Department of Radiation Oncology, Southern California Permanente Medical Group, Los Angeles, California, USA.
Department of Radiology, Southern California Permanente Medical Group, Los Angeles, California, USA.
World Neurosurg. 2024 Oct;190:e403-e412. doi: 10.1016/j.wneu.2024.07.148. Epub 2024 Jul 26.
Stereotactic radiosurgery (SRS) is an established treatment for intracranial meningioma, yet this approach is often precluded by tumor size or proximity to critical structures. Fractionated radiotherapy (RT) may be employed to address these limitations. We performed a comparison of local control (LC) outcomes between 3 stereotactic techniques.
A retrospective review was performed of 543 consecutive patients with 613 histologically-proven World Health Organization grade I or radiographically-defined benign intracranial meningioma treated with SRS (median dose: 1250 cGy) (n = 211), fractionated SRS (2500 cGy in 500 cGy fractions) (n = 170), or conventionally fractionated stereotactic radiotherapy (FSRT) (median dose: 5022 cGy in ≤200 cGy fractions) (n = 232) in the definitive (n = 475) or postoperative (n = 138) setting between January 2008 and December 2021. Postoperative treatment was delivered upfront after a subtotal resection (n = 43) or for recurrent disease (n = 95).
Median follow-up per lesion was 8.0 years. LC for all lesions at 5/10/14 years was 97.4%/86.8%/86.8%. Base of skull location (P = 0.01), tumor volume ≥5 cc (P = 0.01), and recurrent disease (P = 0.02) were associated with inferior LC. No difference was observed in LC by fractionation regimen; LC at 5/10 years was 97.3%/85.7% for SRS, 97.5%/89.1% for fractionated SRS, and 97.5%/86.3% for FSRT. Dose escalation above 1250 cGy for SRS or above 5040 cGy for FSRT did not result in improved LC.
Durable LC was observed at long-term follow-up of intracranial meningioma treated with stereotactic radiosurgery and RT. LC outcomes were similar across the 3 fractionation regimens, suggesting that clinicians may tailor RT recommendations based on clinical factors without concern for reduced efficacy.
立体定向放射外科（SRS）是治疗颅内脑膜瘤的一种成熟治疗方法，但由于肿瘤大小或靠近关键结构，这种方法往往受到限制。分次放射治疗（RT）可能用于解决这些局限性。我们对 3 种立体定向技术的局部控制（LC）结果进行了比较。
对 2008 年 1 月至 2021 年 12 月期间，543 例连续的 613 例经组织学证实的世卫组织 I 级或影像学定义的良性颅内脑膜瘤患者（211 例接受 SRS 治疗（中位剂量：1250 cGy），170 例接受分次 SRS 治疗（2500 cGy 分 500 cGy 分次），232 例接受常规分次立体定向放射治疗（FSRT）（中位剂量：200 cGy 以下 5022 cGy 分次））（211 例接受 SRS 治疗（中位剂量：1250 cGy），170 例接受分次 SRS 治疗（2500 cGy 分 500 cGy 分次），232 例接受常规分次立体定向放射治疗（FSRT）（中位剂量：200 cGy 以下 5022 cGy 分次））），在确定性（475 例）或术后（138 例）治疗中。术后治疗在次全切除（n=43）或复发性疾病（n=95）后立即进行。
每个病变的中位随访时间为 8.0 年。所有病变的 5/10/14 年 LC 分别为 97.4%/86.8%/86.8%。颅底位置（P=0.01）、肿瘤体积≥5 cc（P=0.01）和复发性疾病（P=0.02）与较低的 LC 相关。分层方案的 LC 无差异；SRS 的 5/10 年 LC 为 97.3%/85.7%，分次 SRS 为 97.5%/89.1%，FSRT 为 97.5%/86.3%。SRS 剂量超过 1250 cGy 或 FSRT 剂量超过 5040 cGy 不会导致 LC 改善。
在接受立体定向放射外科和 RT 治疗的颅内脑膜瘤的长期随访中观察到持久的 LC。3 种分次方案的 LC 结果相似，这表明临床医生可以根据临床因素推荐 RT，而不必担心疗效降低。
