Incidence of radiation necrosis following different radiotherapy fractionation schedules for intracranial meningiomas.

IF 2.7 3区医学 Q3 ONCOLOGY

Strahlentherapie und Onkologie Pub Date : 2025-07-08 DOI:10.1007/s00066-025-02432-w

M Palička, A M de Jong, S David, M Rybář, J Jackaninová, L Knybel, Š Reguli, T Blažek, S Tomoszková, J J C Verhoeff, J Cvek

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引用次数: 0

Abstract

Background and purpose: Radiotherapy (RT) may be a safe alternative to surgery for selected intracranial meningiomas, particularly in eloquent or high-risk surgical locations. Reported studies of stereotactic RT have utilized stereotactic radiosurgery (SRS), fractionated stereotactic radiotherapy (hFSRT), or conventional radiotherapy. This retrospective study aimed to compare toxicity in a large international cohort.

Materials and methods: A total of 473 consecutive patients were treated for intracranial meningioma at two radiation oncology clinics. The patients underwent various treatment modalities, including stereotactic radiosurgery (SRS), hypofractionated stereotactic radiotherapy (hFSRT, 2-5 fractions), or normofractionated stereotactic radiotherapy (nFSRT, 28-30 fractions) using CT-linac or Cyberknife radiation techniques. The evaluation of potential brain edema and radiation necrosis (RN) was conducted using magnetic resonance imaging (MRI).

Results: Radiation-induced brain edema occurred in 11.0% of patients, including 4.9% with symptomatic edema requiring corticosteroid therapy, and 4.0% of patients developed radiation necrosis. Despite a smaller irradiated tumor volume, the risk of radiation-related toxicity was higher with SRS compared to hFSRT and nFSRT, for both brain edema (hazard ratio [HR] = 4.10, 95% confidence interval (CI; 2.02; 8.26), p < 0.001) and RN (HR = 11.07, 95% CI (2.65; 46.24), p < 0.001). Cox regression showed a 33 and 28% increased risk of brain edema and RN per 1 cm³ of tumor volume (HR = 1.33, 95% CI (1.21; 1.46), p < 0.001 and HR = 1.28, 95% CI (1.13; 1.46), p < 0.001). For tumor volumes above the median (2.05 cm³), the risk of toxicity following SRS was significantly higher for edema (HR = 9.70, 95% CI (2.90; 32.40), p < 0.001) and RN (HR = 13.34, 95% CI (1.73; 102.80), p = 0.013).

Conclusion: Stereotactic radiotherapy and radiosurgery are safe treatment options for intracranial meningiomas. However, our data indicate a significantly increased risk of radiation necrosis and edema after SRS for tumors larger than 2 cm³ (diameter > 1.55 cm). This study also highlights the safety of both nFSRT and hFSRT in the treatment of larger tumors, supporting treatment selection based on tumor volume.

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颅内脑膜瘤不同放疗分治方案放射坏死的发生率。

背景和目的：放射治疗（RT）可能是一种安全的替代手术治疗颅内脑膜瘤的方法，特别是在有意义或高风险的手术部位。已有报道的立体定向放疗研究包括立体定向放射外科（SRS）、分步立体定向放疗（hFSRT）或常规放疗。本回顾性研究旨在比较大型国际队列的毒性。材料和方法：在两个放射肿瘤学诊所连续治疗颅内脑膜瘤患者473例。患者接受了不同的治疗方式，包括立体定向放射手术（SRS），低分割立体定向放疗（hFSRT， 2-5分），或正分割立体定向放疗（nFSRT， 28-30分），使用ct直线或射波刀放射技术。采用磁共振成像（MRI）评估脑水肿和放射性坏死（RN）。结果：11.0%的患者发生放射性脑水肿，其中4.9%的患者出现症状性水肿，需要皮质类固醇治疗，4.0%的患者发生放射性坏死。尽管放射肿瘤体积较小，但SRS与hFSRT和nFSRT相比，在脑水肿方面发生辐射相关毒性的风险更高(风险比[HR] = 4.10,95% 可信区间(CI；2.02;8.26), p 3 (HR = 1.33,95% CI (1.21；1.46), p 3)，水肿的SRS后毒性风险显著更高(HR = 9.70,95% CI (2.90；32.40)， p 结论：立体定向放疗和放射外科治疗颅内脑膜瘤是安全的治疗选择。然而，我们的数据表明，对于大于2 cm3（直径 > 1.55 cm）的肿瘤，SRS后放射性坏死和水肿的风险显著增加。本研究还强调了nFSRT和hFSRT治疗较大肿瘤的安全性，支持基于肿瘤体积的治疗选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Strahlentherapie und Onkologie 医学-核医学

CiteScore

5.70

自引率

12.90%

发文量

141

审稿时长

3-8 weeks

期刊介绍： Strahlentherapie und Onkologie, published monthly, is a scientific journal that covers all aspects of oncology with focus on radiooncology, radiation biology and radiation physics. The articles are not only of interest to radiooncologists but to all physicians interested in oncology, to radiation biologists and radiation physicists. The journal publishes original articles, review articles and case studies that are peer-reviewed. It includes scientific short communications as well as a literature review with annotated articles that inform the reader on new developments in the various disciplines concerned and hence allow for a sound overview on the latest results in radiooncology research. Founded in 1912, Strahlentherapie und Onkologie is the oldest oncological journal in the world. Today, contributions are published in English and German. All articles have English summaries and legends. The journal is the official publication of several scientific radiooncological societies and publishes the relevant communications of these societies.