-03732-8. Epub 2021 Mar 27.
Most of the current knowledge on the clinical effects of stereotactic radiosurgery (SRS) on the treatment of cavernous sinus meningiomas (CSM) is based on series with limited follow-up. However, determining the role of radiation in a tumor with slow disease progression such as CSM necessitates long term follow up.
To review and pool metadata in the literature to determine the long-term outcomes of SRS with respect to clinical and radiographic tumor control of CSM.
A systematic search was conducted following MOOSE guidelines. Results were screened against predefined criteria, which excluded studies with a median follow-up less than 5 years. The incidences of each outcome were calculated using random-effects metanalysis of proportions.
Seven studies met the inclusion criteria, comprising 645 patients. The median follow-up was 74 months (range 62-87). Progression-free-survival at 5, 10, and 15 years was 93.4% (95% CI 89.1-96.7%), 84.9% (95% CI 77-91.4%), and 81.3% (95% CI 74-87.7%), respectively. Clinical response to SRS at last follow-up defined as improvement of cranial nerve deficits was found in in 36.4% (95% CI 26.3-47.1%) of patients, while worsening or onset of new cranial nerve deficits was found in 11.5% (95% CI 7.9-15.7%). Radiological regression was found in 57.8% (95% CI 43-71.8%), while tumor progression was found in 8.5% (95% CI 5.2-12.6%).
SRS achieves excellent disease control and radiographic response in CSM. Although the risk of long-term cranial neuropathies is minimal, it is relatively higher to what has been previously reported in early series with limited follow-up.
目前关于立体定向放射外科（SRS）治疗海绵窦脑膜瘤（CSM）的临床效果的大部分知识都基于随访有限的系列研究。然而，对于 CSM 等疾病进展缓慢的肿瘤，确定放射治疗的作用需要长期随访。
回顾和汇集文献中的元数据，以确定 SRS 在控制 CSM 的临床和影像学肿瘤方面的长期效果。
根据 MOOSE 指南进行系统搜索。结果根据预先设定的标准进行筛选，排除随访中位数小于 5 年的研究。使用随机效应荟萃分析计算每个结局的发生率。
符合纳入标准的有 7 项研究，共纳入 645 例患者。中位随访时间为 74 个月（范围 62-87）。5、10、15 年无进展生存率分别为 93.4%（95%CI 89.1-96.7%）、84.9%（95%CI 77-91.4%）和 81.3%（95%CI 74-87.7%）。最后一次随访时 SRS 的临床反应定义为颅神经缺损改善，发现有 36.4%（95%CI 26.3-47.1%）的患者，而 11.5%（95%CI 7.9-15.7%）的患者出现恶化或新发颅神经缺损。发现 57.8%（95%CI 43-71.8%）的肿瘤出现放射学退缩，而肿瘤进展的发生率为 8.5%（95%CI 5.2-12.6%）。
SRS 可实现 CSM 的出色疾病控制和放射影像学反应。虽然长期颅神经病变的风险很小，但与之前随访有限的早期系列研究相比，风险相对较高。
