Gamma Knife surgery for skull base meningiomas

Starke, Robert M.; Williams, Brian J.; Hiles, Claire L.; Nguyen, James; Elsharkawy, Mohamed; Sheehan, Jason P.

doi:10.3171/2011.11.jns11530

Cited by 143 publications

(107 citation statements)

References 80 publications

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“…6 Some believe that skull-base tumors behave in a more benign fashion, 18 although others report late failures in this population. 5 Our patient series revealed that tumors in the skull base did not have significantly lower odds of treatment failure compared with non-skull base tumors (p = 0.35, local failure; p = 0.16, distant failure).…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

Patterns of recurrence after stereotactic radiosurgery for treatment of meningiomas

Kuhn¹,

Taksler

Dayton

et al. 2013

FOC

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“…It is noteworthy that these rates of tumor control are typically lower than those afforded by radiosurgery for meningiomas of the skull base. 23 The lower rates of tumor control may well be related to the vascular supply to these tumors and the possibility of recurrence at the margin of the treatment volume, particularly for those patients with prior resection. With radiosurgery in particular, the dural tail of a meningioma is not included in the planned treatment volume; many PSPF meningiomas do have an extensive dural tail.…”

Section: Radiosurgical Treatmentmentioning

confidence: 99%

Radiosurgery for parasagittal and parafalcine meningiomas

Ding

McNeill

et al. 2013

JNS

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Object Parasagittal and parafalcine (PSPF) meningiomas represent the second most common location for intracranial meningiomas. Involvement of the superior sagittal sinus or deep draining veins may prevent gross-total resection of these tumors without significant morbidity. The authors review their results for treatment of PSPF meningiomas with radiosurgery. Methods The authors retrospectively reviewed the institutional review board–approved University of Virginia Gamma Knife database and identified 65 patients with 90 WHO Grade I parasagittal (59%) and parafalcine (41%) meningiomas who had a mean MRI follow-up of 56.6 months. The patients' mean age was 57 years, the median preradiosurgery Karnofsky Performance Status score was 80, and the median initial tumor and treatment volumes were 3 and 3.7 cm3, respectively. The median prescription dose was 15 Gy, isodose line was 40%, and the number of isocenters was 5. Kaplan-Meier analysis was used to determine progression-free survival (PFS). Univariate and multivariate Cox regression analyses were used to identify factors associated with PFS. Results The median overall PFS was 75.6 months. The actuarial tumor control rate was 85% at 3 years and 70% at 5 years. Parasagittal location, no prior resection, and younger age were found to be independent predictors of tumor PFS. For the 49 patients with clinical follow-up (mean 70.8 months), the median postradiosurgery Karnofsky Performance Status score was 90. Symptomatic postradiosurgery peritumoral edema was observed in 4 patients (8.2%); this group comprised 3 patients (6.1%) with temporary and 1 patient (2%) with permanent clinical sequelae. Two patients (4.1%) died of tumor progression. Conclusions Radiosurgery offers a minimally invasive treatment option for PSPF meningiomas, with a good tumor control rate and an acceptable complication rate comparable to most surgical series.

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“…In both cases, the agreement was parameterized by the gamma (γ) function, with a dose agreement of 3% and distance to agreement of 3 mm choosing an acceptance criteria of γ < 1 in more than the 93% of comparison points. 23 The Mean Delivery Time, defined as the approximate time needed in the LINAC "beam-on" phase, was investigated too. Correct patient setup was evaluated for each treatment session using the XVI CBCT and a 2 mm tolerance displacement level was considered acceptable.…”

Section: Rt Protocol:-mentioning

confidence: 99%

Stereotactic Volume Modulated Arc Radiotherapy Protocol for Canine Intracranial Meningioma.

Dolera¹,

Malfassi²,

Carrara³

et al. 2017

IJAR

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Objective: to assess High Dose Hypofractionated Volume Modulated Arc Radiotherapy (HDH-VMAT) feasibility and clinical efficacy in canine meningiomas. Design: a prospective study was conducted on thirty-three patients with a presumptive diagnosis of encephalic meningiomas assumed from Magnetic Resonance Imaging (MRI) findings. Methods: all dogs, whose neurological status was scored through the use of an innovative evaluation scale (Romanengo Veterinary Neurological Scale -RVNS), received HDH-VMAT by a Linear Accelerator (LINAC) equipped with an external beam modulator micro-multileaf collimator and an XVI Cone Beam Computed Tomography system (CBCT). The prescribed mean dose was 33 Gy delivered in 5 fractions. The treatment feasibility was tested through planned and delivered dose agreement checks. Regular clinical examinations were performed during and after irradiation time with regard to mentation, deambulation, cranial nerve dysfunction and seizures. Serial MRI exams were done 60 days after irradiation and after 4, 6, 12, 18, 24 months. Volumetric disease reduction criteria implemented with clinical neurological systematic evaluation were adopted to assess the course and to categorize patients' response. Results: complete and partial responses were observed on the whole in 65,5% of alive patients 24 months after irradiation. Two-year overall and disease-specific survival rates were 74.3% and 97.4%, respectively, and the putative radiotoxic effects were found to be few and slight. Conclusions: HDH-VMAT is a valid therapeutic option for encephalic canine meningioma. Volumetric MRI evaluation together with the hereby proposed RVNS should be considered for the evaluation of the post-treatment response.Copy Right, IJAR, 2017,. All rights reserved.

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Gamma Knife surgery for skull base meningiomas

Cited by 143 publications

References 80 publications

Patterns of recurrence after stereotactic radiosurgery for treatment of meningiomas

Patterns of recurrence after stereotactic radiosurgery for treatment of meningiomas

Radiosurgery for parasagittal and parafalcine meningiomas

Stereotactic Volume Modulated Arc Radiotherapy Protocol for Canine Intracranial Meningioma.

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