Zeng K Liang, Soliman Hany, Myrehaug Sten, Tseng Chia-Lin, Detsky Jay, Chen Hanbo, Lim-Fat Mary-Jane, Ruschin Mark, Atenafu Eshetu G, Keith Julia, Lipsman Nir, Heyn Chris, Maralani Pejman, Das Sunit, Pirouzmand Farhad, Sahgal Arjun
Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Int J Radiat Oncol Biol Phys. 2024 Mar 1;118(3):662-671. doi: 10.1016/j.ijrobp.2023.09.026. Epub 2023 Oct 2.
The optimal modern radiation therapy (RT) approach after surgery for atypical and malignant meningioma is unclear. We present results of dose escalation in a single-institution cohort spanning 2000 to 2021.
Consecutive patients with histopathologic grade 2 or 3 meningioma treated with RT were reviewed. A dose-escalation cohort (≥66 Gy equivalent dose in 2-Gy fractions using an α/β = 10) was compared with a standard-dose cohort (<66 Gy). Outcomes were progression-free survival (PFS), cause-specific survival, overall survival (OS), local failure (LF), and radiation necrosis.
One hundred eighteen patients (111 grade 2, 94.1%) were identified; 54 (45.8%) received dose escalation and 64 (54.2%) standard dose. Median follow-up was 45.4 months (IQR, 24.0-80.0 months) and median OS was 9.7 years (Q1: 4.6 years, Q3: not reached). All dose-escalated patients had residual disease versus 65.6% in the standard-dose cohort (P < .001). PFS at 3, 4, and 5 years in the dose-escalated versus standard-dose cohort was 78.9%, 72.2%, and 64.6% versus 57.2%, 49.1%, and 40.8%, respectively, (P = .030). On multivariable analysis, dose escalation (hazard ratio [HR], 0.544; P = .042) was associated with improved PFS, whereas ≥2 surgeries (HR, 1.989; P = .035) and older age (HR, 1.035; P < .001) were associated with worse PFS. The cumulative risk of LF was reduced with dose escalation (P = .016). Multivariable analysis confirmed that dose escalation was protective for LF (HR, 0.483; P = .019), whereas ≥2 surgeries before RT predicted for LF (HR, 2.145; P = .008). A trend was observed for improved cause-specific survival and OS in the dose-escalation cohort (P < .1). Seven patients (5.9%) developed symptomatic radiation necrosis with no significant difference between the 2 cohorts.
Dose-escalated RT with ≥66 Gy for high-grade meningioma is associated with improved local control and PFS with an acceptable risk of radiation necrosis.
非典型和恶性脑膜瘤术后最佳的现代放射治疗（RT）方法尚不清楚。我们展示了2000年至2021年单机构队列中剂量递增的结果。
回顾性分析接受RT治疗的组织病理学2级或3级脑膜瘤连续患者。将剂量递增队列（使用α/β = 10的2 Gy分割，等效剂量≥66 Gy）与标准剂量队列（<66 Gy）进行比较。观察指标为无进展生存期（PFS）、病因特异性生存期、总生存期（OS）、局部复发（LF）和放射性坏死。
共纳入118例患者（111例2级，占94.1%）；54例（45.8%）接受了剂量递增，64例（54.2%）接受了标准剂量。中位随访时间为45.4个月（四分位间距，24.0 - 80.0个月），中位OS为9.7年（第一四分位数：4.6年，第三四分位数：未达到）。所有接受剂量递增的患者均有残留病灶，而标准剂量队列中这一比例为65.6%（P < 0.001）。剂量递增队列与标准剂量队列3年、4年和5年的PFS分别为78.9%、72.2%和64.6%，以及57.2%、49.1%和40.8%（P = 0.030）。多变量分析显示，剂量递增（风险比[HR]，0.544；P = 0.042）与PFS改善相关，而≥2次手术（HR，1.989；P = 0.035）和年龄较大（HR，1.035；P < 0.001）与PFS较差相关。剂量递增可降低LF的累积风险（P = 0.016）。多变量分析证实，剂量递增对LF有保护作用（HR，0.483；P = 0.019），而RT前≥2次手术预示着LF（HR，2.145；P = 0.008）。剂量递增队列在病因特异性生存期和OS方面有改善趋势（P < 0.1）。7例患者（5.9%）发生有症状的放射性坏死，两组之间无显著差异。
对于高级别脑膜瘤，≥66 Gy的剂量递增RT与改善局部控制和PFS相关，且放射性坏死风险可接受。
