Piper Keenan, Yu Siyuan, Taghvaei Mohammad, Fernandez Christian, Mouchtouris Nikolaos, Smit Rupert D, Yudkoff Clifford, Collopy Sarah, Reyes Maikerly, Lavergne Pascal, Karsy Michael, Prashant Giyarpuram N, Shi Wenyin, Evans James
Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
Front Surg. 2022 Jul 4;9:908745. doi: 10.3389/fsurg.2022.908745. eCollection 2022.
Dural tails are thickened contrast-enhancing portions of dura associated with some meningiomas. Prior studies have demonstrated the presence of tumor cells within the dural tail, however their inclusion in radiation treatment fields remains controversial. We evaluated the role of including the dural tail when treating a meningioma with stereotactic radiation and the impact on tumor recurrence.
This is a retrospective, single-institution, cohort study of patients with intracranial World Health Organization (WHO) grade 1 meningioma and identified dural tail who were treated with stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) from January 2012 to December 2018. SRS and FSRT subgroups were categorized based on coverage or non-coverage of the dural tail by the radiation fields, as determined independently by a radiation oncologist and a neurosurgeon. Demographics, tumor characteristics, radiation plans, and outcomes were evaluated. High grade tumors were analyzed separately.
A total of 187 WHO grade 1 tumors from 177 patients were included in the study (median age: 62 years, median follow-up: 40 months, 78.1% female) with 104 receiving SRS and 83 receiving FSRT. The dural tail was covered in 141 (75.4%) of treatment plans. There was no difference in recurrence rates (RR) or time to recurrence (TTR) between non-coverage or coverage of dural tails (RR: 2.2% vs 3.5%, = 1.0; TTR: 34 vs 36 months, = 1.00). There was no difference in the rate of radiation side effects between dural tail coverage or non-coverage groups. These associations remained stable when SRS and FSRT subgroups were considered separately, as well as in a high grade cohort of 16 tumors.
Inclusion of the dural tail in the SRS or FSRT volumes for meningioma treatment does not seem to reduce recurrence rate. Improved understanding of dural tail pathophysiology, tumor grade, tumor spread, and radiation response is needed to better predict the response of meningiomas to radiotherapy.
硬脑膜尾征是与某些脑膜瘤相关的硬脑膜强化增厚部分。既往研究已证实在硬脑膜尾征内存在肿瘤细胞，然而将其纳入放射治疗野仍存在争议。我们评估了立体定向放射治疗脑膜瘤时纳入硬脑膜尾征的作用及其对肿瘤复发的影响。
这是一项回顾性、单机构队列研究，研究对象为2012年1月至2018年12月期间接受立体定向放射外科治疗（SRS）或分次立体定向放射治疗（FSRT）的世界卫生组织（WHO）1级颅内脑膜瘤且有硬脑膜尾征的患者。SRS和FSRT亚组根据放射野是否覆盖硬脑膜尾征进行分类，由放射肿瘤学家和神经外科医生独立判定。对人口统计学、肿瘤特征、放射治疗计划和治疗结果进行评估。对高级别肿瘤进行单独分析。
该研究共纳入177例患者的187个WHO 1级肿瘤（中位年龄：62岁，中位随访时间：40个月，女性占78.1%），其中104例接受SRS治疗，83例接受FSRT治疗。141个（75.4%）治疗计划覆盖了硬脑膜尾征。硬脑膜尾征未覆盖组和覆盖组之间的复发率（RR）或复发时间（TTR）无差异（RR：2.2%对3.5%，P = 1.0；TTR：34个月对36个月，P = 1.00）。硬脑膜尾征覆盖组和未覆盖组之间的放射副作用发生率无差异。当分别考虑SRS和FSRT亚组以及16个高级别肿瘤队列时，这些关联仍然稳定。
在SRS或FSRT靶区中纳入硬脑膜尾征进行脑膜瘤治疗似乎并不能降低复发率。需要更好地理解硬脑膜尾征的病理生理学、肿瘤分级、肿瘤扩散和放射反应，以更好地预测脑膜瘤对放射治疗的反应。
