Rebecca L Calafiore, Corbin A Helis, Paul Marcet, Eleanor Smith, Benjamin Ramsey, Heather Pacholke, Carol A Kittel, Marc Benayoun, James D Ververs, Christina K Cramer, Adrian W Laxton, Stephen B Tatter, Michael D Chan, Jaclyn J White
{"title":"分次放疗配合立体定向放射外科治疗可控制 2 级脑膜瘤的总体病情。","authors":"Rebecca L Calafiore, Corbin A Helis, Paul Marcet, Eleanor Smith, Benjamin Ramsey, Heather Pacholke, Carol A Kittel, Marc Benayoun, James D Ververs, Christina K Cramer, Adrian W Laxton, Stephen B Tatter, Michael D Chan, Jaclyn J White","doi":"10.1016/j.wneu.2024.11.012","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Opportunity exists for improved local control rates of grade 2 meningiomas that recur despite maximal surgical resection and adjuvant fractionated radiotherapy (RT). We describe a dose escalation strategy of increasing the total tumor radiation dose by adding a stereotactic radiosurgery (SRS) boost targeting gross disease to fractionated RT.</p><p><strong>Methods: </strong>A single-institution retrospective cohort of patients from 2009-2023 with grade 2 meningioma treated with surgical resection, fractionated RT, and SRS boost were evaluated for baseline characteristics, local disease control, and adverse events (AE).</p><p><strong>Results: </strong>Fourteen meningioma patients were included. Ten patients (71.4%) underwent radiosurgery at initial diagnosis, while 4 patients (28.6%) were treated for recurrent disease. The median fractionated dose was 54 Gy, while the median dose for SRS was 7.5 Gy. Among the 13 patients with follow-up available, median follow-up was 34 months. Three patients (23%) had treatment failures; however, none occurred within the SRS volume and 2 thirds occurred in patients treated for recurrent disease. Eighteen-month progression-free survival was 92.3%, while 18-month overall survival was 100%. Most patients experienced no or mild AEs; however, 3 patients (23%) experienced a high-grade (Common Terminology Criteria for Adverse Events v5.0 grade ≥3) AE including radiation necrosis, seizures, and cognitive decline.</p><p><strong>Conclusions: </strong>We found 100% in-field local control at 3 years from an SRS boost to fractionated RT targeting gross disease with an acceptable toxicity profile, suggesting this may be an effective and improved adjuvant treatment strategy in patients with grade 2 meningioma.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123429"},"PeriodicalIF":1.9000,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Fractionated Radiotherapy With Stereotactic Radiosurgery Boost Controls Gross Disease in Grade 2 Meningioma.\",\"authors\":\"Rebecca L Calafiore, Corbin A Helis, Paul Marcet, Eleanor Smith, Benjamin Ramsey, Heather Pacholke, Carol A Kittel, Marc Benayoun, James D Ververs, Christina K Cramer, Adrian W Laxton, Stephen B Tatter, Michael D Chan, Jaclyn J White\",\"doi\":\"10.1016/j.wneu.2024.11.012\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Opportunity exists for improved local control rates of grade 2 meningiomas that recur despite maximal surgical resection and adjuvant fractionated radiotherapy (RT). We describe a dose escalation strategy of increasing the total tumor radiation dose by adding a stereotactic radiosurgery (SRS) boost targeting gross disease to fractionated RT.</p><p><strong>Methods: </strong>A single-institution retrospective cohort of patients from 2009-2023 with grade 2 meningioma treated with surgical resection, fractionated RT, and SRS boost were evaluated for baseline characteristics, local disease control, and adverse events (AE).</p><p><strong>Results: </strong>Fourteen meningioma patients were included. Ten patients (71.4%) underwent radiosurgery at initial diagnosis, while 4 patients (28.6%) were treated for recurrent disease. The median fractionated dose was 54 Gy, while the median dose for SRS was 7.5 Gy. Among the 13 patients with follow-up available, median follow-up was 34 months. Three patients (23%) had treatment failures; however, none occurred within the SRS volume and 2 thirds occurred in patients treated for recurrent disease. 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Fractionated Radiotherapy With Stereotactic Radiosurgery Boost Controls Gross Disease in Grade 2 Meningioma.
Objective: Opportunity exists for improved local control rates of grade 2 meningiomas that recur despite maximal surgical resection and adjuvant fractionated radiotherapy (RT). We describe a dose escalation strategy of increasing the total tumor radiation dose by adding a stereotactic radiosurgery (SRS) boost targeting gross disease to fractionated RT.
Methods: A single-institution retrospective cohort of patients from 2009-2023 with grade 2 meningioma treated with surgical resection, fractionated RT, and SRS boost were evaluated for baseline characteristics, local disease control, and adverse events (AE).
Results: Fourteen meningioma patients were included. Ten patients (71.4%) underwent radiosurgery at initial diagnosis, while 4 patients (28.6%) were treated for recurrent disease. The median fractionated dose was 54 Gy, while the median dose for SRS was 7.5 Gy. Among the 13 patients with follow-up available, median follow-up was 34 months. Three patients (23%) had treatment failures; however, none occurred within the SRS volume and 2 thirds occurred in patients treated for recurrent disease. Eighteen-month progression-free survival was 92.3%, while 18-month overall survival was 100%. Most patients experienced no or mild AEs; however, 3 patients (23%) experienced a high-grade (Common Terminology Criteria for Adverse Events v5.0 grade ≥3) AE including radiation necrosis, seizures, and cognitive decline.
Conclusions: We found 100% in-field local control at 3 years from an SRS boost to fractionated RT targeting gross disease with an acceptable toxicity profile, suggesting this may be an effective and improved adjuvant treatment strategy in patients with grade 2 meningioma.
期刊介绍:
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS