Controversies in Radiotherapy for Meningioma

Maclean, Jillian; Fersht, Naomi; Short, Susan

doi:10.1016/j.clon.2013.10.001

Cited by 70 publications

(54 citation statements)

References 133 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2,7,13,20 However, recent studies assessing volume rather than diameter of residual tumor have demonstrated a significant recurrence in a short time span following radiation therapy. 21 We must insist on the importance of aiming to remove as much of the tumor as possible when complete resection is not possible.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of giant sphenoid wing meningiomas encasing major cerebral arteries

Champagne¹,

Lemoine²,

Bojanowski³

2018

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVESphenoid wing meningiomas are a heterogeneous group of tumors with variable surgical risks and prognosis. Those that have grown to a very large size, encasing the major cerebral arteries, are associated with a high risk of stroke. In reviewing the authors’ series of giant sphenoid wing meningiomas, the goal was to evaluate how the extent of the tumor’s invasion of surrounding structures affected the ability to safely remove the tumor and restore function.METHODSThe authors conducted a retrospective study of a series of giant sphenoid wing meningiomas operated on between 1996 and 2016. Inclusion criteria were meningiomas with a globoid component ≥ 6 cm, encasing at least 1 major intradural cerebral artery. Extent of resection was measured according to Simpson grade.RESULTSThis series included 12 patients, with a mean age of 59 years. Visual symptoms were the most common clinical presentation. There was complete or partial encasement of all 3 major cerebral arteries except for 3 cases in which only the anterior cerebral artery was not involved. The lateral wall of the cavernous sinus was invaded in 8 cases (67%) and the optic canal in 6 (50%). Complete resection was achieved in 2 cases (Simpson grades 2 and 3). In the remaining 10 cases of partial resection (Simpson grade 4), radical removal (> 90%) was achieved in 7 cases (70%). In the immediate postoperative period, there were no deaths. Four of 9 patients with visual deficits improved, while the 5 others remained unchanged. Two patients experienced transient neurological deficits. Other than an asymptomatic lacuna of the internal capsule, there were no ischemic lesions following surgery. Tumor recurrence occurred in 5 patients, between 24 and 168 months (mean 61 months) following surgery.CONCLUSIONSAlthough these giant lesions encasing major cerebral arteries are particularly treacherous for surgery, this series demonstrates that it is possible to safely achieve radical removal and at times even gross-total resection. However, the risk of recurrence remains high and larger studies are needed to see if and how improvement can be achieved, whether in surgical technique or technological advances, and by determining the timing and modality of adjuvant radiation therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Surgical management of giant sphenoid wing meningiomas encasing major cerebral arteries

Champagne¹,

Lemoine²,

Bojanowski³

2018

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…The optimal radiation dose for high-grade meningiomas remains unclear [10]. Local control with fractionated external beam radiation in conventional doses used for benign meningiomas, on the order of 50-54 Gy, is poor [11,12], and the pattern of failure appears to be primarily infield [13], suggesting a rationale for dose escalation or intensification.…”

Section: Introductionmentioning

confidence: 99%

Proton therapy for atypical meningiomas

et al. 2015

View full text Add to dashboard Cite

We report clinical outcomes of proton therapy in patients with World Health Organization grade 2 (atypical) meningiomas. Between 2005 and 2013, 22 patients with atypical meningiomas were treated to a median dose of 63 Gy (RBE) using proton therapy, as an adjuvant therapy after surgery (n=12) or for recurrence or progression of residual tumor (n=10). Six patients had presumed radiation-induced meningiomas, but none had received prior radiotherapy for their meningioma. The median follow-up time after radiation was 39 months (range 7-104) and all patients remain alive at last follow-up. The 5-year estimate of local control was 71.1% (95% CI 49.3-92.9%). The 5-year estimate of local control was 87.5% following a radiation dose > 60 Gy (RBE), compared to 50.0% for ≤ 60 Gy (RBE) (p=0.038). The 5-year estimate of neuraxis dissemination was 5% (95% CI 0-14.6%) and 6.2% (95% CI 0-18.2%) for metastases outside of the central nervous system. Radiation necrosis was observed in one patient with a history of prior cranial irradiation. Fractionated proton therapy was associated with favorable tumor control rates for grade 2 meningiomas. Prospective studies are needed to define the optimal radiation dose for high-grade meningiomas.3

show abstract

“…It has been observed that patients improve without any significant change in tumor size. When the tumor is symptomatic, RT should not be delayed, and if symptoms are severe "debulking" surgery followed by RT may be more appropriate [41,42].…”

Section: Indications and Outcomesmentioning

confidence: 99%

“…The optimal meningioma target definition has not been prospectively addressed and there is a lack of evidence to make any recommendations [41]. The gross tumor volume (GTV) is defined as the contrast-enhanced tumoral mass on T1-weighted MRI.…”

Section: Volumesmentioning

confidence: 99%