Stereotactic Radiosurgery for Atypical (World Health Organization II) and Anaplastic (World Health Organization III) Meningiomas: Results From a Multicenter, International Cohort Study
Jazyk angličtina Země Spojené státy americké Médium print
Typ dokumentu časopisecké články, multicentrická studie
PubMed
33469655
DOI
10.1093/neuros/nyaa553
PII: 6104456
Knihovny.cz E-zdroje
- Klíčová slova
- Anaplastic, Atypical, Gamma knife radiosurgery, Meningioma, Radiosurgery, Stereotactic,
- MeSH
- lidé MeSH
- meningeom mortalita chirurgie MeSH
- pooperační komplikace epidemiologie MeSH
- radiační poranění epidemiologie MeSH
- radiochirurgie * škodlivé účinky metody mortalita MeSH
- reoperace statistika a číselné údaje MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
BACKGROUND: Atypical and anaplastic meningiomas have reduced progression-free/overall survival (PFS/OS) compared to benign meningiomas. Stereotactic radiosurgery (SRS) for atypical meningiomas (AMs) and anaplastic meningiomas (malignant meningiomas, MMs) has not been adequately described. OBJECTIVE: To define clinical/radiographic outcomes for patients undergoing SRS for AM/MMs. METHODS: An international, multicenter, retrospective cohort study was performed to define clinical/imaging outcomes for patients receiving SRS for AM/MMs. Tumor progression was assessed with response assessment in neuro-oncology (RANO) criteria. Factors associated with PFS/OS were assessed using Kaplan-Meier analysis and a Cox proportional hazards model. RESULTS: A total of 271 patients received SRS for AMs (n = 233, 85.9%) or MMs (n = 38, 14.0%). Single-fraction SRS was most commonly employed (n = 264, 97.4%) with a mean target dose of 14.8 Gy. SRS was used as adjuvant treatment (n = 85, 31.4%), salvage therapy (n = 182, 67.2%), or primary therapy (1.5%). The 5-yr PFS/OS rate was 33.6% and 77.0%, respectively. Increasing age (hazard ratio (HR) = 1.01, P < .05) and a Ki-67 index > 15% (HR = 1.66, P < .03) negatively correlated with PFS. MMs (HR = 3.21, P < .05), increased age (HR = 1.04, P = .04), and reduced KPS (HR = 0.95, P = .04) were associated with shortened OS. Adjuvant versus salvage SRS did not impact PFS/OS. A shortened interval between surgery and SRS improved PFS for AMs (HR = 0.99, P = .02) on subgroup analysis. Radiation necrosis occurred in 34 (12.5%) patients. Five-year rates of repeat surgery/radiation were 33.8% and 60.4%, respectively. CONCLUSION: AM/MMs remain challenging tumors to treat. Elevated proliferative indices are associated with tumor recurrence, while MMs have worse survival. SRS can control AM/MMs in the short term, but the 5-yr PFS rates are low, underscoring the need for improved treatment options for these patients.
Center of Image Guided Neurosurgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania
Centro Gamma Knife Dominicano CEDIMAT Plaza de la Salud Santo Domingo Dominican Republic
Department of Neurologic Surgery Cleveland Clinic Foundation Cleveland Ohio
Department of Neurologic Surgery Mayfield Clinic Cincinnati Ohio
Department of Neurologic Surgery University of Virginia Health System Charlottesville Virginia
Department of Neurologic Surgery West Virginia University Morgantown West Virginia
Department of Neurosurgery Taipei Veteran General Hospital Taipei Taiwan
Department of Radiation Oncology Beaumont Health Royal Oak Michigan
Department of Radiation Oncology University of Southern California Los Angeles California
Department of Radiology Taipei Veteran General Hospital Taipei Taiwan
Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czech Republic
Departments of Neurologic Surgery University of Southern California Los Angeles California
Departments of Neurosurgery and Medical Physics
MD Anderson Cancer Center Houston Texas
National Yang Ming University School of Medicine Taipei Taiwan
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