Long-Term Experience of Gamma Knife Radiosurgery for Benign Skull Base Meningiomas

Kreil, Wolfgang; Eustacchio, Sandro; Weigl, Verena; Luggin, Josef; Papaefthymiou, G.; Unger, F.

doi:10.1055/s-2007-984153

Cited by 17 publications

(30 citation statements)

References 21 publications

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“…21 The adverse effects of this nonin vasive technique are rare. 10,16 In our study, we reported a single case of transient hemiparesis that completely re solved without sequelae. Although radiosurgery is a safe therapeutic option, it can only be performed for tumors of limited size.…”

Section: Goals Of Radiosurgerymentioning

confidence: 64%

Grade 2 meningioma and radiosurgery

Aboukaïs¹,

Zaïri²,

Lejeune³

et al. 2015

JNS

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OBJECT World Health Organization Grade 2 meningiomas are aggressive tumors associated with a high recurrence rate leading to repeated surgical procedures, which can seriously worsen a patient's neurological status. Although radiosurgery is an increasingly popular technique, its role in the management of Grade 2 meningiomas has yet to be defined. In this study the authors aimed to evaluate radiosurgery in achieving control of proven tumor progression occurring after resection of Grade 2 meningioma. METHODS This retrospective study included consecutive patients who, between 2000 and 2012, had undergone radiosurgery for radiologically proven progression of a previously surgically treated Grade 2 meningioma. RESULTS Twenty-seven patients were eligible for analysis. There were 9 men and 18 women with a mean age of 59 years. The mean radiation dose was 15.2 Gy (range 12–21 Gy), and the mean target volume was 5.4 cm3 (range 0.194–14.2 cm3). Thirty-four radiosurgical procedures were performed in the 27 patients. The mean progression-free survival after radiosurgery was 32.4 months among those with progression in a target irradiated volume and 26.4 months among those with progression in any intracranial meninges. With a mean follow-up of 56.4 months (range 12–108 months), the 12-, 24-, and 36-month actuarial local control rates for all patients were 75%, 52%, and 40%, respectively, and the regional control rates were 75%, 48%, and 33%. A single case of transient hemiparesis completely resolved without sequelae. CONCLUSIONS Radiosurgery appears to be a safe and effective treatment for the local control of delayed progression after resection of a Grade 2 meningioma. Higher radiation doses similar to those applied for malignant tumors should be recommended when possible.

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Section: Goals Of Radiosurgerymentioning

confidence: 64%

Grade 2 meningioma and radiosurgery

Aboukaïs¹,

Zaïri²,

Lejeune³

et al. 2015

JNS

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“…Many studies have evaluated the efficacy of SRS for treating meningiomas and reported outcomes and common adverse effects. 7,9,16,22,24,31,44 These retrospective studies suggest local control rates between 86% and 99%, tumor regression rates up to 70%, symptom improvement in 8% to 65% of cases, and ARE rates of 2.5% to 43%. In the current early follow-up study of patients with WHO Grade I meningiomas who underwent SRS, we demonstrate the disparity between volumetric and linear measurements with regard to tumor growth.…”

Section: Discussionmentioning

confidence: 83%

Predictors of response to Gamma Knife radiosurgery for intracranial meningiomas

Mansouri

Larjani

Klironomos

et al. 2015

JNS

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M eningioMas are the most common primary intracranial nonglial neoplasms in adults. 34 When feasible, the ideal management of meningiomas is complete resection of the tumor and associated dura mater, with the goal of minimizing further neurological morbidity for the patient. 28 However, not all meningiomas are amenable to gross-total resection (e.g., extensive involvement of skull base structures or invasion into the venous sinuses or other neurovascular structures), and alternative complementary treatment strategies are necessary. 4,27,40 abbreviatioNs ARE = adverse radiation event; CI RTOG = Radiation Therapy Oncology Group Conformity Index; RT = radiotherapy; SGR = specific growth rate; SRS = stereotactic radiosurgery; TVR = treatment volume ratio. obJect In this paper, the authors' aim was to determine short-term volumetric and diametric tumor growth and identify clinical, radiological, and dosimetric predictors of adverse radiation events (AREs) following stereotactic radiosurgery (SRS) for intracranial WHO Grade I meningiomas. methods This is a retrospective review of all WHO Grade I meningiomas that were treated with SRS (primary or adjuvant) between December 2005 and June 2012 at the University Health Network. Seventy-five patients had at least 24 months of both clinical and radiological follow-up and were, therefore, included in this study. Tumor growth was defined as any volumetric or diametric change greater than 10% per year. Any variation less than +10% was considered growth stability. Volumetric measurements were made using T1-weighted gadolinium-enhanced 3-T MRI scans and ITK-SNAP software. Tumor growth rates were calculated using the specific growth rate (SGR). Univariate statistics were used to identify predictors of post-SRS AREs. All statistical analyses were performed using IBM SPSS. results Women accounted for 69.3% of patients, and the mean treatment age was 58.6 years. Median follow-up was 36.2 months. Twenty-one (28%) patients had undergone prior resection. Two (3%) patients required salvage surgical intervention following SRS. The majority of the lesions (56%) were skull base tumors. Median tumor volume and diameter were 5.2 cm 3 and 27.5 mm, respectively. The absence of tumor growth was observed in 39 cases (52%) based on the volumetric measurements, while the absence of tumor growth was observed in 69 cases (92%) based on the diametric measurements. Twenty-six patients (34.6%) experienced new-onset AREs, including headache (17.3%), cranial neuropathy (10.6%), speech impairment (2.7%), tremors (2.7%), and ataxia (1.3%). Fourteen patients (18.7%) experienced new-onset edema, and 4 of these patients were symptomatic. A lower conformity index (1.24 vs 1.4) was significantly associated with the development of edema (p < 0.001 power > 0.8). Patients with meningiomas that had growth rates of more than 10% per year were more likely to experience long-term headaches after SRS (p = 0.022). coNclusioNs Volume-based reporting of SRS outcomes for meningiomas may be a more accurate method given the ...

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“…1) are usually characterized by 5yr actuarial tumor control rates (87%-96%) much higher than those with atypic (49%-77%) or anaplastic (0%-19%) lesions (21,24,37,49,63,73,77). As shown in (TABLE 4), the still limited number of reports with a mean follow up period of 7-10 years have consistently confirmed these differential LTC levels (3,15,41,63,70) Table 4. GKR-, PROTON BEAMLINAC-and Cyberknife-based stereotactic radiosurgery in meningiomas.…”

Section: Gamma Knife Radiosurgerymentioning

confidence: 70%

“…These techniques, and the concomitant diffusion of phantom studies, have repeatedly confirmed the reliability of such referrals, consistently improving the main conformity indexes. To date, the recommended "surface-or "peripheral "doses" for meningiomas range from 11 -to -15 Gy (16,36,37,41,47,49,54,72).…”

Section: Gamma Knife Radiosurgerymentioning

confidence: 99%