COMBINED PROTON AND PHOTON CONFORMAL RADIOTHERAPY FOR INTRACRANIAL ATYPICAL AND MALIGNANT MENINGIOMA
COMBINED PROTON AND PHOTON CONFORMAL RADIOTHERAPY FOR INTRACRANIAL ATYPICAL AND MALIGNANT MENINGIOMA
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DOI：
10.1016/j.ijrobp.2008.10.053
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发表时间：
2009-10-01
影响因子：
7
通讯作者：
Mazeron, Jean-Jacques
中科院分区：
文献类型：
--
作者：
Boskos, Christos;Feuvret, Loic;Mazeron, Jean-Jacques
目的：回顾分析不典型脑膜瘤和恶性脑膜瘤首次手术后适形分割放射治疗的疗效。方法：1999年9月至2006年10月，24例经手术病理证实的脑膜瘤(不典型脑膜瘤19例，恶性脑膜瘤5例)接受了奥赛质子治疗中心201 MeV质子束加高能光子束的联合放射治疗。6例行大部切除，18例行次全切除。肿瘤大体平均体积为44.7cm3，临床靶区体积为153.3 cm3。平均总照射剂量为65.01CGE，平均质子总剂量为34.05CGE，平均光子总剂量为30.96CGE。结果：平均随访时间32.2(1~72)个月。总的平均无局部复发间隔为27.2(10-50)个月，非典型脑膜瘤为28.3(10-50)个月，恶性脑膜瘤为23(13-33)个月。10例肿瘤局部复发。全组患者1、2、3、4、5、8年局控率分别为82.9%±7.8%、82.9%±7.8%、61.3%±11%、46.7%±12.3%、46.7%±12.3%。1、2、3、4、5、8年总生存率分别为100%、95.5%±4.4%、80.4%±8.8%、65.3%±10.6%、53.2%±11.6%、42.6%±13%。存活率与总剂量显著相关。无急性放射治疗并发症发生。1例患者在治疗16个月后发生放射性坏死。结论：质子和光子联合适形放疗治疗不典型脑膜瘤和恶性脑膜瘤是一种耐受性好的治疗方法，可产生长期的肿瘤稳定。(C)2009年爱思唯尔公司。
Purpose: To evaluate retrospectively the efficacy of conformal fractionated radiotherapy combining proton and photon beams after primary surgery for treatment of atypical and malignant meningiomas.Patients and Methods: Between September 1999 and October 2006,24 patients (12 male, 12 female) with histopathologically proven meningioma (atypical 19, malignant 5) received postoperative combined radiotherapy with a 201-MeV proton beam at the Centre Protontherapie d'Orsay and a high-energy photon beam. Six patients underwent gross total resection and 18 a subtotal resection. Median gross tumor volume and clinical target volume were 44.7 cm(3) and 153.3 cm(3), respectively. Mean total irradiation dose was 65.01 CGE (cobalt gray equivalent), with a mean proton total dose of 34.05 CGE and a mean photon total dose 30.96 CGE.Results: The median (range) follow-up interval was 32.2 (1-72) months. The overall mean local relapse-free interval was 27.2 (10-50) months, 28.3 (10-50) months for atypical meningioma and 23 (13-33) months for malignant meningioma. Ten tumors recurred locally. One-, 2-,3-,4-,5-, and 8- year local control rates for the entire group of patients were 82.9% +/- 7.8%, 82.9% +/- 7.8%, 61.3% +/- 11%, 61.3% +/- 11 %, 46.7% +/- 12.3%, and 46.7% +/- 12.3%, respectively. One-, 2-,3-,4-,5-, and 8- year overall survival rates were 100%, 95.5% +/- 4.4%, 80.4% +/- 8.8%, 65.3% +/- 10.6%, 53.2% +/- 11.6%, and 42.6% +/- 13%, respectively. Survival was significantly associated with total dose. There was no acute morbidity of radiotherapy. One patient developed radiation necrosis 16 months after treatment.Conclusions: Postoperative combination of conformal radiotherapy with protons and photons for atypical and malignant meningiomas is a well-tolerated treatment producing long-term tumor stabilization. (C) 2009 Elsevier Inc.