Letter: Patterns of Intermediate- and High-Risk Meningioma Recurrence After Treatment With Postoperative External Beam Radiotherapy.
Letter: Patterns of Intermediate- and High-Risk Meningioma Recurrence After Treatment With Postoperative External Beam Radiotherapy.
复制标题
信件：术后外照射放射治疗后中危和高危脑膜瘤复发的模式。
作者：
Susko,MatthewS;Chen,WilliamC;Vasudevan,HarishN;Magill,StephenT;Lucas,Calixto-HopeG;OberheimBush,NancyAnn;Solomon,DavidA;Theodosopoulos,PhilipV;McDermott,MichaelW;Villanueva-Meyer,JavierE;Boreta,Lauren;Nakamura,JeanL;Sne
致编辑：脑膜瘤的术后外照射放射治疗（EBRT）模式是有争议的。前瞻性、非随机试验的早期结果为这种方法提供了背景和证据，但脑膜瘤EBRT的最佳切缘仍不清楚。RTOG 0539是一项对接受新诊断的世界卫生组织（WHO）2级脑膜瘤或复发性WHO 1级脑膜瘤的大体全切除术至辅助EBRT治疗的中等风险患者进行分层的试验，发现3年无进展生存率为93.8%，大体肿瘤体积（GTV）至临床靶体积（CTV）EBRT扩展为1 cm。1复发或次全切除WHO 2级脑膜瘤或WHO 3级脑膜瘤切除术的高危患者，在RTOG 0539上使用1 - 2 cm GTV至CTV扩展进行辅助EBRT治疗，3年无进展生存率为58.8%。2 RTOG 0539虽然为脑膜瘤EBRT提供了一个急需的前瞻性基准，但没有检查脑膜瘤EBRT边缘。事实上，推荐的GTV到CTV的扩张是各向同性的，即使在没有脑膜瘤侵袭的情况下也包括邻近的脑和骨（尽管允许减少CTV边缘以考虑自然的解剖屏障）。为了尽量减少EBRT的毒性，我们长期以来对脑膜瘤EBRT的机构实践是在没有脑膜瘤侵袭的情况下使用0 cm CTV边缘进入脑或骨。相反，沿着硬脑膜使用各向异性的1.5至2 cm CTV边缘，对于组织学或术中有脑浸润证据的脑膜瘤，在脑内增加最小0.3至0.5 cm CTV边缘。这种方法得到了先前脑膜瘤复发模式研究的支持，该研究表明即使使用5 mm的缩小各向同性CTV边缘，野内复发（83%）也占优势，但该先前研究受到中位随访时间短（26个月）和可用于影像学审查的少量复发（n= 6）的限制。3为了阐明脑膜瘤EBRT的最佳切缘，我们分析了1991年至2015年在我们机构接受手术和EBRT治疗的51例连续中高风险脑膜瘤患者的监测磁共振成像（MRI）研究（表）。本机构审查委员会批准的研究中纳入的所有患者均签署了一份豁免同意书，同意在研究中分析和纳入去识别的临床数据（18-24633）。由委员会认证的神经病理学家根据当前的诊断标准对每个病例的诊断材料进行分类。4辅助放疗后每3 ~ 6个月进行一次增强MRI检查，
To the Editor: Postoperative external beam radiotherapy (EBRT) paradigms for meningioma are controversial. Early results from prospective, nonrandomized trials have provided context and evidence for this approach, but optimal meningioma EBRT margins remains unknown. RTOG 0539, a trial stratifying intermediate-risk patients treated with gross total resection of newly diagnosed World Health Organization (WHO) grade 2 meningiomas or recurrent WHO grade 1 meningiomas to adjuvant EBRT, found progression free survival of 93.8% at 3 yr with 1-cm gross tumor volume (GTV) to clinical target volume (CTV) EBRT expansions. 1 High-risk patients with recurrent or sub-totally resected WHO grade 2 meningiomas, or any resection of WHO grade 3 meningiomas, were treated with adjuvant EBRT on RTOG 0539 using a 1 to 2 cm GTV to CTV expansions and had 3-yr progression free survival of 58.8%. 2 While providing a much-needed prospective benchmark for meningioma EBRT, RTOG 0539 did not examine meningioma EBRT margins. Indeed, recommended GTV to CTV expansions were isotropic, encompassing adjacent brain and bone even in the absence of meningioma invasion (although it was permissible to reduce the CTV margin to account for natural anatomic barriers). In an effort to minimize EBRT toxicity, our longstanding institutional practice for meningioma EBRT has been to use 0-cm CTV margins into brain or bone in the absence of meningioma invasion. Instead, anisotropic 1.5 to 2 cm CTV margins are used along the dura, and a minimal 0.3 to 0.5 cm CTV margin is added into the brain for meningiomas with histologic or intraoperative evidence of brain invasion. This approach is supported by a prior meningioma patterns of recurrence study demonstrating a predominance of in-field recurrences (83%) even when reduced isotropic CTV margins of 5 mm were used, but this prior study was limited by short median follow-up (26 mo) and a small number of recurrences that were available for imaging review (n= 6). 3To shed light on optimal meningioma EBRT margins, we analyzed surveillance magnetic resonance imaging (MRI) studies in 51 consecutive patients with intermediate-or highrick meningiomas according to RTOG 0539 criteria treated with surgery and EBRT from 1991 to 2015 at our institution (Table). All patients included in this Institutional Review Board-approved study signed a waiver of consent for analysis and inclusion of de-identified clinical data in research (18-24633). The diagnostic material from each case was classified according to current diagnostic criteria by a board-certified neuropathologist. 4 Contrast-enhanced MRIs were recommended every 3 to 6 mo after adjuvant radiotherapy, surveillance imaging
影响因子：
4.1
作者：
Rogers L;Zhang P;Vogelbaum MA;Perry A;Ashby LS;Modi JM;Alleman AM;Galvin J;Brachman D;Jenrette JM;De Groot J;Bovi JA;Werner-Wasik M;Knisely JPS;Mehta MP
通讯作者：
Mehta MP
影响因子：
15.9
作者：
Brastianos, Priscilla K.;Galanis, Evanthia;Zadeh, Gelareh
通讯作者：
Zadeh, Gelareh