CyberKnife Stereotactic Radiosurgery for Atypical and Malignant Meningiomas

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• 作者：Michael Zhang¹ ; Allen L. Ho¹ ; Myreille D'Astous¹ ; Arjun V. Pendharkar¹ ; Clara Y.H. Choi⁴ ; Patricia A. Thompson¹ ; Armine T. Tayag¹ ; Scott G. Soltys² ; Iris C. Gibbs² ; Steven D. Chang¹ ; ³ ; ^{sdchang@stanford.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Adjuvant ; Atypical ; CyberKnife ; Hypofractionation ; Malignant ; Meningioma ; Salvage
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：91
• 期：Complete
• 页码：574-581.e1
• 全文大小：1116 K

文摘

Recurrent World Health Organization (WHO) grade II and III meningiomas have traditionally been treated by surgery alone, but early literature suggests that adjuvant stereotactic radiosurgery may greatly improve outcomes. We present the long-term tumor control and safety of a hypofractionated stereotactic radiosurgery regimen.

Methods

Prospectively collected data of 44 WHO grade II and 9 WHO grade III meningiomas treated by CyberKnife for adjuvant or salvage therapy were reviewed. Patient demographics, treatment parameters, local control, regional control, locoregional control, overall survival, radiation history, and complications were documented.

Results

For WHO grade II patients, recurrence occurred in 41%, with local, regional, and locoregional failure at 60 months recorded as 49%, 58%, and 36%. For WHO grade III patients, recurrence occurred in 66%, with local, regional, and locoregional failure at 12 months recorded as 57%, 100%, and 43%. The 60-month locoregional control rates for radiation naïve and experienced patients were 48% and 0% (P = 0.14). Overall, 7 of 44 grade II patients and 8 of 9 grade III patients had died at last follow-up. The 60-month and 12-month overall survival rates for grade II and III meningiomas were 87% and 50%, respectively. Serious complications occurred in 7.5% of patients.

Conclusions

Stereotactic radiosurgery for adjuvant and salvage treatment of WHO grade II meningioma using a hypofractionated plan is a viable treatment strategy with acceptable long-term tumor control, overall survival, and complication rates. Future studies should focus on radiation-naïve patients and local management of malignant meningioma.