Department of Neurosurgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya City, Tokyo, 150-8935, Japan.
Neurosurg Rev. 2021 Dec;44(6):3519-3526. doi: 10.1007/s10143-021-01535-z. Epub 2021 Apr 10.
Few reports exist demonstrating the effects of stereotactic radiotherapy (SRT) on the central skull base meningiomas (CSMs). A retrospective analysis of 113 patients was performed. The median age was 62 (IQR 50-72) years old, and 78 patients (69%) were female. Upfront SRT was performed in 41 (36%), where 17 (15%) patients were asymptomatic. The other SRT was for postoperative adjuvant therapy in 32 (28%), and for the recurrent or relapsed tumors in 40 (35%) patients. Previous operation was done in 74 patients (66%). Among the available pathology in 46 patients, 37 (80%) were WHO grade I, 8 (17%) were grade II, and 1 (2%) was grade III. The median prescribed dose covered 95% of the planning target volume was 25 (IQR 21-25) Gy, and the median target volume was 9.5 (IQR 3.9-16.9) cm. The median progression-free survival (PFS) was 48 (IQR 23-73) months and 84% and 78% were free of tumor progression at 5 and 10 years respectively. The median follow-up was 49 (IQR 28-83) months. PFS was better in grade I than grade II (p = 0.02). No other baseline factors including the history of previous operation were associated with PD or PFS. Adverse events of radiation therapy were radiation-induced optic neuropathy (0.9%), and cerebral edema (4.4%). Asymptomatic cavernous carotid stenosis was found in three (2.7%), five (4.4%) underwent ventriculoperitoneal shunt placement for normal pressure hydrocephalus, and five (4.4%) died. SRT is useful for the management of CSMs with a low rate of adverse events.
立体定向放射治疗（SRT）对颅底中央脑膜瘤（CSMs）的影响鲜有报道。对 113 例患者进行回顾性分析。中位年龄为 62（IQR 50-72）岁，78 例（69%）为女性。41 例患者行初始 SRT（36%），其中 17 例（15%）患者无症状。32 例（28%）行术后辅助治疗，40 例（35%）为复发性或残留肿瘤。74 例患者（66%）之前接受过手术。在 46 例患者中，有 37 例（80%）的病理为世界卫生组织（WHO）I 级，8 例（17%）为 II 级，1 例（2%）为 III 级。95%的计划靶区接受的中位处方剂量为 25（IQR 21-25）Gy，中位靶区体积为 9.5（IQR 3.9-16.9）cm。中位无进展生存期（PFS）为 48（IQR 23-73）个月，5 年和 10 年时肿瘤无进展的比例分别为 84%和 78%。中位随访时间为 49（IQR 28-83）个月。I 级患者的 PFS优于 II 级（p=0.02）。其他基线因素，包括之前手术的病史，与进展或 PFS 均无关。放射治疗的不良反应为放射性视神经病变（0.9%）和脑水肿（4.4%）。发现无症状海绵窦颈动脉狭窄 3 例（2.7%），5 例行脑室-腹腔分流术治疗正常压力脑积水，5 例（4.4%）死亡。SRT 对 CSMs 的管理是有用的，其不良反应发生率较低。
