Malignant meningioma: An indication for initial aggressive surgery and adjuvant radiotherapy
Malignant meningioma: An indication for initial aggressive surgery and adjuvant radiotherapy
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DOI：
10.1023/a:1005853720926
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发表时间：
1998-04-01
影响因子：
3.9
通讯作者：
Chiu, JK
中科院分区：
文献类型：
--
作者：
Dziuk, TW;Woo, S;Chiu, JK
恶性脑膜瘤是脑膜瘤的一种罕见亚型，术后复发的可能性很大。这项回顾研究评估了改变复发率的各种参数。回顾1984~1992年间收治的所有恶性脑膜瘤患者的临床资料，确定复发时间或患者当前状态，并分析各种患者和疾病参数的影响。38例患者接受48次恶性脑膜瘤切除术(28次全切，20次次全切)，25例初发，23例复发；19例术后放疗。亚型包括间变性脑膜瘤32例，血管外皮细胞瘤11例，脑膜肉瘤2例，乳头型脑膜瘤3例。随访时间从3个月到144个月不等，其中5名患者被排除在分析之外。全切除后5年无病/无进展生存率(DFS)为39%，次全切除后为0%(p=0.001)。对于所有完全切除的病变，5年DFS从单纯手术的28%提高到辅助放射治疗的57%(p=NS)。初次切除后辅助性放疗使5年无瘤生存率从15%提高到80%(p=0.002)。对于复发的肿瘤，辅助放射治疗使2年无瘤生存时间从50%提高到89%(p=0.015)，但对5年无瘤生存时间没有影响。多因素分析显示手术切除范围、辅助放疗和复发情况是影响预后的独立因素。恶性脑膜瘤有术后复发的趋势，多中心和复发的脑膜瘤复发率明显增加。彻底的手术切除和在初次切除后给予辅助放射治疗是长期控制的关键。
Malignant meningiomas constitute a rare subset of meningiomas and display a marked propensity for postsurgical recurrence. This retrospective study evaluates the various parameters which alter the recurrence rate. The records of all malignant meningioma patients treated from 1984 through 1992 were reviewed, and the time to recurrence or current patient status was determined, and the influence of various patient and disease parameters were analyzed.Thirty-eight patients were treated with 48 malignant meningioma resections performed (28 total and 20 subtotal), 25 at initial presentation and 23 for recurrent disease; 19 patients received postoperative radiotherapy. Subtypes included 32 anaplastic meningioma, 11 hemangiopericytoma, 2 meningiosarcoma, and 3 papillary meningioma. Followup ranged from 3 to 144 months, with five patients excluded from analysis. Actuarial disease free/progression free survival (DFS) at 5 years was 39% following total resection versus 0% after subtotal resection (p = 0.001). For all totally excised lesions, the 5-yr DFS was improved from 28% for surgery alone to 57% with adjuvant radiotherapy (p = NS). Adjuvant irradiation following initial resection increased the 5-yr DFS rates from 15% to 80% (p = 0.002). When administered for recurrent lesions, adjuvant radiotherapy improved the 2-yr DFS from 50% to 89% (p = 0.015), but had no impact on 5-yr DFS. Multivariate analysis indicates extent of resection, adjuvant radiotherapy and recurrence status are independent prognostic factors.Malignant meningiomas display a tendency for post surgical recurrence, with recurrence significantly increased for multicentric and recurrent disease. Complete surgical resection and the administration of adjuvant irradiation following initial resection are crucial to long-term control.