Kent Collin L, Mowery Yvonne M, Babatunde Olayode, Wright Ato O, Barak Ian, McSherry Frances, Herndon James E, Friedman Allan H, Zomorodi Ali, Peters Katherine, Desjardins Annick, Friedman Henry, Sperduto William, Kirkpatrick John P
Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina.
Adv Radiat Oncol. 2021 Dec 24;7(3):100878. doi: 10.1016/j.adro.2021.100878. eCollection 2022 May-Jun.
Atypical (World Health Organization [WHO] grade 2) and malignant (WHO grade 3) meningiomas have high rates of local recurrence, and questions remain about the role of adjuvant radiation therapy (RT) for patients with WHO grade 2 disease. These patients frequently require salvage therapy, and optimal management is uncertain given limited prospective data. We report on the long-term outcomes for patients with atypical and malignant meningiomas treated with surgery and/or RT at our institution.
Data were collected through a retrospective chart review for all patients with WHO grade 2 or 3 meningiomas treated with surgery and/or RT at our institution between January 1992 and March 2017. Progression-free survival (PFS) and overall survival (OS) were described using the KaplanMeier estimator. The outcomes in the subgroups were compared with a log-rank test. A Cox proportional hazards model was used for the univariable and multivariable analyses of predictors of PFS.
A total of 66 patients were included in this analysis. The median follow-up was 12.4 years overall and 8.6 years among surviving patients. Fifty-two patients (78.8%) had WHO grade 2 meningiomas, and 14 patients (21.2%) had WHO grade 3 disease. Thirty-six patients (54.5%) were treated with surgery alone, 28 patients (42.4%) with surgery and adjuvant RT, and 2 patients (3%) with RT alone. Median PFS and OS were 3.2 years and 8.8 years, respectively. PFS was significantly improved with adjuvant RT compared with surgery alone (hazard ratio, 0.36; 95% confidence interval, 0.18-0.70). Patients with Ki-67 index >10% showed a trend toward worse PFS compared with patients with Ki-67 ≤10% (hazard ratio, 0.51; 95% confidence interval, 0.25-1.04). No significant differences in PFS or OS were observed with respect to Simpson or WHO grade.
For patients with atypical or malignant meningiomas, adjuvant RT was associated with significantly improved PFS, and Ki-67 index >10% was associated with a trend toward worse PFS. Given the long-term survival, high recurrence rates, and efficacy of salvage therapy, patients with atypical and malignant meningiomas should be monitored systematically long after initial treatment.
非典型（世界卫生组织[WHO]2级）和恶性（WHO 3级）脑膜瘤局部复发率高，对于WHO 2级疾病患者辅助放疗（RT）的作用仍存在疑问。这些患者经常需要挽救治疗，鉴于前瞻性数据有限，最佳治疗方案尚不确定。我们报告了在我们机构接受手术和/或RT治疗的非典型和恶性脑膜瘤患者的长期预后。
通过回顾性病历审查收集了1992年1月至2017年3月期间在我们机构接受手术和/或RT治疗的所有WHO 2级或3级脑膜瘤患者的数据。使用Kaplan-Meier估计器描述无进展生存期（PFS）和总生存期（OS）。亚组中的结果通过对数秩检验进行比较。使用Cox比例风险模型对PFS的预测因素进行单变量和多变量分析。
本分析共纳入66例患者。总体中位随访时间为12.4年，存活患者中位随访时间为8.6年。52例患者（78.8%）为WHO 2级脑膜瘤，14例患者（21.2%）为WHO 3级疾病。36例患者（54.5%）仅接受手术治疗，28例患者（42.4%）接受手术及辅助RT治疗，2例患者（3%）仅接受RT治疗。中位PFS和OS分别为3.2年和8.8年。与单纯手术相比，辅助RT显著改善了PFS（风险比，0.36；95%置信区间，0.18 - 0.70）。与Ki-67≤10%的患者相比，Ki-67指数>10%的患者PFS有变差的趋势（风险比，0.51；95%置信区间，0.25 - 1.04）。在Simpson分级或WHO分级方面，未观察到PFS或OS有显著差异。
对于非典型或恶性脑膜瘤患者，辅助RT与显著改善的PFS相关，Ki-67指数>10%与PFS变差趋势相关。鉴于长期生存、高复发率以及挽救治疗的疗效，非典型和恶性脑膜瘤患者在初始治疗后应长期进行系统监测。
