Long-term Tumor Control of Benign Intracranial Meningiomas After Radiosurgery in a Series of 4565 Patients

Santacroce, Antonio; Walier, Maja; Régis, Jean; Liščák, Roman; Motti, Enrico; Lindquist, Christer; Kemeny, Andras; Kitz, K.; Lippitz, Bodo; Álvarez, Roberto Martínez; Pedersen, Paal‐Henning; Yomo, Shoji; Lupidi, Francesco; Dominikus, Karlheinz; Blackburn, Philip; Mindermann, Thomas; Bundschuh, Otto; Eck, Albertus T C J van; Fimmers, Rolf; Horstmann, Gerhard A.

doi:10.1227/neu.0b013e31822d408a

Cited by 197 publications

(139 citation statements)

References 33 publications

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“…18,69,70,75 However, it is unclear what role SRS plays in the treatment of AMs. A review of modern literature on SRS suggests that this modality can be effective for biopsy-proven AMs (Table 5).…”

Section: Radiosurgery As An Adjuvant and Salvage Treatmentmentioning

confidence: 99%

An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas

Sun¹,

Hawasli²,

Huang

et al. 2015

FOC

113

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The management of WHO Grade II “atypical” meningiomas (AMs) and Grade III “malignant” meningiomas (MMs) remains controversial and under-investigated in prospective studies. The roles of surgery, radiation therapy, radiosurgery, and chemotherapy have been incompletely delineated. This has left physicians to decipher how they should treat patients on a case-by-case basis. In this study, the authors review the English-language literature on the management and clinical outcomes associated with AMs and MMs diagnosed using the WHO 2000/2007 grading criteria. Twenty-two studies for AMs and 7 studies for MMs were examined in detail. The authors examined clinical decision points using the literature and concepts from evidence-based medicine. Acknowledging the retrospective nature of the studies concerning AM and MM, the authors did find evidence for the following clinical strategies: 1) maximal safe resection of AM and MM; 2) active surveillance after gross-total resection of AM; 3) adjuvant radiation therapy after subtotal resection of AM, especially in the absence of putative radioresistant features; and 4) adjuvant radiation therapy after resection of MM.

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Section: Radiosurgery As An Adjuvant and Salvage Treatmentmentioning

confidence: 99%

An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas

Sun¹,

Hawasli²,

Huang

et al. 2015

FOC

113

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“…Tumor growth was defined as any volumetric or diametric change greater than 10% per year in order to account for possible pseudoprogression and errors in measurement. 11,39 Any variation less than +10% was considered growth stability. Traditional methods for measuring tumor growth are either diametric or volumetric, whereby the tumor's greatest diameter in any given cardinal plane is assessed over time.…”

Section: Analyzed Variablesmentioning

confidence: 99%

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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“…Stereotactic GammaKnife (Elekta) radiosurgery led to control rates of 92.5% in small meningiomas, with permanent morbidity rates of 6.6% (9).…”

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confidence: 99%

⁹⁰Y-DOTATOC as a Therapeutic Option for Complex Recurrent or Progressive Meningiomas

et al. 2015

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The standard treatment of meningiomas is surgery or radiotherapy. Complex, especially recurrent or progressive cases, may exhibit tumor growth involving critical neurovascular structures or diffuse growth, resulting in limited efficacy and higher risk of standard treatment. We evaluated whether somatostatin receptor-targeted radionuclide therapy with 90 Y-DOTATOC may be a therapeutic option. Methods: Fifteen patients with recurrent or progressive meningiomas after multimodal pretreatment or unfavorable medical risk profile were treated with systemic 90 Y-DOTATOC. Endpoints were progression-free survival and toxicity. Results: Usually applied doses were 7,400 MBq/m 2 of 90 Y-DOTATOC in 2 fractions. Mean observation time was 49.7 mo (range, 12-137 mo). Overall median progression-free survival was at least 24 mo. Toxicity was moderate, mostly hematologic (n 5 8) and transient. Conclusion: 90 Y-DOTATOC therapy is feasible and may represent a promising second-or third-line option for complex meningiomas, which are progressive or otherwise not treatable with a reasonable risk-benefit ratio.

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Long-term Tumor Control of Benign Intracranial Meningiomas After Radiosurgery in a Series of 4565 Patients

Abstract: Radiosurgery is a safe and effective method for treating benign meningiomas even in the medium to long term.

Cited by 197 publications

References 33 publications

An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas

An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas

Predictors of response to Gamma Knife radiosurgery for intracranial meningiomas

⁹⁰Y-DOTATOC as a Therapeutic Option for Complex Recurrent or Progressive Meningiomas

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Long-term Tumor Control of Benign Intracranial Meningiomas After Radiosurgery in a Series of 4565 Patients

Abstract: Radiosurgery is a safe and effective method for treating benign meningiomas even in the medium to long term.

Cited by 197 publications

References 33 publications

An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas

An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas

Predictors of response to Gamma Knife radiosurgery for intracranial meningiomas

90Y-DOTATOC as a Therapeutic Option for Complex Recurrent or Progressive Meningiomas

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⁹⁰Y-DOTATOC as a Therapeutic Option for Complex Recurrent or Progressive Meningiomas