单次立体定向放射手术作为散发性脑膜瘤的主要治疗：一项25年的队列研究。

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

Neurosurgery Pub Date : 2025-06-06 DOI:10.1227/neu.0000000000003528

Rahul Kumar, Lucas P Carlstrom, Ramin Morshed, Paul D Brown, Nadia N Laack, Anita Mahajan, Christopher S Graffeo, Michael J Link, Bruce E Pollock

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引用次数: 0

摘要

背景和目的：立体定向放射外科（SRS）越来越多地被用作颅内脑膜瘤的主要治疗方式。我们的目的是描述散发性颅内脑膜瘤单组分SRS后的临床结果。方法：回顾了1997年4月至2022年2月期间接受SRS（伽玛刀）作为主要治疗方式的散发性脑膜瘤患者的前瞻性数据库。主要结局包括无进展生存期（PFS）和治疗相关并发症。结果：616例患者（653个肿瘤）接受了SRS治疗，中位随访6.3年（四分位数间距[IQR] 3.1-10.5年）。中位肿瘤体积4.5 cm3 （IQR 2.0 ~ 8.0 cm3）。中位边缘剂量为15.0 Gy （IQR为14.0 ~ 16.0）。7例肿瘤（1.1%）出现野内进展，2例肿瘤（0.3%）出现边缘进展，原始失败率为1.4%。5年、10年和15年的PFS估计值分别为99.8%、99.0%和93.2%。单变量分析中，与PFS降低相关的因素包括年龄较大（危险比[HR] 1.14, 95% CI, 1.05-1.22, P < 0.001）、男性（危险比[HR] 5.44, 95% CI, 1.45-20.4, P = 0.010）、肿瘤体积增大（危险比[HR] 1.06, 95% CI, 0.99-1.13, P = 0.028）、肿瘤边缘剂量降低（危险比[HR] 0.65, 95% CI, 0.43-0.97, P = 0.006）。56例（9.1%）患者出现治疗相关并发症，其中45例（7.3%）为暂时性并发症，5例（0.8%）为轻微并发症，6例（1.0%）为永久性和/或需要干预的并发症。与治疗相关并发症相关的放射外科参数包括等中心数增加（比值比[OR] 1.09, 95% CI, 1.04-1.14, P < .001）， 12 gy体积增大（比值比[OR] 1.06, 95% CI, 1.03-1.09, P < .001），肿瘤体积增大（比值比[OR] 1.06, 95% CI, 1.02-1.10, P < .001），最大剂量减小（比值比[OR] 0.90, 95% CI, 0.82-0.98, P = .11）。结论：SRS是散发性、小体积到中体积颅内脑膜瘤的主要治疗方式。对于偶然发现的脑膜瘤，应讨论先发制人的SRS作为一种安全的治疗策略，而不是单独观察。

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Single-Fraction Stereotactic Radiosurgery as Primary Management of Sporadic Meningiomas: A 25-Year Cohort Study.

Background and objectives: Stereotactic radiosurgery (SRS) is increasingly used as a primary treatment modality for intracranial meningiomas. We aim to describe clinical outcomes after single-fraction SRS for sporadic intracranial meningiomas.

Methods: A prospectively maintained database was reviewed for patients with sporadic meningiomas who underwent SRS (Gamma Knife) as primary treatment modality from April 1997 to February 2022. Primary outcomes included progression-free survival (PFS) and treatment-related complications.

Results: Six hundred sixteen patients (653 tumors) underwent SRS with median follow-up of 6.3 years (interquartile range [IQR] 3.1-10.5 years). The median tumor volume was 4.5 cm3 (IQR 2.0-8.0 cm3). The median margin dose was 15.0 Gy (IQR 14.0-16.0). In-field progression was noted in 7 tumors (1.1%) and marginal progression in 2 tumors (0.3%) for a raw failure rate of 1.4%. PFS estimates at 5, 10, and 15 years were 99.8%, 99.0%, and 93.2%, respectively. Factors associated with reduced PFS on univariable analysis included older age (hazards ratio [HR] 1.14, 95% CI, 1.05-1.22, P < .001), male sex (HR 5.44, 95% CI, 1.45-20.4, P = .010), increasing tumor volume (HR 1.06, 95% CI, 0.99-1.13, P = .028), and lower tumor margin dose (HR 0.65, 95% CI, 0.43-0.97, P = .006). Treatment-related complications were noted in 56 patients (9.1%), of which 45 (7.3%) were temporary, 5 (0.8%) were minor, and 6 (1.0%) were permanent and/or required intervention. Radiosurgical parameters associated with treatment-related complications included increased number of isocenters (odds ratio [OR] 1.09, 95% CI, 1.04-1.14, P < .001), higher 12-Gy volume (OR 1.06, 95% CI, 1.03-1.09, P < .001), larger tumor volume (OR 1.06, 95% CI, 1.02-1.10, P < .001), and lower maximal dose (OR 0.90, 95% CI, 0.82-0.98, P = .11).

Conclusion: SRS is effective as a primary treatment modality for sporadic, small-volume to medium-volume intracranial meningiomas. Pre-emptive SRS should be discussed as a safe management strategy compared with observation alone for incidentally discovered meningiomas.

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来源期刊

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.