Department of Neurological Surgery, University of Virginia, Box 800212, Charlottesville, VA, 22908, USA.
J Neurooncol. 2024 Nov;170(2):377-385. doi: 10.1007/s11060-024-04804-1. Epub 2024 Aug 27.
The radio-surgical literature increasingly uses biological effective dose (BED) as a replacement for absorbed dose to analyze outcome of stereotactic radiosurgery (SRS). There are as yet no studies which specifically investigate the association of BED to local tumor control in para-sellar meningioma.
we did a retrospective analysis of patients underwent stereotactic radiosurgery (SRS) for para-sellar meningioma during the period of 1995-2022. Demographic, clinical, SRS parameters, and outcome data were collected. The target margin BED with and without a model for sub-lethal repair was calculated, as well as a ratio of BED at the target margin to the absorbed dose at the target margin. Factors related to local control were further analyzed.
The study was comprised of 91 patients, 20 (22.0%) and 71 (78.0%) of whom were male and female, respectively. The median age was 55.0 (interquartile range Q1, Q3:47.5,65.5years). 34 (37%) patients had a resection of their meningioma prior to SRS. The median interval from SRS to last clinical follow up or progression was 89 months. 13 (14.3%) patients were found to have progression. 3-, 5- and 10-years local tumor control were 98%, 92% and 77%, respectively. In cox univariate analysis, the following factors were significant: Number of prior surgical resections (Hazard Ratio [HR] = 1.82, 95% CI = 1.08-3.05, p = 0.024), BED (HR = 0.96, 95% CI = 0.92-1.00, p = 0.03), and BED/margin (HR = 0.44, 95% CI = 0.21-0.92, p = 0.028). A BED threshold above 68 Gy was associated significantly with tumor control (P = 0.04).
BED and BED /margin absorbed dose ratio can be predictors of local control after SRS in parasellar meningioma. Optimizing the BED above 68Gy may afford better long-term tumor control.
立体定向放射外科（SRS）的放射外科文献越来越多地使用生物有效剂量（BED）来替代吸收剂量，以分析立体定向放射外科的结果。目前还没有专门研究 BED 与鞍旁脑膜瘤局部肿瘤控制之间关系的研究。
我们对 1995 年至 2022 年间接受 SRS 治疗的鞍旁脑膜瘤患者进行了回顾性分析。收集了人口统计学、临床、SRS 参数和结果数据。计算了目标边缘 BED 以及是否存在亚致死修复模型，并计算了目标边缘处 BED 与目标边缘处吸收剂量的比值。进一步分析了与局部控制相关的因素。
该研究共纳入 91 例患者，其中男 20 例（22.0%），女 71 例（78.0%）。中位年龄为 55.0 岁（四分位距 Q1，Q3：47.5，65.5 岁）。34 例（37%）患者在 SRS 前接受了脑膜瘤切除术。SRS 至最后临床随访或进展的中位时间为 89 个月。13 例（14.3%）患者发现进展。3 年、5 年和 10 年局部肿瘤控制率分别为 98%、92%和 77%。在单因素 Cox 分析中，以下因素具有显著意义：术前手术切除次数（风险比[HR] = 1.82，95%置信区间[CI] = 1.08-3.05，p = 0.024）、BED（HR = 0.96，95%CI = 0.92-1.00，p = 0.03）和 BED/边缘（HR = 0.44，95%CI = 0.21-0.92，p = 0.028）。BED 超过 68Gy 与肿瘤控制显著相关（P = 0.04）。
BED 和 BED/边缘吸收剂量比可作为 SRS 后鞍旁脑膜瘤局部控制的预测指标。优化 BED 超过 68Gy 可能提供更好的长期肿瘤控制。
