Atypische und maligne Meningeome: Studie 17 Fälle

[Ulrich]

Atypical and malignant meningiomas: an outcome report of seventeen cases.

Atypische und maligne Meningeome: eine Studie von 17 Fällen.

Dieser Artikel wurde über "medline" recherchiert, von ihm ist nur ein Abstract vorhanden. Bei Bedarf müßte sich ein Interessent, eine Interessentin, den Originalartikel (Volltext) in einer Universitätsbibliothek besorgen und kopieren.
J Neurooncol 1998 Aug; 39(1): 65-70
Atypical and malignant meningiomas: an outcome report of seventeen cases.

Coke CC, Corn BW, Werner-Wasik M, Xie Y, Curran WJ Jr.

Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.

Limited data are available concerning the outcome of patients with atypical and malignant meningiomas. We therefore analyzed the outcome of seventeen patients with meningiomas (9 atypical; 8 malignant) at Thomas Jefferson University Hospital between 1973 and 1996. Strict adherence to the 1993 WHO criteria for the typing of CNS tumors was maintained. The median potential follow-up period for all patients was 87 months. The age at diagnosis ranged from 22 to 72 (mean 51.8 years). There were 5 males and 12 females. The mean tumor diameter was 4.45 cm. Of the 16 cases where the extent of surgical resection was known, 4 were partial and 12 were complete resections. Six patients (35%) had dural or cortical invasion by tumor. Fifteen patients received postoperative megavoltage photon irradiation (mean 61 Gy). One of these fifteen pts. received an additional 20 Gy with Au-198 implantation and 1 received post-radiation chemotherapy for recurrent disease. The overall survival rate for all patients at 5 and 10 years were 87% and 58% respectively. The 5- and 10-year survival rates for atypical meningiomas were 87% and 58%; for malignant meningiomas the survival rates were 60% and 60% respectively. Five patients (30%) have died. Three of these 5 patients initially received less than 54 Gy to the tumor bed and have died of recurrent disease. Local disease progression was documented in 11 patients (65%) after surgery and in 3 patients (18%) after radiation. There was an improvement in performance status in 3 (18%) patients with a decline and no change seen in 1 (6%) and 13 (77%) respectively after receiving radiation. There appeared to be no difference in survival in patients as a function of dural or cortical invasion. Long term survival is possible for patients with atypical and malignant meningiomas treated with surgery and post-operative radiation. We are unable to distinguish a difference in outcome between these two pathological entities. Dural and cortical invasion were not associated with a decrease in survival. In addition, improved tumor control and survival may be associated with increased radiation dose.

[Johanna Teig]

Hallo,

erst mal möchte ich sagen, dass ich dieses Forum einfach genial finde.  
Als ich vor fast einem Jahr mit der Recherche über Meningeome angefangen habe, gab es dieses Forum glaube ich noch nicht, und ich habe seitdem nur immer wieder dieselben Seiten besucht. War ein Fehler.

Zu dieser Studie: Man hat's schon nicht leicht mit mal. Men.
Da gibt es diese Studie mit dem Satz:
"Three of these 5 patients initially received less than 54 Gy to the tumor bed and have died of recurrent disease."
Da will man sich doch gleich bestrahlen lassen. Aber halt!
Da gab es doch noch die andere Studie:

Is stereotactic radiotherapy adequate treatment for atypical and malignant meningiomas?

Simon S Lo, Kwan H Cho, Walter A Hall, Wilson L Hernandez, Kimberly K McCollow, Judy Unger, University of Minnesota, Minneapolis, MN.

Objective: To evaluate whether stereotactic radiotherapy alone is an adequate treatment for recurrent atypical and malignant meningiomas.

Method: From 1992 to 2000, 10 patients with 16 recurrent atypical (A) or malignant (M) meningiomas (5 A and 11 M) were treated with stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT). Patients with tumors greater than 4 cm or closer than 5 mm to the optic apparatus were chosen for FSRT. The SRS doses ranged from 1200 cGy at 50% to 4500 cGy at 50% and the FSRT doses ranged from 4500 cGy at 85% in 25 fractions to 5000 cGy at 90% in 20 fractions. A 2 mm margin was placed around the target as defined on the computerized tomography. The median follow-up ranged from 3 months to 66 months. Five patients had external beam radiation therapy to the same areas previously. All patients had radiologic follow-up with magnetic resonance imaging.

Result: The 5-year actuarial tumor control was 31%. Five (50%) of the 10 patients developed recurrence. Two (40%) of the five patients who developed recurrence had disease recurring in the area outside the treated areas with no evidence of local recurrence. The time to recurrence ranged from 3 to 66 months. Three patients recurred after more than 3 years. The crude tumor shrinkage rate was 19%. The crude local progression rate was 31%.

Result: Our analysis showed that stereotactic therapy alone for the treatment of atypical and malignant was associated with poor tumor control. The suboptimal local control and the propensity of A and M for regional recurrence warrant the investigation of more aggressive and innovative therapies. The potential long latency for tumor recurrence underscores the importance of long-term follow-up of these patients.

Was soll ich denn nun glauben/tun?

[Ulrich]

Zunächst einmal gibt eine Studie über 17 Fälle keine sinnvolle Statistik. Da braucht man schon mehr Zahlenmaterial.

5 von den 17 Patienten sind verstorben. Drei von diesen 5 bekamen weniger als 54 Gy Dosis. Vorsicht: man darf jetzt nicht den Schluß ziehen, hätten sie mehr gehabt, dann wäre das wirksamer gewesen.
In dem oben zitierten Artikel (Is stereotactic radiotherapy adequate treatment...) heißt es übrigens ganz ausdrücklich: "stereotactic therapy alone ... was associated with poor tumor control".

Nochmals: Das Datenmaterial ist zu klein !! und ohne die speziellen Umstände der Patienten zu kennen (die ja aus den Artikeln überhaupt nicht hervorgehen), sollte man KEINE Rückschlüsse auf seine eigene Situation ziehen.