Intensity-modulated radiation therapy (IMRT) for meningioma
Intensity-modulated radiation therapy (IMRT) for meningioma
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DOI：
10.1016/s0360-3016(02)02823-7
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发表时间：
2002-08-01
影响因子：
7
通讯作者：
Butler, EB
中科院分区：
文献类型：
--
作者：
Uy, NW;Woo, SY;Butler, EB
目的：评价调强放射治疗(IMRT)治疗颅内脑膜瘤的安全性和有效性。方法：1994年至1999年，采用Nomos-Peacock系统对40例颅内脑膜瘤(不包括视神经鞘脑膜瘤)进行调强放射治疗。25名患者在手术后接受了调强放疗，作为不完全切除或复发的辅助治疗，15名患者在基于影像的推定诊断后接受了明确的调强放疗。颅底病变32例，非颅底病变8例。处方剂量为40~56Gy1.71~2Gy次/次，靶区体积为1.55~324.57 cc(中位数20.22cc)。靶区平均剂量为44~60GY，中位数53GY。随访期6~71个月(中位数30个月)。使用放射治疗肿瘤学小组(RTOG)的发病率标准评估急性和慢性毒性，并通过患者报告、检查和成像评估肿瘤反应。采用Kaplan-Meier方法计算总生存率、无进展生存率和局部控制率。结果：累积5年局部控制率、无进展生存率和总生存率分别为93%、88%和89%。两名患者在调强放疗后进展，一名是局部的，一名是远处的。在良性脑膜瘤多年多次复发后，每个人都接受了调强放射治疗。两人在调强放疗后复发时都被发现患有恶性脑膜瘤，很可能在进行调强放疗时，他们的肿瘤已经发生了恶变。已定义的正常结构通常接受的剂量明显低于目标。最常见的急性中枢神经系统(CNS)毒性是轻度头痛，通常用类固醇缓解。1例患者发生RTOG 3级急性中枢神经系统毒性，2例患者晚期中枢神经系统毒性3级或更高，1例可能与治疗相关死亡。对视神经/视交叉的平均剂量为47GY，最大剂量为55GY，未见毒性反应。结论：INRT是一种安全、有效的脑膜瘤初级和辅助治疗新技术。局部侵袭史可能预示着恶性退化，并预示着较差的结局。毒性数据令人鼓舞，但存在严重副作用的可能性，一例可能的治疗相关死亡就证明了这一点。需要更大的队列和更长的随访时间才能更好地确定调强放疗的疗效和晚期毒性。(C)2002年爱思唯尔科学公司。
Purpose: To assess the safety and efficacy of intensity-modulated radiation therapy (IMRT) in the treatment of intracranial meningioma.Methods and Materials: Forty patients with intracranial meningioma (excluding optic nerve sheath meningiomas) were treated using IMRT with the NOMOS Peacock system between 1994 and 1999. Twenty-five patients received IMRT after surgery either as adjuvant therapy for incomplete resection or for recurrence, and 15 patients received definitive IMRT after presumptive diagnosis based on imaging. Thirty-two patients had skull base lesions, and 8 had nonskull base lesions. The prescribed dose ranged from 40 to 56 Gy (median 50.4 Gy) at 1.71 to 2 Gy per fraction, and the volume of the primary target ranged from 1.55 to 324.57 cc (median 20.22 cc). The mean dose to the target ranged from 44 to 60 Gy (median 53 Gy). Follow-up ranged from 6 to 71 months (median 30 months). Acute and chronic toxicity were assessed using Radiation Therapy Oncology Group (RTOG) morbidity criteria and tumor response was assessed by patient report, examination, and imaging. Overall survival, progression-free survival, and local control were calculated using the Kaplan-Meier method.Results: Cumulative 5-year local control, progression-free survival, and overall survival were 93%, 88%, and 89%,respectively. Two patients progressed after IMRT, one locally and one distantly. Each was treated with IMRT after multiple recurrences of benign meningioma over many years. Both were found to have malignant meningioma at the time of relapse after IMRT, and it is likely their tumors had already undergone malignant change by the time IMRT was given. Defined normal structures generally received a significantly lower dose than the target. The most common acute central nervous system (CNS) toxicity was mild headache, usually relieved with steroids. One patient experienced RTOG Grade 3 acute CNS toxicity, and 2 experienced Grade 3 or higher late CNS toxicity, with one possible treatment-related death. No toxicity was observed with mean doses to the optic nerve/chiasm up to 47 Gy and maximum doses up to 55 Gy.Conclusion: INRT is a promising new technology that is safe and efficacious in the primary and adjuvant treatment of intracranial meningiomas. A history of local aggression may indicate malignant degeneration and predict a poorer outcome. Toxicity data are encouraging, but the potential for serious side effects exists, as demonstrated by one possible treatment-related death. Larger cohort and longer follow-up are needed to better define efficacy and late toxicity of IMRT. (C) 2002 Elsevier Science Inc.