PURPOSE To evaluate surgical resection with brachytherapy placement as a salvage treatment in patients with recurrent high-grade meningioma who exhausted prior external beam treatment options. METHODS Single-center retrospective review of our institutional experience of brachytherapy implantation from 2012 to 2018. The primary outcome of the study was progression free survival (PFS). Secondary outcomes included overall survival (OS) and complications. A matched cohort of patients not treated with brachytherapy over the same time period was evaluated as a control group. All patients had received prior radiation treatment and underwent planned gross total resection (GTR) surgery. RESULTS A total of 27 cases were evaluated. Compared with prior treatment, brachytherapy implantation demonstrated a statistically significant improvement in tumor control [HR 0.316 (0.101 - 0.991), p = 0.034]. PFS-6 and PFS-12 were 92.3% and 84.6%, respectively. Compared with the matched control cohort, brachytherapy treatment demonstrated improved PFS [HR 0.310 (0.103 - 0.933), p = 0.030]. Overall survival was not statistically significantly different between groups [HR 0.381 (0.073 - 1.982), p = 0.227]. Overall postoperative complications were comparable between groups, although there was a higher incidence of radiation necrosis in the brachytherapy cohort. CONCLUSION Brachytherapy with planned GTR improved PFS in recurrent high-grade meningioma patients who exhausted prior external beam radiation treatment options. Future improvement of brachytherapy dose delivery methods and techniques may continue to prolong control rates and improve outcomes for this challenging group of patients.

中文翻译：

---

近距离放射疗法结合外科手术切除作为复发性高级别脑膜瘤的挽救性治疗：一项配对队列研究。

目的评估复发性高级别脑膜瘤患者在用完外部束治疗方法后已用尽的近距离脑膜瘤的挽救治疗，以评估手术切除的可能性。方法我们对2012年至2018年间近距离放射治疗植入的机构经验进行了单中心回顾性研究。研究的主要结果是无进展生存期（PFS）。次要结果包括总生存期（OS）和并发症。在同一时间段内未接受近距离放射治疗的患者的配对队列被评估为对照组。所有患者均已接受放射治疗，并已进行了计划的大体总切除术（GTR）手术。结果共评估27例。与以前的治疗相比，近距离放射治疗植入物在肿瘤控制方面显示出统计学上的显着改善[HR 0.316（0.101-0.991），p = 0.034]。PFS-6和PFS-12分别为92.3％和84.6％。与配对对照组相比，近距离放射治疗显示出改善的PFS [HR 0.310（0.103-0.933），p = 0.030]。两组之间的总生存期无统计学差异[HR 0.381（0.073-1.982），p = 0.227]。尽管近距离放射治疗队列中放射坏死的发生率较高，但两组之间的总体术后并发症相当。结论计划内GTR的近距离放射治疗可改善复发性高级别脑膜瘤患者的PFS，这些患者在先前已接受外部束放射治疗的情况下已经筋疲力尽。