Pituitary Unit, Pituitary Neurosurgery Program, IRCCS Institute of Neurological Sciences, Bologna, Italy.
Department of Bio-Medical and Neuro-Motor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
J Neurosurg Sci. 2022 Jun;66(3):240-250. doi: 10.23736/S0390-5616.21.05522-3. Epub 2021 Nov 11.
Management of grade II atypical meningiomas (AM) remains controversial. Conflicting evidence exist on the possible protective effect of adjuvant radiotherapy (ART) on recurrence in grossly resected AMs. The aim of this meta-analysis is to evaluate the role of ART in grossly resected (Simpson grades 1-3) AMs on the recurrence and survival.
Literature review was performed by the study investigators who handily queried the MEDLINE database using keywords and MeSH terms in different combinations using the Boolean operators "AND" or "OR," and database-related filters to maximize the chance to identify articles focusing on role of radiotherapy in atypical (WHO grade II) meningiomas. Data were retrieved from comparative studies of AMs undergone surgical resection alone vs. surgery + ART. Only grossly total resected AMs (Simpson grades 1-3) were included. The individual and pooled odds ratio (OR) for the crude recurrence, progression free survival (PFS) at 1, 3 and 5-years, as well as for the overall survival (OS) at 5-years were calculated by using the Mantel-Haenszel model in surgery alone vs. surgery + ART.
Eleven studies were considered eligible. 8 were included for the outcome "crude recurrence;" 6 for PFS at 1-3 years, 7 for PFS at 5-years; 6 for the OS at 5-years. Results suggest that surgery + ART might have a protective role on recurrence in gross-totally resected AMs (OR:1.66). Specifically, surgery + ART slightly improved PFS at 1-year (OR:0.92) and more consistently at 3- and 5-years (OR:0.31 and 0.35 respectively) hence favoring a combined approach.
Current literature on the impact of ART after gross total resection of AM are still heterogeneous and not systematically reported. The present meta-analysis suggests a possible protective role of postoperative RT against long-term recurrence as compared to surgical resection alone.
二级非典型脑膜瘤（AM）的治疗仍存在争议。在大体全切除的 AM 中，辅助放疗（ART）对复发的可能保护作用存在相互矛盾的证据。本荟萃分析的目的是评估 ART 在大体全切除（Simpson 分级 1-3）AM 中的作用，以评估其对复发和生存的影响。
研究人员进行了文献回顾，他们使用关键字和 MeSH 术语，通过不同的组合使用布尔运算符“AND”或“OR”，并使用数据库相关过滤器，以最大限度地提高确定聚焦于放疗在非典型（WHO 分级 II）脑膜瘤中的作用的文章的机会，对手动查询 MEDLINE 数据库。数据来自单独手术切除与手术+ART 治疗的 AM 比较研究。仅纳入大体全切除 AM（Simpson 分级 1-3）。使用 Mantel-Haenszel 模型，计算单独手术与手术+ART 治疗的 AM 患者的原始复发、1、3 和 5 年无进展生存率（PFS）以及 5 年总生存率（OS）的个体和汇总优势比（OR）。
认为有 11 项研究符合条件。8 项研究纳入“原始复发”结果；6 项研究纳入 1-3 年 PFS，7 项研究纳入 5 年 PFS；6 项研究纳入 5 年 OS。结果表明，手术+ART 可能对大体全切除 AM 的复发有保护作用（OR：1.66）。具体而言，手术+ART 略改善了 1 年时的 PFS（OR：0.92），并且在 3 年和 5 年时更一致（OR：0.31 和 0.35），因此更倾向于联合治疗。
目前关于 AM 大体全切除术后 ART 影响的文献仍然存在异质性，并且没有系统报告。本荟萃分析表明，与单独手术切除相比，术后 RT 可能对长期复发有保护作用。
