Long-term disease control and treatment outcomes of stereotactic radiosurgery in cavernous sinus meningiomas

Martínez-Pérez, Rafael; Florez-Perdomo, William Andrés; Freeman, Lindsey; Ung, Timothy H.; Youssef, A. Samy

doi:10.1007/s11060-021-03732-8

Cited by 11 publications

(17 citation statements)

References 43 publications

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“…This study reported our 20-year experience of performing LINAC-based SRS, which showed similar results as previous studies for meningioma[ 43 90 94 95 96 97 ], schwannoma[ 56 89 ], and pituitary adenoma[ 64 65 ]. The 5-year TCR s were comparable with GK series, and the neurological toxicities were not increased.…”

Section: Discussionsupporting

confidence: 87%

Clinical outcomes of benign brain tumors treated with single fraction LINAC-based stereotactic radiosurgery

Lin¹,

Chew²,

Chen³

et al. 2022

Tzu Chi Medical Journal

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Objectives: Accelerator-based stereotactic radiosurgery (SRS) is a noninvasive and effective treatment modality widely used for benign brain tumors. This study aims to report 20-year treatment outcomes in our institute. Materials and Methods: From May 2001 to December 2020, 127 patients treated with LINAC-based single-fraction SRS for their benign brain lesions were included. A neurosurgeon and two radiation oncologists retrospectively reviewed all data. Computed tomography (CT) simulation was performed after head-frame fixation under local anesthesia. All planning CT images were co-registered and fused with gadolinium-enhanced magnetic resonance imaging taken within 3 months for lesions targeting and critical organs delineation. The marginal dose was prescribed at 60%–90% isodose lines, respectively, to cover ≥95% planning target volume. Outcome evaluations included clinical tumor control rate (TCR), defined as the need for salvage therapy, and radiological response, defined as no enlargement of >2 cm in the maximal diameter. Overall survival (OS) and adverse reaction (defined according to CTCAE 5.0) were also analyzed. Results: The present study included 76 female and 51 male patients for analysis. The median age was 59 years (range, 20–88 years). Their diagnoses were vestibular schwannoma (VS, n = 54), nonvestibular cranial nerve schwannoma ( n = 6), meningioma ( n = 50), and pituitary adenoma ( n = 17). Totally 136 lesions were treated in a single fraction, predominantly skull base tumors, accounting for 69.1%. Median and mean follow-up duration was 49 and 61 months (range, 1–214 months), Overall TCR was 92.9%. The 5-year disease-specific TCR for VS, nonvestibular schwannoma, meningioma, and pituitary adenoma were 97.4%, 91.7%, 93.8%, and 83.3%. Salvage therapy was indicated for eight patients at 4–110 months after SRS. Among symptomatic patients, post-SRS symptom(s) was improved, stable, and worse in 68.2%, 24.3%, and 3.6%, respectively. Radiological response rate for 111 evaluable patients was 94.6% (shrinkage, 28.8%; stable, 65.8%). OS was 96.1% without treatment-related mortality. One patient with post-SRS cranial nerve injury (0.8%, involving the trigeminal nerve, grade 2 toxicities). No grade 3–4 acute or late toxicity was found. Conclusion: Our results suggested that LINAC-based SRS effectively controls tumor growth and tumor-related neurological symptoms for patients with benign brain tumors. SRS is less aggressive, associated with low neurological morbidity and no mortality. Continuous follow-up is indicated to conclude longer outcomes.

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Section: Discussionsupporting

confidence: 87%

Clinical outcomes of benign brain tumors treated with single fraction LINAC-based stereotactic radiosurgery

Lin¹,

Chew²,

Chen³

et al. 2022

Tzu Chi Medical Journal

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“…Large retrospective analyses of symptomatic patients with petroclival, cavernous sinus, and cerebellopontine meningiomas reveal tumor control by radiation therapy in greater than 90% of cases with significant improvement in cranial nerve function (46.5%), particularly in petroclival and cavernous sinus meningiomas ( 84 , 85 ). These findings were replicated in a series of retrospective analyses meta-analyses specifically looking at patients with cavernous sinus meningiomas treated with fractionated radiotherapy, demonstrating a local control rate of approximately 90% at 10 years with cranial nerve deficit improvement in 26-45% of patients and a 10% rate of new cranial nerve dysfunction ( 86 – 90 ). Clinical trials further investigating the application of fractionated radiotherapy in the treatment of meningioma are ongoing with encouraging results.…”

Section: Clinical Managementmentioning

confidence: 80%

Identification and Management of Aggressive Meningiomas

et al. 2022

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Meningiomas are common primary central nervous system tumors derived from the meninges, with management most frequently entailing serial monitoring or a combination of surgery and/or radiation therapy. Although often considered benign lesions, meningiomas can not only be surgically inaccessible but also exhibit aggressive growth and recurrence. In such cases, adjuvant radiation and systemic therapy may be required for tumor control. In this review, we briefly describe the current WHO grading scale for meningioma and provide demonstrative cases of treatment-resistant meningiomas. We also summarize frequently observed molecular abnormalities and their correlation with intracranial location and recurrence rate. We then describe how genetic and epigenetic features might supplement or even replace histopathologic features for improved identification of aggressive lesions. Finally, we describe the role of surgery, radiotherapy, and ongoing systemic therapy as well as precision medicine clinical trials for the treatment of recurrent meningioma.

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“…Other studies of SRS-treated meningiomas have published similar outcomes, with tumor control rates ranging from 83% to 93% and PFS rates of 91%-100% at 5 years, 76%-95% at 10 years, and 68.8%-87% at 15 years. 5,7,20,[23][24][25][26][27][28][29] Influence of Previous Surgery We highlight the reduction in PFS rate after 14 years of followup because of the growth of 3 meningiomas, indicating that a follow-up longer than 10 years is necessary, despite the apparent stability of lesions. Previous surgery had a negative effect on tumor control in bivariate analysis (HR 3.8 [95%CI 1.136-12.71], P = .030), in line with other reports, 23,27,30, although this remains under debate.…”

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Long-term Experience of LINAC Single-Dose Radiosurgery for Skull Base Meningiomas: A Retrospective Single-Center Study of 241 Cases

Ortiz García,

Rodríguez Valero,

Jorques Infante

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Stereotactic radiosurgery (SRS) is increasingly applied to treat meningiomas, attributable to their increased incidence in older individuals at greater surgical risk. To evaluate the effectiveness of treatment with linear accelerator (LINAC)–based stereotactic radiosurgery in skull base meningiomas as either primary treatment or postresection adjuvant therapy. METHODS: This study included 241 patients diagnosed with skull base meningiomas treated by single-dose SRS, with a median age of 59 years. SRS was primary treatment in 68.1% (n = 164) and adjuvant treatment in 31.9% (n = 77), using LINAC (Varian 600, 6 MeV). The median tumor volume was 3.2 cm3, and the median coverage dose was 14 Gy. Bivariate and multivariate analyses were performed to determine predictive factors for tumor progression, clinical deterioration, and complications. Kaplan-Meier analysis was used for survival analysis. RESULTS: After the median follow-up of 102 months, the tumor control rate was 91.2% (n = 220). Progression-free survival rates were 97.07%, 90.1%, and 85.7% at 5, 10, and 14 years, respectively. Clinical improvement was observed in 56 patients (23.2%). In multivariate analysis, previous surgery (hazard ratio 3.8 [95%CI 1.136-12.71], P = .030) and selectivity (hazard ratio .21 [95%CI 0.066-0.677], P = .009) were associated with tumor progression and increased maximum dose (odds ratio [OR] 4.19 [95% CI 1.287-13.653], P = .017) with clinical deterioration. The permanent adverse radiation effect rate was 6.2% (n = 15) and associated with maximum brainstem dose >12.5 Gy (OR 3.36 [95% CI .866-13.03], P = .08) and cerebellopontine angle localization (OR 3.93 [95% CI 1.29-11.98], P = .016). CONCLUSION: Treatment of skull base meningiomas with single-dose SRS using LINAC is effective over the long term. Superior tumor control is obtained in patients without previous surgery. Adverse effects are related to localization in the cerebellopontine angle, and maximum brainstem radiation dose was >12.5 Gy.

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Long-term disease control and treatment outcomes of stereotactic radiosurgery in cavernous sinus meningiomas

Cited by 11 publications

References 43 publications

Clinical outcomes of benign brain tumors treated with single fraction LINAC-based stereotactic radiosurgery

Clinical outcomes of benign brain tumors treated with single fraction LINAC-based stereotactic radiosurgery

Identification and Management of Aggressive Meningiomas

Long-term Experience of LINAC Single-Dose Radiosurgery for Skull Base Meningiomas: A Retrospective Single-Center Study of 241 Cases

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