Ho Vincent K Y, Anten Monique M, Garst Anniek, Bos Eelke M, Snijders Tom J, Eekers Daniëlle B P, Seute Tatjana
Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), P.O. Box 19079, 3501 DB , Utrecht, The Netherlands.
Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
J Neurooncol. 2024 Oct;170(1):41-52. doi: 10.1007/s11060-024-04730-2. Epub 2024 Aug 29.
Meningiomas classified as grade 2-3 according to the World Health Organisation (WHO) require combined surgery and in most cases radiotherapy (RT). Their initial management was evaluated using the Dutch Brain Tumour Registry.
The study included 393 patients aged ≥ 18 years with newly diagnosed meningioma WHO grade 2-3 between 2016 and 2021. Factors associated with adjuvant RT < 6 months following surgery were identified using logistic regression analyses, thereby accounting for variation between CNS regional tumour boards through mixed-effect modelling. This variation was further assessed by funnel plots for case-mix adjusted ratios of RT across tumour boards. The association with patients' survival at 5 years was evaluated with inverse probability-weighted accelerated failure (Weibull) models. Analyses were performed on multiple imputed datasets (m = 10) to account for missing data.
Adjuvant RT was administered to 22.2% (59/266) of patients with WHO grade 2 meningioma following a total resection, to 61.1% (58/95) following a partial resection, and to 68.8% (22/32) of patients with WHO grade 3 meningioma (61.5% after partial and 73.7% after total resection). RT was associated with grade 3, partial resection, bone invasion, and absence of multiple lesions. Management varied across tumour boards for grade 2 meningioma following total resection. Adjuvant RT was associated with survival benefit in case of grade 3 disease (hazard ratio: 0.40, 95%-confidence interval: 0.16-0.95, p = 0.04).
This national review revealed variation across CNS regional tumour boards in the management of grade 2 meningioma following total resection, and demonstrated survival benefit of adjuvant RT in grade 3 meningioma.
根据世界卫生组织（WHO）分类为2-3级的脑膜瘤需要联合手术治疗，并且在大多数情况下需要放疗（RT）。使用荷兰脑肿瘤登记处对其初始治疗进行评估。
该研究纳入了2016年至2021年间393例年龄≥18岁的新诊断为WHO 2-3级脑膜瘤的患者。通过逻辑回归分析确定与术后<6个月辅助放疗相关的因素，从而通过混合效应模型考虑中枢神经系统区域肿瘤委员会之间的差异。通过漏斗图进一步评估各肿瘤委员会放疗病例组合调整率的差异。使用逆概率加权加速失败（威布尔）模型评估与患者5年生存率的相关性。对多个插补数据集（m = 10）进行分析以处理缺失数据。
WHO 2级脑膜瘤患者在全切除后，22.2%（59/266）接受了辅助放疗；部分切除后，61.1%（58/95）接受了辅助放疗；WHO 3级脑膜瘤患者中，68.8%（22/32）接受了辅助放疗（部分切除后为61.5%，全切除后为73.7%）。放疗与3级、部分切除、骨侵犯和无多发病变相关。全切除后，2级脑膜瘤的治疗在各肿瘤委员会之间存在差异。3级疾病时，辅助放疗与生存获益相关（风险比：0.40，95%置信区间：0.16-0.95，p = 0.04）。
这项全国性综述揭示了中枢神经系统区域肿瘤委员会在2级脑膜瘤全切除后治疗方面的差异，并证明了3级脑膜瘤辅助放疗的生存获益。
