脑膜瘤的长期随访表明，在10年后，复发率范围从2.5％到48％不等，这取决于组织学分级。目前可用的数据有限，无法指导复发和先前接受过放射治疗的颅底脑膜瘤的治疗管理，与拯救性手术，再次放射治疗以及缺乏明确的系统治疗策略相关的挑战仍然存在。在本研究中，作者分析了对复发和先前接受过放射治疗的脑膜瘤的经验数据，以评估拯救性手术和再次放射治疗对进展无生存期（PFS）的影响。 进行了48名患有复发和先前接受过放射治疗的脑膜瘤患者的回顾性队列研究，这些患者在1995年至2021年之间接受了治疗。数据从医疗记录中提取，并包括临床，放射学和病理学报告。根据WHO分级，患者被分组。作者使用Cox比例风险模型分析了与再次放射治疗和拯救性手术相关的并发症以及不同治疗模式对PFS的影响。 经第一次放射治疗治疗后，48名患有复发和先前接受过放射治疗的患者（33例患有WHO I级，11例患有WHO II级和4例患有WHO III级脑膜瘤）治疗了143次复发。对于WHO I级脑膜瘤，辅助性重复放射治疗未改变肿瘤控制率（HR 0.784，95％CI 0.349-1.759; p = 0.55），在切除范围（EOR）方面，仅剩余的切除（STR）相对于完全切除（GTR）时与复发风险有关（HR 3.38，95％CI 1.268-9.036，p = 0.0189）。对于WHO II级脑膜瘤，与STR相比，GTR并未明显提高肿瘤控制（HR 0.42，95％CI 0.17-1.037; p = 0.055），但是STR后辅助性重复放射治疗与改善结果有关（HR 0.316，95％CI 0.13-0.768; p = 0.0029）。最后，对于WHO III级脑膜瘤，EOR与结果不相关（HR 0.75，95％CI 0.22-2.482; p = 0.588），但是仅重复放射治疗与降低进展的可能性有关（HR 0.276，95％CI 0.078-0.97；p = 0.0028）。 本研究研究了曾先前接受放射治疗的复发脑膜瘤患者的大量队列中再治疗对PFS的影响。在复发时，WHO I级脑膜瘤在GTR下显示出改善的PFS，亚全切除的WHO II级脑膜瘤在再次放射治疗时似乎有改善的PFS，而WHO III级脑膜瘤的再放射治疗显示出改善的PFS。

Long-term follow-up of meningiomas has demonstrated recurrence rates ranging from 2.5% to 48% after 10 years, depending on histology grade. There are limited data available to guide the management of recurrent and previously irradiated skull base meningiomas, and challenges related to salvage surgery, reirradiation, and lack of clear systemic therapy strategies remain. In this study, the authors analyzed data from their experience with recurrent and previously irradiated meningiomas to assess the impact of salvage surgery and reirradiation on progression-free survival (PFS).A retrospective cohort study of 48 patients with recurrent and previously irradiated meningiomas who were treated between 1995 and 2021 was conducted. Data were extracted from medical records and included clinical, radiological, and pathologic reports. Patients were clustered according to WHO grades. The authors analyzed the complications related to reirradiation and salvage surgery and the impact of different treatment modalities on PFS using Cox proportional hazard ratios.Forty-eight patients (33 with WHO grade I, 11 with WHO grade II, and 4 with WHO grade III meningiomas) were treated for 143 recurrences after their first radiation treatment. For WHO grade I meningiomas, there was no change in tumor control rates with adjuvant repeat radiotherapy (HR 0.784, 95% CI 0.349-1.759; p = 0.55), and in terms of extent of resection (EOR), subtotal resection (STR) alone was associated with an increased risk of recurrence when compared with gross-total resection (GTR) (HR 3.38, 95% CI 1.268-9.036; p = 0.0189). For WHO grade II meningiomas, GTR did not significantly confer improved tumor control relative to STR (HR 0.42, 95% CI 0.17-1.037; p = 0.055), but adjuvant repeat radiotherapy after STR was associated with improved outcomes (HR 0.316, 95% CI 0.13-0.768; p = 0.0029). Finally, for WHO grade III meningiomas, EOR did not correlate with outcomes (HR 0.75, 95% CI 0.22-2.482; p = 0.588), but repeat radiotherapy alone was associated with a decreased odds of progression (HR 0.276, 95% CI 0.078-0.97; p = 0.0028).This study examined the impact of retreatment on PFS in a large cohort of patients with recurrent meningiomas that had been previously irradiated. At the time of recurrence, WHO grade I meningiomas exhibited improved PFS with GTR, subtotally resected WHO grade II meningiomas appeared to have improved PFS when reirradiated, and reirradiation in WHO grade III meningiomas showed improved PFS.