Adjuvant radiotherapy for atypical meningiomas
Adjuvant radiotherapy for atypical meningiomas
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DOI：
10.3171/2016.5.jns152809
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发表时间：
2017-06-01
影响因子：
4.1
通讯作者：
Shrieve, Dennis C.
中科院分区：
文献类型：
--
作者：
Bagshaw, Hilary P.;Burt, Lindsay M.;Shrieve, Dennis C.
目的本文的目的是评估在初次诊断时或首次复发时单独手术治疗与手术和放疗相比的非典型脑膜瘤（AM）患者的结局。方法回顾性分析了1991年至2014年在犹他州大学治疗的经病理证实的AM患者。评估局部控制（LC）、总生存期（OS）、Karnofsky体力状态（KPS）和毒性。接受辅助放疗的患者的结果与单纯手术治疗的患者进行了比较。采用Kaplan-Meier法和log-rank检验进行LC和OS分析。分析时，52例患者存活，中位随访时间为42个月。所有肿瘤的LC为57%，中位局部失败时间（TTLF）为48个月。手术和放疗后的中位TTLF为180个月，而单纯手术后为46个月（p = 0.02）。排除Simpson IV级（次全）切除，对于Simpson I、II和III级切除肿瘤，增加放疗仍有LC获益（手术和放疗后中位TTLF为180个月，而单纯手术为46个月[p = 0.002]）。在任何初始治疗（单独手术或手术和辅助放疗）后首次复发时治疗的患者的中位TTLF为26个月，而首次诊断时治疗的肿瘤的中位TTLF为48个月（p = 0.007）。2例3级毒性反应和1例4级毒性反应与放疗有关。结论：辅助放疗可改善AM的LC。即使是Simpson I、II或III级切除术后增加辅助放疗也能使LC获益。复发性疾病很难控制，强调了积极的初始治疗的重要性。
OBJECTIVE The aim of this paper was to evaluate outcomes in patients with atypical meningiomas (AMs) treated with surgery alone compared with surgery and radiotherapy at initial diagnosis, or at the time of first recurrence.METHODS Patients with pathologically confirmed AMs treated at the University of Utah from 1991 to 2014 were retrospectively reviewed. Local control (LC), overall survival (OS), Karnofsky Performance Status (KPS), and toxicity were assessed. Outcomes for patients receiving adjuvant radiotherapy were compared with those for patients treated with surgery alone. Kaplan-Meier and the log-rank test for significance were used for LC and OS analyses.RESULTS Fifty-nine patients with 63 tumors were reviewed. Fifty-two patients were alive at the time of analysis with a median follow-up of 42 months. LC for all tumors was 57% with a median time to local failure (TTLF) of 48 months. The median TTLF following surgery and radiotherapy was 180 months, compared with 46 months following surgery alone (p = 0.02). Excluding Simpson Grade IV (subtotal) resections, there remained an LC benefit with the addition of radiotherapy for Simpson Grade I, II, and III resected tumors (median TTLF 180 months after surgery and radiotherapy compared with 46 months with surgery alone [p = 0.002]). Patients treated at first recurrence following any initial therapy (either surgery alone or surgery and.adjuvant radiotherapy) had a median TTLF of 26 months compared with 48 months for tumors treated at first diagnosis (p = 0.007). There were 2 Grade 3 toxicities and 1 Grade 4 toxicity associated with radiotherapy.CONCLUSIONS Adjuvant radiotherapy improves LC for AMs. The addition of adjuvant radiotherapy following even a Simpson Grade I, II, or III resection was found to confer an LC benefit. Recurrent disease is difficult to control, underscoring the importance of aggressive initial treatment.