Coke C C, Corn B W, Werner-Wasik M, Xie Y, Curran W J
Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
J Neurooncol. 1998 Aug;39(1):65-70. doi: 10.1023/a:1005981731739.
Limited data are available concerning the outcome of patients with atypical and malignant meningiomas. We therefore analyzed the outcome of seventeen patients with meningiomas (9 atypical; 8 malignant) at Thomas Jefferson University Hospital between 1973 and 1996. Strict adherence to the 1993 WHO criteria for the typing of CNS tumors was maintained. The median potential follow-up period for all patients was 87 months. The age at diagnosis ranged from 22 to 72 (mean 51.8 years). There were 5 males and 12 females. The mean tumor diameter was 4.45 cm. Of the 16 cases where the extent of surgical resection was known, 4 were partial and 12 were complete resections. Six patients (35%) had dural or cortical invasion by tumor. Fifteen patients received postoperative megavoltage photon irradiation (mean 61 Gy). One of these fifteen pts. received an additional 20 Gy with Au-198 implantation and 1 received post-radiation chemotherapy for recurrent disease. The overall survival rate for all patients at 5 and 10 years were 87% and 58% respectively. The 5- and 10-year survival rates for atypical meningiomas were 87% and 58%; for malignant meningiomas the survival rates were 60% and 60% respectively. Five patients (30%) have died. Three of these 5 patients initially received less than 54 Gy to the tumor bed and have died of recurrent disease. Local disease progression was documented in 11 patients (65%) after surgery and in 3 patients (18%) after radiation. There was an improvement in performance status in 3 (18%) patients with a decline and no change seen in 1 (6%) and 13 (77%) respectively after receiving radiation. There appeared to be no difference in survival in patients as a function of dural or cortical invasion. Long term survival is possible for patients with atypical and malignant meningiomas treated with surgery and post-operative radiation. We are unable to distinguish a difference in outcome between these two pathological entities. Dural and cortical invasion were not associated with a decrease in survival. In addition, improved tumor control and survival may be associated with increased radiation dose.
关于非典型和恶性脑膜瘤患者的预后，可用数据有限。因此，我们分析了1973年至1996年间在托马斯·杰斐逊大学医院接受治疗的17例脑膜瘤患者（9例非典型；8例恶性）的预后情况。严格遵循1993年世界卫生组织（WHO）关于中枢神经系统肿瘤分型的标准。所有患者的中位潜在随访期为87个月。诊断时年龄范围为22至72岁（平均51.8岁）。男性5例，女性12例。肿瘤平均直径为4.45厘米。在已知手术切除范围的16例病例中，4例为部分切除，12例为完全切除。6例患者（35%）存在肿瘤侵犯硬脑膜或皮质。15例患者接受了术后兆伏光子照射（平均61 Gy）。这15例患者中有1例额外接受了20 Gy的金-198植入治疗，1例因疾病复发接受了放疗后化疗。所有患者5年和10年的总生存率分别为87%和58%。非典型脑膜瘤的5年和10年生存率分别为87%和58%；恶性脑膜瘤的生存率分别为60%和60%。5例患者（30%）死亡。这5例患者中有3例最初接受的肿瘤床照射剂量不足54 Gy，并死于疾病复发。术后有11例患者（65%）记录有局部疾病进展，放疗后有3例患者（18%）出现局部疾病进展。放疗后3例患者（18%）的功能状态有所改善；1例患者（6%）功能状态下降，13例患者（77%）功能状态无变化。似乎患者的生存情况与硬脑膜或皮质侵犯无关。接受手术和术后放疗的非典型和恶性脑膜瘤患者有可能实现长期生存。我们无法区分这两种病理类型在预后方面的差异。硬脑膜和皮质侵犯与生存率降低无关。此外，改善肿瘤控制和提高生存率可能与增加放疗剂量有关。
