Long-Term Outcome After Radiotherapy in Patients With Atypical and Malignant Meningiomas-Clinical Results in 85 Patients Treated in a Single Institution Leading to Optimized Guidelines for Early Radiation Therapy
Long-Term Outcome After Radiotherapy in Patients With Atypical and Malignant Meningiomas-Clinical Results in 85 Patients Treated in a Single Institution Leading to Optimized Guidelines for Early Radiation Therapy
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DOI：
10.1016/j.ijrobp.2011.08.010
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发表时间：
2012-07-01
影响因子：
7
通讯作者：
Combs, Stephanie E.
中科院分区：
文献类型：
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作者：
Adeberg, Sebastian;Hartmann, Christian;Combs, Stephanie E.
目的：以前，我们可以证明，新的世界卫生组织（WHO）脑膜瘤分类与非典型和间变性组织学患者的预后显著相关。在目前的工作中，我们分析了我们的长期经验，在放射治疗的非典型性和恶性脑膜瘤诊断根据最新的WHO分类system.Patients和方法：62例非典型性和23例恶性脑膜瘤患者进行了放射治疗。60%的患者在手术切除后接受放疗（RT），19%在疾病进展时接受放疗，8.3%作为主要治疗。采用不同的技术进行放射治疗，包括分次立体定向RT（FSRT）、调强RT和碳离子联合治疗。中位PTV为156.0 mL。平均剂量为57.6戈伊（范围：30-68.4戈伊），分次1.8-3戈伊。所有患者定期随访，包括临床神经随访，以及计算机断层扫描或磁共振imaging.Results：总生存率显着影响组织学分级，在5年的非典型或间变性脑膜瘤，分别为81%和53%。该差异具有显著性，p = 0.022。18例患者在随访期间死于肿瘤进展。2年和5年时，非典型组的无进展生存率分别为95%和50%，间变性组分别为63%和13%。该差异具有显著性，p = 0.017。尽管组织学，我们不能观察到任何预后因素，包括年龄，切除状态，或Karnofsky性能评分。然而，在63例患者中观察到的预先存在的临床症状改善了29.3%，这些patients.Conclusion：RT导致预先存在的临床症状的改善;结果与文献中报道的其他系列相当。RT应在初次诊断后手术切除后提供，以增加无进展生存期和总生存期。新的临床概念正在研究中，以进一步改善高级别脑膜瘤患者的预后。(C)2012 Elsevier Inc.
Purpose: Previously, we could show that the new World Health Organization (WHO) classification of meningiomas significantly correlated with outcome in patients with atypical and anaplastic histology. In the present work, we analyzed our long-term experience in radiotherapy for atypical and malignant meningioma diagnosed according to the most recent WHO categorization system.Patients and Methods: Sixty-two patients with atypical and 23 patients with malignant meningioma have been treated with radiotherapy. Sixty percent of all patients received radiotherapy (RT) after surgical resection, 19% at disease progression and 8.3% as a primary treatment. Radiation was applied using different techniques including fractionated stereotactic RT (FSRT), intensity-modulated RT, and combination treatment with carbon ions. The median PTV was 156.0 mL. An average dose of 57.6 Gy (range, 30-68.4 Gy) in 1.8-3 Gy fractions was applied. All patients were followed regularly including clinical-neurological follow-up as well as computed tomographies or magnetic resonance imaging.Results: Overall survival was impacted significantly by histological grade, with 81% and 53% at 5 years for atypical or anaplastic meningiomas, respectively. This difference was significant at p = 0.022. Eighteen patients died of tumor progression during follow-up. Progression-free survival was 95% and 50% for atypical, and 63% and 13% for anaplastic histology at 2 and 5 years. This difference was significant at p = 0.017. Despite histology, we could not observe any prognostic factors including age, resection status, or Karnofsky performance score. However, preexisting clinical symptoms observed in 63 patients improved in 29.3% of these patients.Conclusion: RT resulted in improvement of preexisting clinical symptoms; outcome is comparable to other series reported in the literature. RT should be offered after surgical resection after initial diagnosis to increase progression-free survival as well as overall survival. Novel clinical concepts are under investigation to further improve outcome in patients with high-grade meningiomas. (C) 2012 Elsevier Inc.