Fractionated Radiotherapy Is Associated with Lower Rates of Treatment-Related Edema than Stereotactic Radiosurgery in Magnetic Resonance Imaging–Defined Meningiomas

Abstract

OBJECTIVE: Both stereotactic radiosurgery (SRS) and fractionated radiation therapy (FRT) techniques are used for treatment of intracranial meningiomas with excellent local control (LC) rates. Although SRS techniques are convenient, toxicity including treatment-related edema can significantly impact patient quality of life. The long-term clinical outcomes of patients with magnetic resonance imaging (MRI)—defined meningiomas treated with radiation therapy (RT) alone are reported. METHODS: The charts of 211 patients with meningiomas diagnosed by contrast-enhanced MRI treated with either SRS or FRT between 1991 and 2012 at a single institution were reviewed. Actuarial rates for LC and development of treatment-related radiographic edema (TRE) were determined by the Kaplan-Meier method. RESULTS: There were 211 patients who received radiation therapy for 223 lesions. Median follow-up was 5.7 years. Eleven patients experienced a local failure; of these, 2 were ultimately found to have pathologically proven metastatic carcinoma. Two- and 5-year LC was 97.8% and 94.6%, respectively, with no significant difference based on modality of therapy. Actuarial rate for development of TRE at 1 and 2 years was 30.1% and 34.6% for the SRS group and 1.6% and 2.5% for the FRT group, respectively (P < 0.001). CONCLUSIONS: RT alone using a limited margin is an effective treatment option for MRI-defined meningiomas and should be considered even without biopsy if surgery will present significant morbidity. Although LC with SRS versus FRT was comparable, FRT was associated with a significantly decreased risk of TRE.

Health-related quality of life in meningioma

“… 61 While SRS and fractionated radiation therapy both exhibit good local control rates for meningioma, fractionated radiotherapy is associated with a lower risk of treatment-related edema. 62 …”

“…While not commonly used after gross-total resection of grade 1 meningioma, adjuvant radiation is often added to the surgical management of grade II and III meningioma or in the instance of recurrent disease. 60 Up front primary radiosurgery for radiographically suspected meningiomas demonstrates excellent local control rates, 62 however, the literature is scarce when it comes to comparing HRQOL among the different treatment populations of surgery, surgery followed by RT, and RT alone for meningioma. Despite short-term impairments in verbal memory, working memory, and executive functioning, long-term stabilization or improvements in HRQOL have been noted after skull-base meningioma resection 65 and radiosurgery for brain metastasis.…”

Quantifying effects of radiotherapy-induced microvascular injury; review of established and emerging brain MRI techniques

“…Currently available advanced radiotherapy techniques applying limited and fractionated doses have decreased the risk of symptomatic and debilitating brain oedema, as well as the need for treatment [31]. The risk of developing oedema is higher with stereotactic radiosurgery (SRS) than with fractionated radiation therapy [32,33]. Because vasogenic brain oedema can be challenging to detect on MRI, its prevalence is not well known.…”

The positive effects of surgery on symptomatic stereotactic radiation-induced peritumoral brain edema: A report of three cases

“…[ 14 , 15 , 23 , 29 ] However, peritumoral brain edema (PTBE) after radiosurgery may occur in a small but significant group of patients, ranging from 8% to 15%, and can seriously affect survival. [ 3 - 5 , 7 - 9 , 13 , 16 , 19 , 28 , 30 ] It usually develops a few weeks - months after radiosurgery and resolves within 2 years. In case of mass-effect symptoms, not much is available in terms of pharmacological treatment; most patients are administered steroids and osmotic agents with uncertain efficacy.…”