Linear accelerator-based stereotactic radiosurgery of intracranial meningiomas: results of the first 5 years of clinical practice

Abstract

Meningiomas are mostly benign but some are atypical or malignant. Surgical resection is curative when complete removal of benign meningiomas is contemplated. Incompletely excised and recurrent tumors are frequently treated with fractionated radiation therapy or stereotactic radiosurgery. The purpose of this study is to evaluate the short-term radiological and functional outcomes of a single center using linear accelerator (Linac) stereotactic radiosurgery for the treatment of intracranial meningiomas. Twenty-nine patients (12 males and 17 females) with 30 meningiomas, in different brain locations (skull base and non-skull base meningiomas), were treated with Linac-based stereotactic radiosurgery. The mean tumor volume was 6.3 cm³, and the mean tumor marginal and maximum doses were 10.9 and 15 Gy, respectively. The median prescribed isodose line was 80%. The patients were followed-up for a minimum of 3 years. Regarding radiological outcome, nine (30%) meningiomas demonstrated evident volume reduction, 19 (63.3%) meningiomas remained unchanged, and two (6.7%) meningiomas increased in size after radiosurgery. The local tumor control rates for skull base meningiomas and non-skull base meningiomas after radiosurgery were 90.9% and 100%, respectively. Regarding functional outcomes, 64% of patients presenting with cranial neuropathies showed improvement of their cranial nerve functions and 29% of patients remained unchanged. One patient had temporary trigeminal neuropathy. Although radiosurgery for meningiomas is generally effective and quite safe in achieving high control rates with minimum morbidity over short- and intermediate-term periods of follow-up, tumor progression might occur in a delayed manner after initial apparent control for few years. We recommend continued follow-up for longer periods to better assess the long-term outcomes.

Stereotactic Radiosurgery for Intracranial Noncavernous Sinus Benign Meningioma: International Stereotactic Radiosurgery Society Systematic Review, Meta-Analysis and Practice Guideline

“…After the removal of duplicates, 2233 papers remained, out of which 1927 were excluded upon title and abstract evaluation. Following a full text scrutiny of the remaining 305 studies, 27 studies 10-36 were deemed to have met the inclusion criteria and selected for this review and summarized in Figure 1 . One study was prospective, 19 in 4 studies the study design was unclear, 10 , 21 , 24 , 32 and the remaining studies were retrospective.…”

“…Following a full text scrutiny of the remaining 305 studies, 27 studies 10-36 were deemed to have met the inclusion criteria and selected for this review and summarized in Figure 1 . One study was prospective, 19 in 4 studies the study design was unclear, 10 , 21 , 24 , 32 and the remaining studies were retrospective. Two studies were multicenter, 19 , 35 while the remaining were single-center institutional series.…”

Predictors of Treatment Response and Survival Outcomes in Meningioma Recurrence with Atypical or Anaplastic Histology

“…23 The roles of radiation therapy (RT) and stereotactic radiosurgery (SRS) have recently been explored for treating both atypical 23,[25][26][27] and incompletely resected meningiomas. [28][29][30][31][32][33][34][35][36] Although adjuvant RT is increasingly being considered in the literature following primary resection for atypical histology, 26,[37][38][39][40][41][42] there remains significant heterogeneity between centers. 43 A recent SEER practice review found 76% of patients with atypical and 34% with anaplastic meningiomas did not receive adjuvant RT following STR, with similar rates after GTR.…”

X-rays sensing properties of MEH-PPV, Alq3 and additive components: A new organic dosimeter as a candidate for minimizing the risk of accidents of patients undergoing radiation oncology

“…This way they will have the assurance that the prescribed dose for their cancer treatment will be administered correctly. Unfortunately, errors are common in radiation therapy and to establish medical and hospital routines to prevent negative impacts on the treatment of patients with cancer are a current challenge [4][5][6][7]. Some of the difficulties in establishing new routines are associated with the complexity of cancer treatments and also to tighter control of the operating conditions of hospital equipment prior to patient exposure to radiation.…”