Fractionated Radiotherapy With Stereotactic Radiosurgery Boost Controls Gross Disease in Grade 2 Meningioma.

IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY World neurosurgery Pub Date : 2024-12-06 DOI:10.1016/j.wneu.2024.11.012
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
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Abstract

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.

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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。
背景和目的:尽管进行了最大限度的手术切除和辅助分次放疗,2级脑膜瘤仍有机会提高复发的局部控制率。我们介绍了一种剂量升级策略,即在分次放疗的基础上,增加针对粗大病灶的立体定向放射手术(SRS),从而提高肿瘤的总放射剂量:方法:对2009-2023年期间接受手术切除、分割放疗和SRS增强治疗的2级脑膜瘤患者进行基线特征、局部疾病控制和不良事件(AE)评估:结果:共纳入14例脑膜瘤患者。结果:共纳入14名脑膜瘤患者,其中10名患者(71.4%)在初诊时接受了放射外科治疗,4名患者(28.6%)因疾病复发而接受治疗。中位分次剂量为 54 Gy,而 SRS 的中位剂量为 7.5 Gy。在有随访记录的13名患者中,中位随访时间为34个月。3名患者(23%)治疗失败,但无一发生在SRS范围内,三分之二发生在接受复发疾病治疗的患者中。18个月的PFS为92.3%,18个月的总生存率为100%。大多数患者未出现或出现了轻微的AE,但有3名患者(23%)出现了高级别(CTCAE v5.0≥3级)AE,包括放射性坏死、癫痫发作和认知能力下降:我们发现,针对粗大病灶的SRS增强分次放疗三年后的现场局部控制率达100%,且毒性反应可接受,这表明这可能是2级脑膜瘤患者的一种有效且更好的辅助治疗策略。
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来源期刊
World neurosurgery
World neurosurgery CLINICAL NEUROLOGY-SURGERY
CiteScore
3.90
自引率
15.00%
发文量
1765
审稿时长
47 days
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
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