Hypofractionated Stereotactic Radiotherapy for the Treatment of Benign Intracranial Meningiomas: Long-Term Safety and Efficacy

Abstract

Introduction: Hypofractionated stereotactic radiotherapy (hSRT) has emerged as an alternative to single-fraction stereotactic radiosurgery (SRS) and conventionally fractionated radiotherapy for the treatment of intracranial meningiomas (ICMs). However, there is a need for data showing long-term efficacy and complication rates, particularly for larger tumors in sensitive locations. Methods: A retrospective review was conducted on adult patients with ICMs seen at a tertiary care center. Eligible patients were treated with the CyberKnife platform and had a planned treatment course of 3–5 fractions from 2011–2020. The local control was assessed based on radiographic stability and the late toxicity/radionecrosis rates were recorded. Radiographic progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method. Results: In total, 62 patients (age 26–87) with 67 treated tumors were included in this study with a median follow-up of 64.7 months. RT was delivered as the primary treatment in 62.7% of cases and for recurrence in 37.3%. The most common tumor locations were the convexity of the brain and the base of the skull. The tumor sizes ranged from 0.1–51.8 cc and the median planning target volume was 4.9 cc. The most common treatment schedule was 18 Gy in 3 fractions. The five-year PFS and OS were 85.2% and 91.0%, respectively. The late grade III/IV toxicity rate was 3.2% and the radionecrosis rate was 4.8%. Conclusions: Based on our data, hSRT remains an effective modality to treat low-grade ICMs with acceptable long-term toxicity and radionecrosis rates. hSRT should be offered to patients who are not ideal candidates for SRS while preserving the benefits of hypofractionation.

Evaluating the Efficacy and Safety of CyberKnife for Meningiomas: A Systematic Review

“…Analyzing the 21 studies provided, several key themes emerge regarding using CyberKnife in managing meningiomas [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44].…”

Outcomes and predictors of response to fractionated radiotherapy as primary treatment for intracranial meningiomas

“…The majority of meningiomas treated in our study received 50 Gy/25 Fr or 54 Gy/30 Fr (129/137, 94%) with only a minority receiving a hypofractionated regimen (40 Gy/15 Fr) or dose escalation (60 Gy/30 Fr). While hypofractionation has been found to be an effective strategy for some meningiomas post-operatively, our cohort did not include a sufficient number of patients to perform a matched analysis comparing this to conventional fractionation [19] , [20] , [21] . Dose escalation (to 60 Gy and beyond) has also been investigated but mostly in smaller studies and in the context of treating higher grade meningiomas (WHO grades 2 and 3), including those with subtotal resections [22] , [23] , [24] , [25] .…”

Multidisciplinary approach to anaplastic and metastatic meningioma: A case report and review of the literature

“…There are few high-level studies supporting the use of hypofractionated radiosurgery for intracranial meningiomas, although it is a widely accepted and used treatment. [ 26 ]…”

“…ere are few high-level studies supporting the use of hypofractionated radiosurgery for intracranial meningiomas, although it is a widely accepted and used treatment. [26] Metastatic meningioma is a rare clinical entity, with an estimated prevalence ranging from 0.1% to 0.76% of all patients with meningiomas according to different reported series. [3,14,21] e metastatic rate for grade II meningiomas ranges from 1.3% to 2%, and around 8% for grade III meningiomas, according to different authors.…”