Objective: To evaluate the possibility of dose de-escalation, with consideration of the efficacy and safety of robotic stereotactic CyberKnife radiotherapy in patients diagnosed with intracranial meningiomas. Methods: The study group consisted of 172 patients (42 men and 130 women) treated in III Radiotherapy and Chemotherapy Clinic of Maria Sklodowska-Curie National Research Institute of Oncology in Gliwice between January 2011 and July 2018. The qualification for dose de-escalation was based on MRI (magnetic resonance imaging) features: largest tumor diameter less than 5 cm, well-defined tumor margins, no edema, and no brain infiltration. The age of patients was 21–79 years (median 59 years) at diagnosis and 24–80 years (median 62 years) at radiotherapy. Sixty-seven patients (Group A) were irradiated after initial surgery. Histopathological findings were meningioma grade WHO 1 in 51 and WHO 2 in 16 cases. Group B (105 patients) had no prior surgery and the diagnosis was based on the typical features of meningioma on MRI. All patients qualified for the robotic stereotactic CyberKnife radiotherapy, and the total dose received was 18 Gy in three fractions to reference isodose 78–92%. Results: Follow-up period was 18 to 124 months (median 67.5 months). Five- and eight-year progression free survival was 90.3% and 89.4%, respectively. Two patients died during the follow-up period. Progression of tumor after radiotherapy was registered in 16 cases. Four patients required surgery due to progressive disease, and three of them were progression free during further follow-up. Twelve patients received a second course of robotic radiotherapy, 11 of them had stable disease, and one patient showed further tumor growth but died of heart failure. Crude progression free survival after both primary and secondary treatment was 98.8%. Radiotherapy was well-tolerated: acute toxicity grade 1/2 (EORTC-RTOG scale) was seen in 10.5% of patients. We did not observe any late effects of radiotherapy. Conclusion: Stereotactic CyberKnife radiotherapy with total dose of 18 Gy delivered in three fractions showed comparable efficacy to treatment schedules with higher doses. This could support the idea of dose de-escalation in the treatment of intracranial meningiomas.
目的：评估在考虑机器人立体定向射波刀放疗对颅内脑膜瘤患者疗效与安全性的基础上，实施剂量递减的可能性。方法：研究组纳入2011年1月至2018年7月期间在格利维采玛丽亚·斯克沃多夫斯卡-居里国家肿瘤研究所第三放疗化疗科接受治疗的172例患者（男性42例，女性130例）。剂量递减的筛选标准基于磁共振成像特征：肿瘤最大直径小于5厘米、边界清晰、无水肿及无脑组织浸润。患者确诊时年龄21-79岁（中位59岁），接受放疗时年龄24-80岁（中位62岁）。67例患者（A组）在初次手术后接受放疗，其中51例为WHO 1级脑膜瘤，16例为WHO 2级。B组（105例）患者未接受手术，诊断基于磁共振成像的典型脑膜瘤特征。所有患者均接受机器人立体定向射波刀放疗，总剂量18 Gy分3次照射，参考等剂量线为78-92%。结果：随访时间18-124个月（中位67.5个月）。5年及8年无进展生存率分别为90.3%和89.4%。随访期间2例患者死亡。16例出现放疗后肿瘤进展，其中4例因疾病进展需手术治疗（3例后续随访无进展）。12例接受第二疗程机器人放疗，11例病情稳定，1例肿瘤继续进展但死于心力衰竭。初次及二次治疗后的总体无进展生存率达98.8%。放疗耐受性良好：10.5%患者出现1/2级急性毒性反应（EORTC-RTOG量表），未观察到任何远期放疗副作用。结论：总剂量18 Gy分3次照射的立体定向射波刀放疗方案与更高剂量方案疗效相当，这为颅内脑膜瘤治疗中的剂量递减策略提供了依据。
肿瘤(癌症)患者之家