Grzbiela Hanna, Nowicka Elzbieta, Gawkowska Marzena, Tarnawska Dorota, Tarnawski Rafal
III Radiotherapy and Chemotherapy Clinic, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-100 Gliwice, Poland.
Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia in Katowice, 75 Pulku Piechoty 1A, 41-500 Chorzow, Poland.
Cancers (Basel). 2023 Nov 16;15(22):5436. doi: 10.3390/cancers15225436.
To evaluate the possibility of dose de-escalation, with consideration of the efficacy and safety of robotic stereotactic CyberKnife radiotherapy in patients diagnosed with intracranial meningiomas.
The study group consisted of 172 patients (42 men and 130 women) treated in III Radiotherapy and Chemotherapy Clinic of Maria Sklodowska-Curie National Research Institute of Oncology in Gliwice between January 2011 and July 2018. The qualification for dose de-escalation was based on MRI (magnetic resonance imaging) features: largest tumor diameter less than 5 cm, well-defined tumor margins, no edema, and no brain infiltration. The age of patients was 21-79 years (median 59 years) at diagnosis and 24-80 years (median 62 years) at radiotherapy. Sixty-seven patients (Group A) were irradiated after initial surgery. Histopathological findings were meningioma grade WHO 1 in 51 and WHO 2 in 16 cases. Group B (105 patients) had no prior surgery and the diagnosis was based on the typical features of meningioma on MRI. All patients qualified for the robotic stereotactic CyberKnife radiotherapy, and the total dose received was 18 Gy in three fractions to reference isodose 78-92%.
Follow-up period was 18 to 124 months (median 67.5 months). Five- and eight-year progression free survival was 90.3% and 89.4%, respectively. Two patients died during the follow-up period. Progression of tumor after radiotherapy was registered in 16 cases. Four patients required surgery due to progressive disease, and three of them were progression free during further follow-up. Twelve patients received a second course of robotic radiotherapy, 11 of them had stable disease, and one patient showed further tumor growth but died of heart failure. Crude progression free survival after both primary and secondary treatment was 98.8%. Radiotherapy was well-tolerated: acute toxicity grade 1/2 (EORTC-RTOG scale) was seen in 10.5% of patients. We did not observe any late effects of radiotherapy.
Stereotactic CyberKnife radiotherapy with total dose of 18 Gy delivered in three fractions showed comparable efficacy to treatment schedules with higher doses. This could support the idea of dose de-escalation in the treatment of intracranial meningiomas.
考虑机器人立体定向射波刀放射治疗对颅内脑膜瘤患者的疗效和安全性，评估降低剂量的可能性。
研究组由2011年1月至2018年7月期间在格利维采的玛丽亚·斯克洛多夫斯卡-居里国家肿瘤研究所第三放射治疗与化疗诊所接受治疗的172例患者（42例男性和130例女性）组成。降低剂量的标准基于磁共振成像（MRI）特征：肿瘤最大直径小于5 cm、肿瘤边缘清晰、无水肿且无脑浸润。患者诊断时年龄为21 - 79岁（中位年龄59岁），放疗时年龄为24 - 80岁（中位年龄62岁）。67例患者（A组）在初次手术后接受放疗。组织病理学结果显示，51例为世界卫生组织（WHO）1级脑膜瘤，16例为WHO 2级脑膜瘤。B组（105例患者）未接受过手术，诊断基于MRI上脑膜瘤的典型特征。所有患者均符合机器人立体定向射波刀放射治疗条件，总剂量为18 Gy，分三次给予，参考等剂量线为78 - 92%。
随访期为18至124个月（中位67.5个月）。5年和8年无进展生存率分别为90.3%和89.4%。随访期间有2例患者死亡。放疗后有16例患者出现肿瘤进展。4例患者因疾病进展需要手术，其中3例在进一步随访期间无进展。12例患者接受了第二轮机器人放射治疗，其中11例病情稳定，1例患者肿瘤进一步生长，但死于心力衰竭。初次和二次治疗后的粗无进展生存率为98.8%。放疗耐受性良好：10.5%的患者出现1/2级急性毒性（欧洲癌症研究与治疗组织-美国放射肿瘤学会量表）。我们未观察到放疗的任何晚期效应。
总剂量18 Gy分三次给予的立体定向射波刀放射治疗与更高剂量的治疗方案疗效相当。这可能支持颅内脑膜瘤治疗中降低剂量的观点。
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