Hoffmann W, Mühleisen H, Hess C F, Kortmann R D, Schmidt B, Grote E H, Bamberg M
Department of Radiotherapy, University of Tübingen, Federal Republic of Germany.
Acta Neurochir (Wien). 1995;135(3-4):171-8. doi: 10.1007/BF02187764.
We retrospectively analysed 13 patients (pts.) treated at the University of Tübingen from 1985 to 1993 to evaluate the results of radiation therapy (XRT) given as an adjuvant to totally or subtotally resected meningiomas. The overall survival was 38% at five years with a probability of relapse of 50% at this time. Reclassification of the tumours according to the new WHO-classification of brain tumours [14] revealed 10 grade-II-tumours (atypical meningioma) and 3 grade-III-tumours (anaplastic meningioma). Radiotherapy failed in all 3 pts. with macroscopically incomplete resection (Simpson's grade IV), who died with relapse between 4 and 51 months after radiotherapy. 5 out of 10 pts. with grade-II-tumours relapsed. All 3 pts. with grade-III-tumours died with relapse between 6 and 21 months after XRT. Morbidity was seen in 2 pts. after irradiation with 60 GY (ICRU dose specification). Complete surgical exstirpation offers the best possibility of tumour control. Grade-III-tumours should be irradiated whatever the extent of the primary surgery was. Our results might indicate a possible indication for XRT in pts. with atypical grade-II-tumours especially when radical surgery must be in doubt. Prospective multicentre trials are warranted to prove the prognostic value of the new WHO-classification for atypical and anaplastic meningiomas and to define the ultimate role of radiotherapy in this setting.
我们回顾性分析了1985年至1993年在图宾根大学接受治疗的13例患者，以评估作为全切除或次全切除脑膜瘤辅助治疗的放射治疗（XRT）的效果。五年总生存率为38%，此时复发概率为50%。根据世界卫生组织（WHO）新的脑肿瘤分类标准[14]对肿瘤进行重新分类，发现有10例二级肿瘤（非典型脑膜瘤）和3例三级肿瘤（间变性脑膜瘤）。3例肉眼切除不完全（辛普森四级）的患者放射治疗均失败，他们在放疗后4至51个月死于复发。10例二级肿瘤患者中有5例复发。3例三级肿瘤患者均在放疗后6至21个月死于复发。2例患者在接受60GY（国际辐射单位委员会剂量规范）照射后出现并发症。完整的手术切除提供了最佳的肿瘤控制可能性。无论初次手术范围如何，三级肿瘤均应接受放疗。我们的结果可能表明，对于非典型二级肿瘤患者，尤其是在根治性手术存在疑问时，XRT可能有适应证。有必要进行前瞻性多中心试验，以证明WHO新分类对非典型和间变性脑膜瘤的预后价值，并确定放疗在这种情况下的最终作用。
