Division of Neurosurgery, University of British Columbia, Vancouver, Canada.
M.D. Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
World Neurosurg. 2022 May;161:e748-e756. doi: 10.1016/j.wneu.2022.02.088. Epub 2022 Feb 28.
We sought to evaluate overall survival (OS) and local recurrence (LR) in patients with grade 2 meningiomas treated with adjuvant radiotherapy compared to surgery alone at time of diagnosis.
All patients at the authors' institution between 2007 and 2020 were retrospectively reviewed. OS, LR, and treatment toxicities were assessed. Sensitivity analyses were performed for patients with initial gross total resection (GTR) and subtotal resection (STR). Kaplan-Meier analyses and log-rank test for significance were used to compare surgery alone and adjuvant radiotherapy groups.
We included 189 patients with mean age 57.4 ± 14.6 years. Patients were 64% female, and median follow-up was 64 (interquartile range: 20-96) months. At initial treatment, 21 patients received adjuvant radiotherapy and 168 received surgery alone. There was no significant difference for OS (hazard ratio = 1.3 [95% confidence interval 0.4-4.5], P = 0.92) overall or when limited to GTR (P = 0.38) or STR (P = 0.85). There was no significant difference in LR overall (P = 0.75) or when restricted to GTR (P = 0.77) or STR (P = 0.20). No patient had radiotherapy stopped or altered because of side effects; however, 71.4% reported tolerable side effects during the treatment period and 14.3% reported chronic side effects persisting longer than 12 months post treatment.
In a large retrospective cohort, we found no survival or local recurrence benefit to adjuvant radiotherapy in treatment of grade 2 meningiomas. Sensitivity analysis limited to initial GTR and STR also failed to demonstrate any OS or LR benefit with adjuvant radiotherapy. In our experience, there is limited utility to upfront adjuvant radiotherapy following initial surgical resection in the treatment of grade 2 meningiomas.
我们旨在评估与单独手术相比，辅助放疗在诊断时治疗 2 级脑膜瘤患者的总生存期（OS）和局部复发（LR）的效果。
回顾性分析了作者所在机构 2007 年至 2020 年期间的所有患者。评估了 OS、LR 和治疗毒性。对初始完全切除（GTR）和次全切除（STR）的患者进行了敏感性分析。采用 Kaplan-Meier 分析和对数秩检验比较单纯手术组和辅助放疗组。
我们纳入了 189 例平均年龄为 57.4 ± 14.6 岁的患者。患者中 64%为女性，中位随访时间为 64（四分位距：20-96）个月。在初始治疗时，21 例患者接受了辅助放疗，168 例患者接受了单纯手术。总生存期（危险比=1.3 [95%置信区间 0.4-4.5]，P=0.92）和仅限于 GTR（P=0.38）或 STR（P=0.85）时均无显著差异。总体上 LR 无显著差异（P=0.75），或限于 GTR（P=0.77）或 STR（P=0.20）时也无显著差异。没有患者因副作用而停止或改变放疗；然而，71.4%的患者在治疗期间报告了可耐受的副作用，14.3%的患者报告了治疗后 12 个月以上持续存在的慢性副作用。
在一项大型回顾性队列研究中，我们发现辅助放疗在治疗 2 级脑膜瘤中没有生存或局部复发获益。对初始 GTR 和 STR 的敏感性分析也未能证明辅助放疗在 OS 或 LR 方面有任何获益。根据我们的经验，在初始手术切除后，在治疗 2 级脑膜瘤时，辅助放疗的应用有限。
