Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Neurosurgery, The University of Tokyo, Bunkyo, Tokyo, Japan.
J Neurooncol. 2021 Dec;155(3):335-342. doi: 10.1007/s11060-021-03882-9. Epub 2021 Oct 27.
To clarify the role of stereotactic radiosurgery (SRS) for atypical meningiomas (AM).
A retrospective analysis of 68 patients with AM having SRS from 1995 until 2019.
Nineteen patients (28%) had undergone prior external beam radiation therapy (EBRT) (median dose, 54 Gy). The median follow-up period was 52 months. Eighteen (26%), 17 (25%), and 33 (49%) patients received SRS as an upfront adjuvant (≤ 6 months), early salvage (7-18 months), or late salvage treatment (> 18 months), respectively. The 3-, 5-, and 10-year progression-free survivals (PFSs) were 52%, 35%, and 25%, respectively. The 3-, 5-, and 10-year disease-specific survivals were 85%, 78%, and 61%, respectively. Adverse radiation events (AREs) were observed in 12 patients (18%), with increased or new seizures being the most frequent complication (n = 7). Prior EBRT was associated with reduced PFS (HR 5.92, P < 0.01), reduced DSS (HR 5.84, P < 0.01), and an increased risk of ARE (HR 3.31, P = 0.04). Timing of SRS was correlated with reduced PFS for patients having early salvage treatment compared to upfront adjuvant (HR 3.17, P = 0.01) or late salvage treatment (HR 4.39, P < 0.01).
PFS for patients with residual/recurrent AM remains poor despite SRS. Prior EBRT was associated with worse tumor control, higher tumor-related mortality, and an increased risk of ARE. Further study on the timing of SRS is needed to determine if upfront adjunctive SRS improves tumor control compared to salvage SRS.
阐明立体定向放射外科（SRS）在非典型脑膜瘤（AM）中的作用。
回顾性分析了 1995 年至 2019 年期间接受 SRS 治疗的 68 例 AM 患者。
19 例（28%）患者曾接受过外照射放疗（EBRT）（中位剂量 54Gy）。中位随访时间为 52 个月。18 例（26%）、17 例（25%）和 33 例（49%）患者分别接受 SRS 作为辅助治疗（≤6 个月）、早期挽救治疗（7-18 个月）和晚期挽救治疗（>18 个月）。3 年、5 年和 10 年无进展生存率（PFS）分别为 52%、35%和 25%。3 年、5 年和 10 年疾病特异性生存率分别为 85%、78%和 61%。12 例（18%）患者出现放射性不良反应（ARE），其中最常见的并发症是癫痫发作增加或新发（n=7）。既往 EBRT 与 PFS 降低相关（HR 5.92，P<0.01）、DSS 降低相关（HR 5.84，P<0.01）和 ARE 风险增加相关（HR 3.31，P=0.04）。与辅助治疗（HR 3.17，P=0.01）或晚期挽救治疗（HR 4.39，P<0.01）相比，早期挽救治疗的患者 SRS 时机与 PFS 降低相关。
尽管接受了 SRS，残留/复发 AM 患者的 PFS 仍较差。既往 EBRT 与肿瘤控制较差、肿瘤相关死亡率较高和 ARE 风险增加相关。需要进一步研究 SRS 的时机，以确定与挽救性 SRS 相比，辅助性 SRS 是否能改善肿瘤控制。
