Haisraely Ory, Jaffe Marcia, Taliansky Alicia, Lawerence Yaakov Richard
Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel.
Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel.
World Neurosurg. 2025 Mar;195:123704. doi: 10.1016/j.wneu.2025.123704. Epub 2025 Feb 19.
Spinal meningiomas (SMs) are rare, predominantly benign tumors that account for 1.2%-12.7% of all meningiomas. While surgical resection is the primary treatment, recurrence occurs in a subset of patients, necessitating subsequent therapies such as reoperation or definitive radiation therapy (RT). This study evaluates the outcomes of definitive RT versus third surgery for recurrent World Health Organization (WHO) grade 1 SM, focusing on progression-free survival (PFS) and treatment-related toxicities.
A retrospective review of 48 patients with third progression of WHO grade 1 SM was conducted between 2008 and 2021. Inclusion criteria required prior second surgery and a confirmed pathology of WHO grade 1. Patients who received RT after earlier surgeries or whose pathology upgraded to WHO grade 2 or 3 were excluded. Data on demographics, tumor characteristics, surgical outcomes, and RT parameters were analyzed. PFS was assessed using Kaplan-Meier survival analysis, and treatment-related toxicities were recorded.
Of the 48 patients, 31 underwent third surgery and 17 received definitive RT (median dose: 54 Gy in 30 fractions). Median follow-up was 30 months. PFS at 36 months was comparable between surgery (77.4%) and RT (76.4%). Tumor size was larger in the surgery group (median 1.8 cm vs. 1 cm, P < 0.001). Neurological improvements were noted in 79.1% of surgery patients and 58.3% of RT patients. RT offered superior pain control, with no cases of radiation myelopathy observed.
Definitive RT appears to be a feasible alternative to third surgery for recurrent SM in selected patients, providing comparable PFS and manageable toxicities. Larger prospective studies are needed to validate these findings and refine treatment approaches for recurrent SM.
脊髓脑膜瘤（SMs）较为罕见，主要为良性肿瘤，占所有脑膜瘤的1.2%-12.7%。虽然手术切除是主要治疗方法，但部分患者会复发，需要后续治疗，如再次手术或确定性放射治疗（RT）。本研究评估了复发性世界卫生组织（WHO）1级SM的确定性RT与第三次手术的疗效，重点关注无进展生存期（PFS）和治疗相关毒性。
对2008年至2021年间48例WHO 1级SM第三次进展的患者进行回顾性研究。纳入标准要求既往进行过第二次手术且病理确诊为WHO 1级。排除早期手术后接受RT或病理升级为WHO 2级或3级的患者。分析人口统计学、肿瘤特征、手术结果和RT参数数据。使用Kaplan-Meier生存分析评估PFS，并记录治疗相关毒性。
48例患者中，31例接受了第三次手术，17例接受了确定性RT（中位剂量：54 Gy，分30次）。中位随访时间为30个月。手术组和RT组36个月时的PFS相当（分别为77.4%和76.4%）。手术组肿瘤体积更大（中位值分别为1.8 cm和1 cm，P < 0.001）。79.1%的手术患者和58.3%的RT患者神经功能得到改善。RT在疼痛控制方面更优，未观察到放射性脊髓病病例。
对于部分复发性SM患者，确定性RT似乎是第三次手术的可行替代方案，具有相当的PFS且毒性可控。需要更大规模的前瞻性研究来验证这些发现并完善复发性SM的治疗方法。
