Longitudinal experience with WHO Grade III (anaplastic) meningiomas at a single institution
Longitudinal experience with WHO Grade III (anaplastic) meningiomas at a single institution
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DOI：
10.1007/s11060-016-2321-8
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发表时间：
2017-02-01
影响因子：
3.9
通讯作者：
Chao, Samuel T.
中科院分区：
文献类型：
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作者：
Balasubramanian, Suresh K.;Sharma, Mayur;Chao, Samuel T.
回顾性分析和评估间变性脑膜瘤（AM）患者的预后和预后因素（WHO分级III）。分析了2000年3月至2015年6月期间首次治疗的18例III级脑膜瘤（AM，根据世界卫生组织2016年的定义）患者的临床数据和结果[总（OS）和无进展（PFS）生存率]。11例患者（61%）为男性，诊断时中位年龄63岁（范围48 ~ 86岁），55%（10/18例）表现良好（KPS >= 80）。8名患者（45%）在升级为AM之前患有较低级别疾病（I-n = 2; II-n = 6）。10例患者在原发性手术后进行了分次放疗，8例患者进行了补救性分次放疗，1例患者进行了立体定向放射手术（SRS）增强与原发性放疗，14例患者进行了18个单独区域的补救性SRS。补救性化疗主要用于第三次或第四次复发。13例（72%）复发，10例（56%）死亡。中位PFS为14.5个月（95% CI 6.9-22.2）。5年生存率为40±15%，中位OS为55.8个月（95% CI 27.7-80.3）。在所有检查的因素中，只有Karnofsky性能状态（KPS）影响结果（PFS p = 0.0003; OS p = 0.0003）。中位生存期为55个月（4.6年），我们的结果与现有的AM患者预后不良的报告一致。从现有数据来看，手术切除后再进行RT和补救性放射手术和/或化疗可延长生存期；然而，随着治疗的不断进行，效果可能会下降。
To retrospectively analyze and assess the outcomes and prognostic factors in patients with anaplastic meningioma (AM) (WHO Grade III). Clinical data and outcome [overall (OS) and progression-free (PFS) survival] from 18 patients with Grade III meningioma (AM, based on World Health Organization 2016 definition) initially treated between March 2000 and June 2015 were analyzed. Eleven patients (61%) were male, median age at diagnosis was 63 (range 48-86), and 55% (10/18 patients) had good performance status (KPS >= 80). Eight patients (45%) had lower grade disease (Grade I-n = 2; Grade II-n = 6) prior to being upgraded to AM. Ten patients had fractionated radiation after primary surgery, eight patients had salvage fractionated RT, stereotactic radiosurgery (SRS) boost along with primary RT in 1 patient, and salvage SRS to 18 separate areas in 14 patients. Salvage chemotherapy was mainly considered in third or fourth recurrences. 13 (72%) patients recurred and 10 (56%) have died. Median PFS was 14.5 months (95% CI 6.9-22.2). The 5-year survival rate was 40 +/- 15% and median OS was 55.8 months (95% CI 27.7-80.3). Of all factors examined, only Karnofsky performance status (KPS) affected outcome (PFS p = 0.0003; OS p = 0.0003). With median OS of 55 months (4.6 years) our results are consistent with existing reports of the poor outcomes for AM patients. From the available data, surgical resection followed by RT and salvage radiosurgery and/or chemotherapy can lead to extended survival; however the benefit may decrease with successive treatments.