Long-Term Results of Gamma Knife Radiosurgery for Intracranial Meningioma

Jang, Chang Ki; Jung, Hyun Ho; Chang, Jong Hee; Chang, Jin Woo; Park, Yong Gou; Chang, Won Seok

doi:10.14791/btrt.2015.3.2.103

Cited by 23 publications

(22 citation statements)

References 24 publications

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“…The large study from the Hospital Na Homolce in Prague published by Kollova and colleagues had demonstrated peri-lesional oedema after radiosurgery in 15.4% and temporary and permanent morbidity rates of 10.2% and 5.7%, respectively [28]. Virtually the same rate for the risk of oedema (15%) was recently reported in large series by Jang (15%) [23] or by Hoe (15.3%) [18].…”

Section: Adverse Radiation Effectsmentioning

confidence: 64%

“…The Gamma Knife was the first available technology for stereotactic neuro-radiosurgery [ 12 ] with its 3D precision for the delivery of radiation still being unsurpassed. Gamma Knife radiosurgery (GKRS) of meningioma is highly effective with 5-year actuarial tumour control rates (or 5-year actuarial progression-free survival) ranging between 87 and 98.5% in 36 Gamma Knife radiosurgery (GKRS) of meningioma is highly effective with tumour control rates ranging between 70 and 98.5% in 39 Gamma Knife series comprising a total of 12,431 patients published between 2000 and December 2018 [ 2 , 4 , 5 , 7 , 9 – 11 , 13 , 14 , 16 – 21 , 23 , 25 , 26 , 28 , 30 , 31 , 34 – 36 , 38 , 44 – 46 , 48 , 49 , 51 , 52 , 54 , 56 – 59 , 61 ] (Table 1 ). Since meningiomas are slowly growing tumours, it is paramount to validate these results in a long-term perspective.…”

Section: Introductionmentioning

confidence: 99%

“… 66.7 8.8 cc (mean) (0.05–54.8) 13 Gy (5–30 Gy) 763 Sellar and parasellar Gande et al [ 11 ] J Neurooncol , 2014 95% (10-year progression-free tumour control rates) 65 8.5 cc (0.6–56.1) 13 Gy (10–20 Gy) 41 Olfactory groove Park et al [ 45 ] J Neurosurg , 2014 95% (5-year progression-free survival) 40 (mean) 3.0 cc (0.3–17.1) 13 Gy (11–16 Gy) 74 Cerebello-pontine angle Ding et al [ 7 ] Neurosurgery , 2014 95% (overall tumour control rate) 94.7% (overall 5-year progress.-free surv.) 47 3.6 cc 13 Gy 177 Cerebello-pontine angle Jang et al [ 23 ] Brain Tumor Res Treat , 2015 94.7% (actuarial 5-year progress.-free surv.) 37 .…”

Section: Introductionmentioning

confidence: 99%

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Ten-year follow-up after Gamma Knife radiosurgery of meningioma and review of the literature

2020

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Objectives With regard to the generally slow growth of meningioma, it is essential to analyse clinical treatment results in a longterm perspective. The purpose of the present analysis is to provide clinical data after Gamma Knife radiosurgery of meningioma in a 10-year perspective together with a review of the current literature. Methods The current study is a retrospective analysis of 86 consecutive Swedish patients with meningiomas treated using Gamma Knife radiosurgery at the Karolinska Hospital Stockholm between March 1991 and May 2001. A total of 130 tumours were treated in 115 treatment sessions. The median radiological follow-up was 10 years (1.8-16.5 years), and the median clinical follow-up was 9.4 years (2.1-17.4 years). Results After a median follow-up period of 10 years, local tumour control was achieved in 87.8% of meningiomas (108/123 tumours). The median latency between initial treatment and local (in-field) recurrence (n = 15) was 5.8 years (1.9-11.5). Recurrences adjacent but outside the initial radiation field occurred in 15.1% of patients (13/86) at a median of 7.5 years (1.3-15.7). New meningiomas were seen in 10.5% after a median of 5.4 years (0.9-10.8). In 72% of patients, no further treatment was required, 17.4% (15/86) underwent a second Gamma Knife treatment, 4.7% (4/86) required later open surgery and 5.8% (5/86) required both secondary treatments. Eightysix percent of patients were neurologically unchanged or improved. A significantly lower rate of local (in-field) recurrences was seen in meningiomas treated with a prescription dose of > 13.4 Gy (7.1% vs. 24%, p = 0.02). Conclusions The current retrospective analysis provides a 10-year follow-up and comprises one of the longest available followup studies of radiosurgically treated meningiomas. The current series documents a persistent high local tumour control after Gamma Knife treatment, while providing an estimation of a necessary minimum dose for long-term tumour control in meningiomas. The study confirms the validity of previous short-term data in a long-term perspective.

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Section: Adverse Radiation Effectsmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ten-year follow-up after Gamma Knife radiosurgery of meningioma and review of the literature

2020

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“…For the predictors of tumor recurrence or progression, some studies revealed that increasing tumor volume was an independent predictor, which was also proved in our study. 10,16,29 In this study, many patients with intracranial meningiomas had low subjective acceptance of craniotomy; even though there were significant mass effect or neurological symptoms or signs, they preferred GKRS instead of craniotomy, which resulted in a high rate of large tumor (≥ 10 cm 3 ) in proportion at the time of GKRS, and reduced the treatment effect of GKRS in the cohort. In addition, a GKRS dose-plan defect may also influence local tumor control.…”

Section: Discussionmentioning

confidence: 77%

Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients

Ge¹,

Liu²,

Zhang³

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe authors retrospectively analyzed the follow-up data in 130 patients with intracranial benign meningiomas after Gamma Knife radiosurgery (GKRS), evaluated the tumor progression-free survival (PFS) rate and neurological function preservation rate, and determined the predictors by univariate and multivariate survival analysis.METHODSThis cohort of 130 patients with intracranial benign meningiomas underwent GKRS between May 2012 and May 2015 at the Second Hospital of Tianjin Medical University. The median age was 54.5 years (range 25–81 years), and women outnumbered men at a ratio of 4.65:1. All clinical and radiological data were obtained for analysis. No patient had undergone prior traditional radiotherapy or chemotherapy. The median tumor volume was 3.68 cm3 (range 0.23–45.78 cm3). A median margin dose of 12.0 Gy (range 10.0–16.0 Gy) was delivered to the tumor with a median isodose line of 50% (range 50%–60%).RESULTSDuring a median follow-up of 36.5 months (range 12–80 months), tumor volume regressed in 37 patients (28.5%), was unchanged in 86 patients (66.2%), and increased in 7 patients (5.4%). The actuarial tumor progression-free survival (PFS) rate was 98%, 94%, and 87% at 1, 3, and 5 years, respectively, after GKRS. Tumor recurred in 7 patients at a median follow-up of 32 months (range 12–56 months). Tumor volume ≥ 10 cm3 (p = 0.012, hazard ratio [HR] 8.25, 95% CI 1.60–42.65) and pre-GKRS Karnofsky Performance Scale score < 90 (p = 0.006, HR 9.31, 95% CI 1.88–46.22) were independent unfavorable predictors of PFS rate after GKRS. Of the 130 patients, 101 (77.7%) presented with one or more neurological symptoms or signs before GKRS. Neurological symptoms or signs improved in 40 (30.8%) patients, remained stable in 83 (63.8%), and deteriorated in 7 (5.4%) after GKRS. Two (1.5%) patients developed new cranial nerve (CN) deficit. Tumor volume ≥ 10 cm3 (p = 0.042, HR = 4.73, 95% CI 1.06–21.17) and pre-GKRS CN deficit (p = 0.045, HR = 4.35, 95% CI 0.84–22.48) were independent unfavorable predictors for improvement in neurological symptoms or signs. Six (4.6%) patients developed new or worsening peritumoral edema with a median follow-up of 4.5 months (range 2–7 months).CONCLUSIONSGKRS provided good local tumor control and high neurological function preservation in patients with intracranial benign meningiomas. Patients with tumor volume < 10 cm3, pre-GKRS Karnofsky Performance Scale score ≥ 90, and no pre-GKRS CN deficit (I–VIII) can benefit from stereotactic radiosurgery. It can be considered as the primary or adjuvant management of intracranial benign meningiomas.

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“…Otherwise, rates of local control for grade II meningioma range from 41.7% to 95% following photon-based SRS. 8,14,34 Survival rates are especially poor for grade III meningioma treated with photon therapy, ranging from 40% to 44% at 5 years. 49,66 Local control (72%-82.6%) and freedom from recurrence have been favorable but variable for atypical meningioma treated with any form of radiation therapy.…”

Section: Prognostic Factors For Local Tumor Control and Overall Survivalmentioning

confidence: 99%

Efficacy and toxicity of particle radiotherapy in WHO grade II and grade III meningiomas: a systematic review

Jin

Meola

et al. 2019

Neurosurgical Focus

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OBJECTIVEAdjuvant radiotherapy has become a common addition to the management of high-grade meningiomas, as immediate treatment with radiation following resection has been associated with significantly improved outcomes. Recent investigations into particle therapy have expanded into the management of high-risk meningiomas. Here, the authors systematically review studies on the efficacy and utility of particle-based radiotherapy in the management of high-grade meningioma.METHODSA literature search was developed by first defining the population, intervention, comparison, outcomes, and study design (PICOS). A search strategy was designed for each of three electronic databases: PubMed, Embase, and Scopus. Data extraction was conducted in accordance with the PRISMA guidelines. Outcomes of interest included local disease control, overall survival, and toxicity, which were compared with historical data on photon-based therapies.RESULTSEleven retrospective studies including 240 patients with atypical (WHO grade II) and anaplastic (WHO grade III) meningioma undergoing particle radiation therapy were identified. Five of the 11 studies included in this systematic review focused specifically on WHO grade II and III meningiomas; the others also included WHO grade I meningioma. Across all of the studies, the median follow-up ranged from 6 to 145 months. Local control rates for high-grade meningiomas ranged from 46.7% to 86% by the last follow-up or at 5 years. Overall survival rates ranged from 0% to 100% with better prognoses for atypical than for malignant meningiomas. Radiation necrosis was the most common adverse effect of treatment, occurring in 3.9% of specified cases.CONCLUSIONSDespite the lack of randomized prospective trials, this review of existing retrospective studies suggests that particle therapy, whether an adjuvant or a stand-alone treatment, confers survival benefit with a relatively low risk for severe treatment-derived toxicity compared to standard photon-based therapy. However, additional controlled studies are needed.

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Long-Term Results of Gamma Knife Radiosurgery for Intracranial Meningioma

Cited by 23 publications

References 24 publications

Ten-year follow-up after Gamma Knife radiosurgery of meningioma and review of the literature

Ten-year follow-up after Gamma Knife radiosurgery of meningioma and review of the literature

Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients

Efficacy and toxicity of particle radiotherapy in WHO grade II and grade III meningiomas: a systematic review

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