Stereotactic Radiosurgery of Central Skull Base Meningiomas-Volumetric Evaluation and Long-Term Outcomes
Stereotactic Radiosurgery of Central Skull Base Meningiomas-Volumetric Evaluation and Long-Term Outcomes
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DOI：
10.1016/j.wneu.2017.08.166
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发表时间：
2017-12-01
影响因子：
2
通讯作者：
Sheehan, Jason
中科院分区：
文献类型：
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作者：
Patibandla, Mohana Rao;Lee, Cheng-chia;Sheehan, Jason
背景与目的：中央颅底脑膜瘤(CSM)完全切除是可能的，但其发病率往往较高。立体定向放射外科(SRS)在颅底脑膜瘤的治疗中发挥着重要作用。材料与方法：219例患者中，女性占73.9%(n=162)，中位年龄55岁(19~88岁)。其中以SRS为主的占45.7%(n=100)，肿瘤残留占37.9%(n=83)，复发占14.2%(n=31)，其他原因占5%。中位肿瘤体积为4.9 cm(3)(0.3~105 cm(3))，中位切缘剂量为14Gy5~35Gy.结果：队列患者的中位临床和影像随访时间分别为72(24-298)个月和66(18-298)个月。总的肿瘤控制率为83.4%(n=183)，肿瘤消退率为72.1%(n=158)。神经症状改善占6.8%(n=15)，稳定占72.6%(n=159)，恶化占20.5%(n=45)。临床恶化多发生在肿瘤进展的患者(P<；0.001)。SRS后，体积分析证实，3年内肿瘤体积变化预测可靠，5年(R-2=0.694)预测肿瘤控制，P=0.001；10年(R-2=0.571)P=0.001。结论：SRS对大多数CSMS患者提供了有效的肿瘤体积控制和神经稳定性或改善。SRS后3年用容量计法测定的CSM的放射学反应可预测SRS后5年和10年的长期肿瘤反应。
BACKGROUND AND OBJECTIVE: Complete resection of a central skull base meningioma (CSM) is possible, but it is often associated with high morbidity. Stereotactic radiosurgery (SRS) plays an appreciable role in the management of skull base meningiomas. This study aims to apply volumetric methods to assess the CSM response after SRS and correlate it with clinical outcomes.MATERIALS AND METHODS: The cohort consisted of 219 patients, of whom 73.9% were female (n =162), with a median age of 55 years (19-88). SRS was the primary treatment for 45.7% (n =100), while 37.9% (n =83) underwent treatment for residual tumors, 14.2% (n =31) for recurrence, and in 5 with others reasons. The median tumor volume was 4.9 cm(3) (0.3-105 cm(3)) to a median margin dose of 14 Gy (5-35 Gy). Volumetric analysis of CSM was performed on the SRS scan and each available magnetic resonance image thereafter.RESULTS: The median clinical and imaging follow-ups of the cohort were 72 (24-298) and 66 (18-298) months, respectively. The overall tumor control rate was 83.4% (n =183) at last follow-up with tumor regression 72.1% (n =158). Neurologic symptoms were improved after SRS in 6.8% (n =15), stable in 72.6% (n =159), and worsened in 20.5% (n =45). The clinical deterioration usually occurred in the patients with tumor progression (P < 0.001). Following SRS, the volumetric analysis confirmed that tumor response at 3 years reliably projected volumetric change and tumor control at 5 years (R-2 = 0.694) with P < 0.001 and 10 years (R-2 = 0.571) with P = 0.001.CONCLUSION: SRS affords effective tumor volumetric control and neurologic stability or improvement in the majority of patients with CSMs. The radiologic response of CSM as determined by volumetry at 3 years post-SRS is predictive of long-term tumor response at 5 and 10 years following SRS.