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IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology Pub Date : 2025-01-30 DOI:10.1016/j.adro.2024.101709

Sanjeev Sreenivasan MD, MCh , Salem Najjar BA , Daniel Ma MD , Sabrina L. Begley BS , Yen-Ruh Wuu MD , Zaker Rana MD , Emile Gogineni DO , Michael Schulder MD , Anuj Goenka MD

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引用次数: 0

摘要

目的：尽管最近在治疗非典型脑膜瘤方面取得了进展，但高危患者的控制率仍然不理想。立体定向放射外科（SRS）提供了一种低毒性的改善局部控制（LC）的能力。然而，可用的数据有限。我们的目的是对诊断为高风险非典型脑膜瘤并接受SRS的连续队列患者进行全面回顾，无论是单部分SRS还是低部分SRS (hf-SRS)，并评估LC率（LCR），特别强调治疗失败的模式。方法和材料我们确定了2014年至2021年间在单一机构连续诊断为高危世界卫生组织2级脑膜瘤并接受SRS治疗的患者。高危脑膜瘤被定义为初始大体全切除后的残留疾病或复发。分析随访数据以评估lcr和治疗失败模式。我们将局部失败定义为肿瘤在处方等剂量线内复发，边缘失败定义为在处方等剂量线外5毫米内复发，远处/局部失败定义为在处方等剂量线外5毫米但在手术腔内2厘米内复发。结果我们在25例患者中发现45例经病理证实的不典型脑膜瘤。33例接受单段SRS， 12例接受半段SRS。中位随访为36个月（范围2-86个月）。3年LCR为84.6%，总生存率为96.0%。4例患者共7个肿瘤治疗失败。失败是局部的（3例患者和3个病变）或边缘的（3例患者和4个病变）。接受hf-SRS治疗的患者没有表现出局部、边缘或远处的失败。结论非典型脑膜瘤患者放射手术治疗的机构数据与现有文献中采用分次放射治疗的数据比较有利。SRS为改善这一患者群体的LC提供了一种很有前途的策略，边缘衰竭的发生在创造临床靶体积边缘方面起着重要作用。

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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Exploring the Role of Radiosurgery for Atypical Meningiomas: Addressing Suboptimal Local Control in High-Risk Patients

Purpose

Despite recent advancements in the treatment of atypical meningioma, control rates in high-risk patients continue to be suboptimal. Stereotactic radiosurgery (SRS) offers the ability to achieve improved local control (LC) with a low toxicity profile. However, available data are limited. We aimed to conduct a comprehensive review of a consecutive cohort of patients diagnosed with high-risk atypical meningioma who underwent SRS, either as a single-fraction SRS or in the hypofractionated SRS (hf-SRS), and evaluate the LC rates (LCR) with a specific emphasis on patterns of treatment failure.

Methods and Materials

We identified consecutive patients diagnosed with high-risk World Health Organization grade 2 meningioma treated with SRS at a single institution between 2014 and 2021. High-risk meningioma was defined as a residual disease or recurrence after initial gross total resection. Follow-up data were analyzed to evaluate LCRs and patterns of treatment failure. We defined local failure as tumor recurrence wthin the prescription isodose line, marginal failure as recurrence within 5 mm but outside the prescription isodose line, and distant/regional failure as recurrence beyond 5 mm of the prescription isodose line but within 2 cm of the surgical cavity.

Results

We identified 45 pathologically confirmed atypical meningiomas in 25 patients. Thirty-three tumors underwent single-fraction SRS, and 12 tumors received hf-SRS. The median follow-up was 36 months (range, 2-86 months). The 3-year LCR was 84.6%, and overall survival was 96.0%. Four patients with a total of 7 tumors experienced treatment failure. Failures were either local (3 patients and 3 lesions) or marginal (3 patients and 4 lesions). Patients treated with hf-SRS did not exhibit local, marginal, or distant failures.

Conclusions

Our institutional data on atypical patients with meningioma treated with radiosurgery compare favorably to existing literature using fractionated radiation therapy. SRS offers a promising strategy to improve LC in this patient population, and the occurrence of marginal failure plays a role in creating clinical target volume margins.

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来源期刊

Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.60

自引率

4.30%

发文量

208

审稿时长

98 days

期刊介绍： The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.