手术切除的颅内脑膜瘤的分割放疗：一项多中心回顾性队列研究。

Fractionated radiotherapy for surgically resected intracranial meningiomas: A multicentre retrospective cohort study.

作者信息

Wang Justin Z, Nassiri Farshad, Landry Alexander P, Patil Vikas, Rebchuk Alexander, Merali Zamir A, Gui Chloe, Lee Grace, Rogers Lauren, Sinha Jessica, Patel Zeel, Zuccato Jeffrey A, Voisin Mathew R, Munoz David, Spears Julian, Cusimano Michael D, Das Sunit, Makarenko Serge, Yip Stephen, Gao Andrew, Laperriere Normand, Tsang Derek S, Zadeh Gelareh

机构信息

MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.

Division of Neurosurgery, Vancouver General Hospital, Vancouver, BC, Canada.

出版信息

Radiother Oncol. 2023 Nov;188:109861. doi: 10.1016/j.radonc.2023.109861. Epub 2023 Aug 22.

DOI:10.1016/j.radonc.2023.109861

PMID:37619659

Abstract

BACKGROUND

Aside from surgical resection, the only standard of care treatment modality for meningiomas is radiotherapy (RT). Despite this, few studies have focused on identifying clinical covariates associated with failure of fractionated RT following surgical resection (fRT), and the timing of fRT following surgery still remains controversial (adjuvant versus salvage fRT). We assessed the outcomes of the largest, multi-institutional cohort of surgically resected meningiomas treated with subsequent adjuvant and salvage fRT to identify factors associated with local freedom from recurrence (LFFR) over 3-10 years post-fRT and to determine the optimal timing of fRT.

METHODS

Patients with intracranial meningiomas who underwent surgery and fRT between 1997 and 2018 were included. Primary endpoints were radiographic recurrence/progression and time to progression from the completion of fRT.

RESULTS

404 meningiomas were included for analysis. Of these, 167 (41.3%) recurred post-fRT. Clinical covariates independently associated with worse PFS post-fRT included receipt of previous RT to the meningioma, having a WHO grade 3 meningioma or recurrent meningioma, the meningioma having a higher MIB1-index or brain invasion on pathology, and older patient age at diagnosis. Subgroup analysis identified higher MIB1-index as a histological factor associated with poorer LFFR in WHO grade 2 meningiomas. 179 patients underwent adjuvant RT shortly after surgery whereas 225 patients had delayed, salvage fRT after recurrence/progression. Following propensity score matching, patients that underwent adjuvant fRT had improved LFFR post-fRT compared to those that received salvage fRT.

CONCLUSION

There is a paucity of clinical factors that can predict a meningioma's response to fRT following surgery. Adjuvant fRT may be associated with improved PFS post-fRT compared to salvage fRT. Molecular biomarkers of RT-responsiveness are needed to better inform fRT treatment decisions.

摘要

背景

除手术切除外，脑膜瘤唯一的标准治疗方式是放射治疗（RT）。尽管如此，很少有研究专注于识别与手术切除后分次放疗（fRT）失败相关的临床协变量，且手术后脑膜瘤分次放疗的时机仍存在争议（辅助性放疗与挽救性放疗）。我们评估了接受后续辅助性和挽救性分次放疗的最大规模多机构队列的手术切除脑膜瘤患者的预后，以确定与分次放疗后3至10年局部无复发生存（LFFR）相关的因素，并确定分次放疗的最佳时机。

方法

纳入1997年至2018年间接受手术和分次放疗的颅内脑膜瘤患者。主要终点为影像学复发/进展以及从分次放疗完成起的进展时间。

结果

404例脑膜瘤纳入分析。其中，167例（41.3%）在分次放疗后复发。与分次放疗后较差的无进展生存期独立相关的临床协变量包括既往曾对脑膜瘤进行过放疗、WHO 3级脑膜瘤或复发性脑膜瘤、脑膜瘤病理检查显示较高的MIB1指数或脑侵犯，以及诊断时患者年龄较大。亚组分析确定较高的MIB1指数是WHO 2级脑膜瘤中与较差的局部无复发生存相关的组织学因素。179例患者术后不久接受了辅助性放疗，而225例患者在复发/进展后接受了延迟的挽救性分次放疗。倾向评分匹配后，接受辅助性分次放疗的患者与接受挽救性分次放疗的患者相比，分次放疗后的局部无复发生存情况有所改善。