Linear Accelerator-Based Stereotactic Radiotherapy for Low-Grade Meningiomas: Improved Local Control With Hypofractionation

Wegner, Rodney E.; Hasan, Shaakir; Abel, Stephen; Anderson, Sidney; Fuhrer, Russell; Williamson, Richard; Karlovits, Stephen

doi:10.1177/1179573519843880

Cited by 9 publications

(9 citation statements)

References 29 publications

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“…Due to the lack of studies with large patient numbers, statistics for OS and LC in WHO grade II and III meningiomas show a broad variance (0.0-89.0%) (Table 3) [30,32,33,38,40,42,43]. Our estimated 5-year LC for WHO grade II (66.7%) and WHO grade III (53.1%) meningiomas is compatible with the majority of published data (Table 3) [11,13,15,30,32,33,38,40,42,[44][45][46][47]. Our 5-year and 10-year OS rates for each WHO grade, however, seem to be more favorable in comparison to published ones.…”

Section: Discussionsupporting

confidence: 87%

Health-Related Quality Of Life And Clinical Outcome After Radiotherapy of Patients With Intracranial Meningioma

Lisowski

Trömel

Lutyj

et al. 2022

Preprint

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Purpose: This retrospective, single-institutional study investigated long-term outcome, toxicity and health-related quality of life (HRQOL) in meningioma patients after radiotherapy. Methods: We analyzed the data of 119 patients who received radiotherapy at our department from 1997 to 2014 for intracranial WHO grade I-III meningioma. Fractionated stereotactic radiotherapy (FSRT), intensity modulated radiotherapy (IMRT) or radiosurgery radiation was applied using a linear accelerator. A median total dose of 54.7 Gy (IQR 54.0-60.0 Gy) was prescribed in median single doses of 1.8 Gy (IQR 1.8-1.9 Gy). Overall survival (OS) and local control (LC) rates were obtained. In addition, the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Core questionnaire (QLQ-C30) and the EORTC Brain Cancer Module (QLQ-BN20) were completed for assessment of HRQOL. Results were compared with normal population and with already published data. Results: OS for the entire cohort was 89.6% at 5 years and 75.9% at 10 years. LC at 5 and 10 years was 82.4% and 73.4%, respectively. Local recurrence was observed in 22 patients (18.5%). CTCAE grade ≥3 acute and chronic toxicities were observed in seven patients (5.9%) and five patients (4.2%), respectively. Global health status was rated with a mean of 59.9 points (SD 22.3) on QLQ-C30. HRQOL was lower after radiotherapy in comparison to normal population and to meningioma patients treated by surgery alone. Conclusion: Radiotherapy resulted in very good long-term survival and tumor control rates with low rates of severe toxicities. Nevertheless, long-term HRQOL may be negatively affected by radiotherapy.

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Section: Discussionsupporting

confidence: 87%

Health-Related Quality Of Life And Clinical Outcome After Radiotherapy of Patients With Intracranial Meningioma

Lisowski

Trömel

Lutyj

et al. 2022

Preprint

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“… 18 Publications of hypofractionated regimens have reported similar rates of control (>90%), but with a limited range of tumor volumes (<75 cm 3 ). 4 , 11 , 19 , 20 , 21 , 22 , 23 , 24 In the context of these studies, our findings support a similar efficacy of moderately hypofractionated radiation for larger tumor volumes (up to 245 cm 3 ) and those near critical structures.…”

Section: Discussionsupporting

confidence: 79%

Moderately Hypofractionated Radiation for Benign Meningiomas and Schwannomas: A Report of 70 Patients Treated Between 2008 and 2018

Dhere

Tian

Buchwald

et al. 2020

Advances in Radiation Oncology

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Purpose Radiosurgery and fractionated intensity modulated radiation therapy (IMRT) are effective treatment modalities for meningiomas and schwannomas. Although fractionated IMRT yields favorable tumor control, daily treatments for 5 to 6 weeks can be burdensome for patients and health care systems. Thus, hypofractionated radiation may be a reasonable alternative. The purpose of this study was to review the results of patients with benign meningiomas or schwannomas treated at our institution with moderately hypofractionated IMRT. Methods and Materials After institutional review board approval, patients treated at a single academic institution between 2008 and 2018 with a primary diagnosis of either meningioma or schwannoma and who received 30 Gy at 3 Gy per fraction were identified. Patient and tumor characteristics, as well as follow-up documentation, were reviewed. Tumor progression was determined by reviewing patient imaging and provider notations. Results From 2008 to 2018, 70 patients with either meningioma or schwannoma were treated to 30 Gy. The median patient age was 73 years (range, 43-92 years). At the median follow up of 3.2 years, the local control was 92.9%. Two patients (2.9%) had disease progression, which occurred at 9.6 and 6.6 years after treatment. One patient developed asymptomatic radiographic changes consistent with radiation necrosis, which resolved without intervention. All patients completed the prescribed course without interruption. The mean tumor volume was 18.9 cm 3 , median volume was 36.6 cm 3 (range, 3.4-245.5 cm 3 ), and tumor volume was not associated with recurrence risk. Both tumors with progression were schwannomas. Conclusions Hypofractionated radiation with 30 Gy at 3 Gy per fraction is an effective, convenient, and well-tolerated alternative for patients with benign meningiomas or schwannomas. Modest hypofractionation provided durable control for a wide range of tumor volumes and should be considered for patients with a limited life expectancy or those unable to receive a more extended fractionated radiation therapy course.

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“…One prior study has shown statistically significant association between development of post-treatment peritumoral edema and single-fraction SRS versus hypofractionated SRS courses [ 15 ]. In addition, hypofractionated SRS is preferred over SRS for tumors larger than 10 cm 3 and multiple studies have shown excellent outcomes with low toxicity (less than 5%) [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Trends in the use of radiation for meningioma across the United States

Matani

Abel

et al. 2022

Radiat Oncol J

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Purpose: Meningiomas are tumors originating from arachnoid cap cells on the surface of the brain or spinal cord. Treatment differs by grade but can consist of observation, surgery, radiation therapy or both. We utilized the National Cancer Database (NCDB) to compare trends in the use stereotactic radiosurgery (SRS) and external beam radiation therapy (EBRT) in the management of meningioma. Materials and Methods: We queried the NCDB from 2004–2015 for meningioma patients (grade 1–3) treated with radiation therapy, either SRS or EBRT. Multivariable logistic regression was used to identify predictors of each treatment and to generate a propensity score. Propensity adjusted Kaplan-Meier survival curve analysis and multivariable Cox hazards ratios were used to identify predictors of survival. Results: We identified 5,406 patients with meningioma meeting above criteria with 45%, 44%, and 11% having World Health Organization (WHO) grade 1, 2, and 3 disease, respectively. Median follow up was 43 months. Predictors for SRS were grade 1 disease, distance from treatment facility, and histology. The only predictor of EBRT was grade 3 disease. Treatment year, histology, race and female sex were associated with improved survival. Five- and 10-year survival rates were 89.2% versus 72.6% (p < 0.0001) and 80.3% versus 61.4% (p = 0.29) for SRS and EBRT respectively. After propensity matching 226 pairs were generated. For SRS, 5-year survival was not significantly improved at 88.2% compared with EBRT (p = 0.056).Conclusion: In the present analysis, predictors of SRS utilization in management of meningioma include WHO grade 1 disease, distance from treatment facility and histology whereas conventional EBRT utilization was associated with grade 2 and 3 disease. Future studies need to be performed in order to optimize management of atypical and malignant meningioma.

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Linear Accelerator-Based Stereotactic Radiotherapy for Low-Grade Meningiomas: Improved Local Control With Hypofractionation

Cited by 9 publications

References 29 publications

Health-Related Quality Of Life And Clinical Outcome After Radiotherapy of Patients With Intracranial Meningioma

Health-Related Quality Of Life And Clinical Outcome After Radiotherapy of Patients With Intracranial Meningioma

Moderately Hypofractionated Radiation for Benign Meningiomas and Schwannomas: A Report of 70 Patients Treated Between 2008 and 2018

Trends in the use of radiation for meningioma across the United States

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