Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas

DiBiase, Steven J.; Kwok, Young; Yovino, Susannah; Arena, Cristan; Naqvi, S; Temple, Richard; Regine, William F.; Amin, Pradip; Guo, Chuanfa; Chin, Lawrence S.

doi:10.1016/j.ijrobp.2004.05.073

Cited by 215 publications

(132 citation statements)

References 18 publications

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“…4 The current study and prior ones suggest but do not irrefutably demonstrate that resection, even if incomplete, may be of benefit to such patients if it will enable a reduction in the tumor volume below 10 cm 3 and eliminate the edema at the time of radiosurgery delivery. 4 Practically, less than one-fourth of all cases of * Regression: edema index decrease persistently > 10%; Stable: edema index decrease or increase within ± 10%; progression, then regression: edema index increase > 10% and then decrease > 10% compared to original edema index; progression: edema index increase persistently >10%; no edema: edema index = 0 during the period of SRS and follow-up. involving a parasagittal/parafalcine meningioma lead to a Simpson Grade I removal, and this is particularly the case when the tumor invades the dura of the superior sagittal sinus.…”

Section: Discussionmentioning

confidence: 48%

Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

Sheehan

Lee²,

Xu³

et al. 2015

JNS

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OBJECT Stereotactic radiosurgery (SRS) has been shown to offer a high probability of tumor control for Grade I meningiomas. However, SRS can sometimes incite edema or exacerbate preexisting edema around the targeted meningioma. The current study evaluates the incidence, timing, and degree of edema around parasagittal or parafalcine meningiomas following SRS. METHODS A retrospective review was undertaken of a prospectively maintained database of patients treated with Gamma Knife radiosurgery at the University of Virginia Health System. All patients with WHO Grade I parafalcine or parasagittal meningiomas with at least 6 months of clinical follow-up were identified, resulting in 61 patients included in the study. The median radiographic follow-up was 28 months (range 6–158 months). Rates of new or worsening edema were quantitatively assessed using volumetric analysis; edema indices were computed as a function of time following radiosurgery. Statistical methods were used to identify favorable and unfavorable prognostic factors for new or worsening edema. RESULTS Progression-free survival at 2 and 5 years was 98% and 90%, respectively, according to Kaplan-Meier analysis. After SRS, new peritumoral edema occurred or preexisting edema worsened in 40% of treated meningiomas. The median time to onset of peak edema was 36 months post-SRS. Persistent and progressive edema was associated with 11 tumors, and resection was undertaken for these lesions. However, 20 patients showed initial edema progression followed by regression at a median of 18 months after radiosurgery (range 6–24 months). Initial tumor volume greater than 10 cm3, absence of prior resection, and higher margin dose were significantly (p < 0.05) associated with increased risk of new or progressive edema after SRS. CONCLUSIONS Stereotactic radiosurgery offers a high rate of tumor control in patients with parasagittal or parafalcine meningiomas. However, it can lead to worsening peritumoral edema in a minority of patients. Following radiosurgery, transient edema occurs earlier than persistent and progressive edema. Longitudinal follow-up of meningioma patients after SRS is required to detect and appropriately treat transient as well as progressive edema.

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Section: Discussionmentioning

confidence: 48%

Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

Sheehan

Lee²,

Xu³

et al. 2015

JNS

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“…DiBiase and colleagues reported 5-year disease-free survival rates of 91.9% for patients with tumors ≤ 10 cm 3 as compared with 68% for larger tumors. 6 Kondziolka et al similarly cited a decreased local control rate with larger tumors. 11 Local control has been the primary focus of long-term outcomes studies, but disease progression may manifest as local, marginal, or distant failure.…”

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confidence: 98%

Patterns of recurrence after stereotactic radiosurgery for treatment of meningiomas

Kuhn¹,

Taksler

Dayton

et al. 2013

FOC

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Object The purpose of this study was to evaluate patterns of failure after stereotactic radiosurgery (SRS) for meningiomas and factors that may influence these outcomes. Methods Based on a retrospective chart review, 279 patients were treated with SRS for meningiomas between January 1999 and March 2011 at Wake Forest Baptist Health. Disease progression was determined using serial imaging, with a minimum follow-up of 6 months (median 34.2 months). Results The median margin dose was 12.0 Gy (range 8.8–20 Gy). Local control rates for WHO Grade I tumors were 96.6%, 84.4%, and 75.7% at 1, 3, and 5 years, respectively. WHO Grade II and III tumors had local control rates of 72.3%, 57.7%, and 52.9% at 1, 3, and 5 years, respectively. Tumors without pathological grading had local control rates of 98.7%, 97.6%, and 94.2% at 1, 3, and 5 years, respectively. Of the local recurrences, 63.1% were classified as marginal (within 2 cm of treatment field). The 1-, 3-, and 5-year rates of distant failure were 6.5%, 10.3%, and 16.6%, respectively, for Grade I tumors and 11.4%, 17.2%, and 22.4%, respectively, for Grade II/III tumors. Tumors without pathological grading had distant failure rates of 0.7%, 3.2%, and 6.5% at 1, 3, and 5 years, respectively. Wilcoxon analysis revealed that multifocal disease (p < 0.001) and high-grade histology (WHO Grade II or III; p < 0.001) were significant predictors of local recurrence. Additionally, male sex was a significant predictor of distant recurrence (p = 0.04). Multivariate analysis also showed that doses greater than or equal to 12 Gy were associated with improved local control (p = 0.015). Conclusions In this patient series, 12 Gy was the minimum sufficient margin dose for the treatment of meningiomas. Male sex is a risk factor for distant failure, whereas high-grade histology and multifocal disease are risk factors for local failure.

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“…After 1 year and 5 years, the rate for radiation-related complications were 6% and 11%, respectively. Other authors reported comparable results [11,12,32]. SRS is therefore commonly used for small lesions ( < 3 cm) while larger lesions, and lesions with a close proximity to the brain stem or other organs at risk, are treated by fractionated stereotactic radiotherapy.…”

Section: Skull Base Tumorsmentioning

confidence: 86%

Stereotactic radiosurgery (SRS) and stereotactic radiation therapy (SRT) for neurooncological and neurological diseases: state of the art and future perspectives

Münter

Welker

Jensen

et al. 2013

Innovative Neurosurgery

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Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) are well established in a high number of neurooncological and neurological lesions. Modern technologies discussed in this review, especially the integration of multimodality imaging in the daily clinical routine, will further improve the results of SRS and SRT. Currently, the different technical methods used are comparable regarding the clinical results in different clinical indications. The technological advances allow high treatment flexibility, and therefore, new treatment indications can be established based on the new technologies. In the future, it has to be defined more clearly whether a single fraction, hypofractionated concepts, or fractionated stereotactic radiotherapy is more effective regarding the clinical results and side effects of the therapy. The main area of development for radiosurgery will be stereotactic body radiosurgery. More randomized clinical studies for all possible indications are needed in the next few decades in order to establish radiosurgery more precisely, and also to determine its true value, especially in normal-fractionated radiotherapy. In technological development, the next step has been completed and proton or particle based stereotactic radiosurgery may have increased use in the future.

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Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas

Cited by 215 publications

References 18 publications

Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

Patterns of recurrence after stereotactic radiosurgery for treatment of meningiomas

Stereotactic radiosurgery (SRS) and stereotactic radiation therapy (SRT) for neurooncological and neurological diseases: state of the art and future perspectives

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