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  • [Neurosurgery.] Risk Stratification to Define the Role of Radiotherapy for Benign and Atypical Meningioma: A Recursive Partitioning Analysis

    [Neurosurgery.] Risk Stratification to Define the Role of Radiotherapy for Benign and Atypical Meningioma: A Recursive Partitioning Analysis

    서울의대 / 장원익, 이주호*

  • 출처
    Neurosurgery.
  • 등재일
    2022 May 1
  • 저널이슈번호
    90(5):619-626. doi: 10.1227/neu.0000000000001904.
  • 내용

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    Abstract
    Background: The role of adjuvant radiotherapy (RT) for benign or atypical meningioma is controversial.

    Objective: To identify prognostic factors and a subgroup that could be potentially indicated for adjuvant RT.

    Methods: A total of 336 patients with benign and 157 patients with atypical meningioma underwent surgical resection between January 2015 and December 2019. We retrospectively analyzed 407 patients who did not receive adjuvant RT to stratify risk groups for recurrence. A recursive partitioning analysis (RPA) with the prognostic factors for their failure-free survival (FFS) divided the patients into risk groups.

    Results: The 3-year FFS with surgical resection only was 76.5%. Identified prognostic factors for FFS were skull base location, tumor size, brain invasion, a Ki-67 proliferation index of ≥5%, and subtotal resection. The RPA-classified patients were divided into 4 risk groups: very low, low, intermediate, and high, and their 3-year FFS were 98.9%, 78.5%, 59.8%, and 34.2%, respectively. Intermediate-risk and high-risk groups comprise the patients with meningioma of sizes ≥2 cm after subtotal resection or meningioma of sizes >3 cm, located in the skull base or with brain invasion, respectively. After combining with patients treated with adjuvant RT, no FFS benefit was found in the very low-risk and low-risk groups after adjuvant RT, whereas significantly improved FFS was found in the intermediate-risk and high-risk groups (P < .05).

    Conclusion: The RPA classification revealed a subgroup of patients who could be potentially indicated for adjuvant RT even after gross total resection or for whom adjuvant RT could be deferred.

     

     

     

    Affiliations

    Won Ick Chang  1 , Il-Han Kim  1 , Seung Hong Choi  2 , Tae Min Kim  3 , Soon-Tae Lee  4 , Jae Kyung Won  5 , Sung-Hye Park  5 , Min-Sung Kim  6 , Jin Wook Kim  6 , Yong Hwy Kim  6 , Chul-Kee Park  6 , Joo Ho Lee  1
    1 Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
    2 Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
    3 Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
    4 Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
    5 Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
    6 Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

  • 연구소개
    Benign 및 atypical meningioma 환자의 수술 후 재발을 기준으로 recursive partitioning analysis를 통해 risk group을 나눠 보조적 방사선치료가 도움이 되는 risk group을 찾고자 한 논문입니다. Intermediate 및 high-risk group에서 보조적 방사선치료가 환자의 치료실패율을 낮추는 역할이 있음을 확인할 수 있었습니다. 본 연구를 통해 수술후 보조적 방사선치료의 역할이 확립되지 않은 benign 및 atypical meningioma에서 방사선치료의 역할 및 적응증을 정의하는데 도움이 될 수 있으리라 생각합니다.
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