Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.
Department of Radiation Oncology, Huashan Hospital, Fudan University, Shanghai, China.
J Neurooncol. 2023 Nov;165(2):241-250. doi: 10.1007/s11060-023-04401-8. Epub 2023 Nov 17.
To investigate the efficacy and safety of particle beam radiotherapy (PBRT) in the management of patients with WHO grade 2 and 3 meningiomas.
Thirty-six consecutive and non-selected patients with WHO grade 2 (n = 28) and grade 3 (n = 8) meningiomas were treated at the Shanghai Proton and Heavy Ion Center, from May 2015 to March 2022. The median age of the cohort at PBRT was 48 years. There were 25 and 11 patients treated with PBRT in the setting of newly diagnosed diseases and progressive/recurrent diseases, respectively. PBRT was utilized as re-irradiation in 5 patients. Proton radiotherapy (PRT) and carbon-ion radiotherapy (CIRT), with a median dose of 60 Gy-Equivalent (GyE), were provided to 30 and 6 patients, respectively.
With a median follow-up of 23.3 months, the local control rates were 92.0%, 82.0%, and 82.0% at 1, 2, and 3 years for the entire cohort, respectively. Patients with WHO grade 2 meningiomas (100%, 94.1%, 94,1% at 1,2,3 years) had a much better local control than those with WHO grade 3 meningiomas (50%, 25%, 25% at 1,2,3 years; P < 0.001). Three patients, all with WHO grade 3 meningiomas, had deceased at the time of this analysis. Multivariate analyses revealed that WHO grade (grade 2 vs. 3) (p = 0.016) was a significant prognosticator for local control. No severe toxicities (G3 or above) were observed.
Treatment-induced efficacy and toxicities to PBRT in WHO grade 2 and 3 meningiomas were both highly acceptable. Longer follow-up is needed to evaluate the long-term outcome in terms of disease control, survival, as well as potential late effects.
探讨粒子束放疗（PBRT）在治疗世界卫生组织（WHO）分级 2 级和 3 级脑膜瘤患者中的疗效和安全性。
2015 年 5 月至 2022 年 3 月，上海质子重离子医院收治了 36 例连续且未经选择的 WHO 分级 2 级（n=28）和 3 级（n=8）脑膜瘤患者。该队列患者的 PBRT 中位年龄为 48 岁。分别有 25 例和 11 例患者接受 PBRT 治疗的疾病处于初诊期和进展/复发性疾病期。5 例患者接受了 PBRT 再放疗。质子放疗（PRT）和碳离子放疗（CIRT）的中位剂量分别为 60Gy 等效剂量（GyE），分别为 30 例和 6 例患者提供了放疗。
中位随访 23.3 个月后，全组患者的局部控制率分别为 1 年时为 92.0%、2 年时为 92.0%、3 年时为 92.0%。WHO 分级 2 级脑膜瘤患者（1 年时为 100%、94.1%、94.1%，2 年时为 100%、94.1%、94.1%，3 年时为 100%、94.1%、94.1%）的局部控制情况明显优于 WHO 分级 3 级脑膜瘤患者（1 年时为 50%、25%、25%，2 年时为 50%、25%、25%，3 年时为 50%、25%、25%；P<0.001）。3 例患者均为 WHO 分级 3 级脑膜瘤患者，在分析时已死亡。多因素分析显示，WHO 分级（2 级 vs. 3 级）（p=0.016）是局部控制的显著预后因素。未观察到严重毒性（G3 或以上）。
PBRT 治疗 WHO 分级 2 级和 3 级脑膜瘤的疗效和毒性均高度可接受。需要更长时间的随访来评估疾病控制、生存以及潜在的迟发性效应方面的长期结果。
