Gamma Knife Radiosurgery for Atypical and Anaplastic Meningiomas

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• 作者：Wei-Hsin Wang¹ ; ³ ; Cheng-Chia Lee¹ ; ² ; ³ ; Huai-Che Yang¹ ; ³ ; Kang-Du Liu¹ ; ³ ; Hsiu-Mei Wu³ ; ⁴ ; Cheng-Ying Shiau³ ; ⁵ ; Wan-You Guo³ ; ⁴ ; David Hung-Chi Pan¹ ; ³ ; Wen-Yuh Chung¹ ; ³ ; Ming-Teh Chen¹ ; ³ ; ^{weihsin0103@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Atypical meningioma ; Anaplastic meningioma ; Gamma Knife radiosurgery
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：87
• 期：Complete
• 页码：557-564
• 全文大小：5435 K

文摘

Atypical and anaplastic meningiomas have much higher recurrence rates after surgical resection compared with benign meningiomas, but the role of adjuvant radiosurgery remains unclear. This study was undertaken to evaluate the outcomes of gamma knife radiosurgery for patients with atypical and anaplastic meningiomas.

Methods

In this retrospective analysis of a prospectively maintained database, 46 patients with histologically proven atypical or anaplastic meningiomas by current World Health Organization (WHO) criteria underwent postoperative Gamma Knife radiosurgery between 1993 and 2013. The median follow-up period was 32.6 months. The median tumor volume and margin dose were 11.7 mL (range, 2–53 mL) and 13.1 Gy (range, 12.0–16.5 Gy), respectively.

Results

Local control at 3 and 5 years was 50.6% and 32.1%, respectively. Gender (P = 0.013) and marginal dose less than or equal to 13Gy (P = 0.049) were associated with the local control. The 3- and 5-year overall survival for patients with WHO grade II was 97.1% and 88.3%, respectively, compared with 66.7% and 66.7% for patients with WHO grade III meningiomas. Radiation therapy before Gamma Knife radiosurgery (GKRS; P = 0.018) and tumor grade (P = 0.019) were the factors associated with a worse overall survival rate. Fourteen patients (30.4%) developed adverse radiation effects after GKRS treatment, and all were Radiation Therapy Oncology Group grade I.

Conclusions

Postoperative GKRS treatment for patients with atypical and anaplastic meningioma is challenging. More aggressive treatment, including of safely maximizing the extent of surgical resection and using a higher margin dose (>13Gy), should be applied to achieve better local control.