Zare Amirhossein, Zare Amirhessam, Hajikarimloo Bardia, Mohammadi Barbod, Sheehan Jason P, Iranmehr Arad
Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran.
Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
J Neurooncol. 2025 May 21. doi: 10.1007/s11060-025-05076-z.
Ependymomas, rare malignant central nervous system (CNS) lesions (2-6% of primary CNS tumors), are typically treated with maximal safe resection followed by fractionated radiation therapy. Stereotactic radiosurgery (SRS) has emerged as an alternative, particularly in recurrent or residual cases. This study evaluates the safety and efficacy of SRS for CNS ependymomas, while also identifying key prognostic factors.
A systematic search was conducted to identify studies that evaluated the efficacy and safety of SRS in WHO Grade 2/3 CNS ependymoma patients. Random-effect meta-analysis was employed.
Fourteen studies with 298 patients and 496 lesions were included. Our meta-analysis demonstrated an overall local tumor control (LTC) rate of 72% (95% CI: 65-79%). LTC rates at 1, 3, and 5 years were 83% (95% CI: 76-88%), 72% (95% CI: 64-78%), and 69% (95% CI: 61-76%), respectively. Progression-free survival (PFS) rates at 1, 3, and 5 years were estimated at 67% (95% CI: 50-80%), 56% (95% CI: 48-64%), and 51% (95% CI: 39-63%), respectively. Additionally, the 5-year overall survival (OS) rate was 58% (95% CI: 48-67%). The incidence of adverse radiation events (ARE) was 20% (95% CI: 12-31%). Meta-regression showed older age correlated with improved tumor control (P = 0.02) and lower ARE (P = 0.06) and radionecrosis rates (P < 0.01), while larger tumor volumes (P = 0.03) and anaplastic histology (P = 0.01) were associated with poorer PFS.
SRS is a reasonably valuable therapeutic option in the multimodal management of WHO Grade 2/3 CNS ependymomas, especially for individuals with inoperable, recurrent, or residual lesions. Key patient and tumor characteristics have been analyzed to determine factors potentially impacting treatment outcomes.
室管膜瘤是罕见的恶性中枢神经系统（CNS）病变（占原发性中枢神经系统肿瘤的2%-6%），通常采用最大安全切除，随后进行分次放射治疗。立体定向放射外科（SRS）已成为一种替代方案，尤其是在复发或残留病例中。本研究评估了SRS治疗中枢神经系统室管膜瘤的安全性和有效性，同时确定关键的预后因素。
进行系统检索以确定评估SRS对世界卫生组织（WHO）2/3级中枢神经系统室管膜瘤患者疗效和安全性的研究。采用随机效应荟萃分析。
纳入了14项研究，共298例患者和496个病灶。我们的荟萃分析显示总体局部肿瘤控制（LTC）率为72%（95%置信区间：65%-79%）。1年、3年和5年的LTC率分别为83%（95%置信区间：76%-88%）、72%（95%置信区间：64%-78%）和69%（95%置信区间：61%-76%）。1年、3年和5年的无进展生存期（PFS）率估计分别为67%（95%置信区间：50%-80%）、56%（95%置信区间：48%-64%）和51%（95%置信区间：39%-63%）。此外，5年总生存期（OS）率为58%（95%置信区间：48%-67%）。不良放射事件（ARE）的发生率为20%（95%置信区间：12%-31%）。荟萃回归显示年龄较大与更好的肿瘤控制（P = 0.02）、较低的ARE发生率（P = 0.06）和放射性坏死率（P < 0.01）相关，而肿瘤体积较大（P = 0.03）和间变组织学（P = 0.01）与较差的PFS相关。
SRS是WHO 2/3级中枢神经系统室管膜瘤多模式管理中一种相当有价值的治疗选择，特别是对于无法手术、复发或残留病灶的患者。已分析关键的患者和肿瘤特征以确定可能影响治疗结果的因素。
