Hajikarimloo Bardia, Tos Salem M, Mohammadzadeh Ibrahim, Hemmati Sara, Savedkoohi Alaleh, Diyanati Maryam, Akbarzadeh Diba, Alvani Mohammadamin Sabbagh, Hezaveh Ehsan Bahrami, Hashemi Rana, Habibi Mohammad Amin
Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
J Clin Neurosci. 2025 Aug;138:111384. doi: 10.1016/j.jocn.2025.111384. Epub 2025 Jun 11.
Managing large intracranial meningiomas (LIMs) is challenging. Because of the significant morbidity associated with resection, stereotactic radiosurgery (SRS) has increasingly been employed for LIMs. This systematic review and meta-analysis assessed the role of SRS in LIMs.
On March 21, 2025, we performed a literature search. Studies evaluating outcomes after upfront or adjuvant SRS in patients with LIMs, with volumes larger than 8 cm or a maximum diameter exceeding 2.5 cm, were included.
Eleven studies involving 793 patients were included. The mean tumor volume ranged from 14.1 to 37.3 cm. The meta-analysis revealed a pooled local control (LC) rate of 91 % (95 % CI: 86 %-94 %). Additionally, the analysis demonstrated a pooled 5-year progression-free survival (PFS) rate of 92 % (95 % CI: 86 %-96 %) and a 10-year PFS rate of 81 % (95 % CI: 76 %-84 %). It exhibited a pooled overall survival (OS) rate of 88 % (95 % CI: 77 %-96 %), a 5-year OS rate of 94 % (95 % CI: 89 %-97 %), and a 10-year OS rate of 88 % (95 % CI: 58 %-100 %). Moreover, the meta-analysis revealed a pooled adverse radiation effect (ARE) and post-SRS resection rates of 19 % (95 % CI: 7 %-36 %) and 3 % (95 % CI: 0 %-8%), respectively. Hypofractionated SRS (99 % [95 % CI: 91 %-100 %]) was associated with a significantly higher pooled OS rate than volume-staged SRS (82 % [95 % CI: 69 %-92 %]) and single session SRS (85 % [95 % CI: 48 %-100 %]) (P = 0.01).
Upfront or adjuvant SRS is linked to promising radiological and clinical outcomes with manageable radiation-related complications. Further research is needed to compare upfront versus adjuvant SRS and evaluate the relative efficacy and safety of single-session, hypofractionated, and volume-staged SRS in individuals with LIMs.
大型颅内脑膜瘤（LIMs）的治疗具有挑战性。由于手术切除相关的显著发病率，立体定向放射外科（SRS）越来越多地被用于LIMs的治疗。本系统评价和荟萃分析评估了SRS在LIMs治疗中的作用。
2025年3月21日，我们进行了文献检索。纳入评估体积大于8 cm或最大直径超过2.5 cm的LIMs患者接受初始或辅助SRS治疗后的结局的研究。
纳入了11项研究，共793例患者。平均肿瘤体积为14.1至37.3 cm。荟萃分析显示，局部控制（LC）率合并为91%（95%CI：86%-94%）。此外，分析显示5年无进展生存（PFS）率合并为92%（95%CI：86%-96%），10年PFS率为81%（95%CI：76%-84%）。总体生存（OS）率合并为88%（95%CI：77%-96%），5年OS率为94%（95%CI：89%-97%），10年OS率为88%（95%CI：58%-100%）。此外，荟萃分析显示，放射不良反应（ARE）和SRS后切除率合并分别为19%（95%CI：7%-36%）和3%（95%CI：0%-8%）。与体积分割SRS（82%[95%CI：69%-92%]）和单次SRS（85%[95%CI：48%-100%]）相比，大分割SRS（99%[95%CI：91%-100%]）的合并OS率显著更高（P = 0.01）。
初始或辅助SRS与良好的放射学和临床结局相关，且放射相关并发症可控。需要进一步研究比较初始SRS与辅助SRS，并评估单次、大分割和体积分割SRS在LIMs患者中的相对疗效和安全性。
