Radiation-Induced Edema After Single-Fraction or Multifraction Stereotactic Radiosurgery for Meningioma: A Critical Review

Milano, Michael T.; Sharma, M. L.; Soltys, Scott G.; Sahgal, Arjun; Usuki, K.Y.; Saenz, Jon-Michael; Grimm, Jimm; Naqa, Issam El

doi:10.1016/j.ijrobp.2018.03.026

Cited by 39 publications

(26 citation statements)

References 45 publications

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“…Sheehan et al 38 reported on 212 patients who underwent GKRS for parasagittal and parafalcine meningiomas, of whom 11 patients (5.2%) had new or worsening peritumoral edema during a median follow-up period of 19.6 months (range 6-158 months). In a multicenter study, Milano et al 26 analyzed the follow-up data of SRS on the treatment of non-skull base meningiomas and indicated that the incidence of peritumoral edema ranged from 5% to 43% within 3-9 months following SRS. The results of these reports support the consensus that GKRS is a safe and effective treatment choice for intracranial benign meningiomas due to its low morbidity and mortality rates.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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“…Stereotactic radiosurgery for the treatment of brain metastases can lead to higher local control rates and lower radiation doses to surrounding normal brain tissue, which plays an important role in the treatment of brain metastases. However, for patients with obvious cerebral edema, stereotactic radiosurgery may induce or aggravate cerebral edema, which cause poor tolerance to this treatment. Hence, it is necessary to pretreat edema before treatment with stereotactic radiosurgery (SRS).…”

Section: Introductionmentioning

confidence: 99%

Stereotactic radiosurgery combined with anlotinib for limited brain metastases with perilesional edema in non‐small cell lung cancer: Rvision‐001 study protocol

Wang

Guan

et al. 2020

Thoracic Cancer

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Introduction: About 50% of patients with non-small cell lung cancers (NSCLC) are diagnosed with brain metastases during treatment, and stereotactic radiosurgery (SRS) is an important treatment for brain oligometastasis. Some patients with brain metastases have cerebral edema before treatment, and radiation therapy may also cause, or aggravate brain edema. Vascular endothelial growth factor (VEGF) promotes angiogenesis and increase vascular permeability, and previous studies have shown that anti-VEGF treatment can reduce brain edema. We hypothesized that anlotinib hydrochloride can reduce perilesional edema around brain metastases, create conditions for subsequent SRS, increase local control rate and improve patient prognosis. Methods: From one week before stereotactic radiosurgery, patients begin to receive anlotinib once a day (12 mg) from day 1-14 of a 21 day cycle, with two cycles in total. Brain magnetic resonance imaging (MRI) scan is taken before treatment, one week and one month after medication. A total of 50 patients will be included in this study. The primary endpoint is the Edema Index, and the secondary endpoints are intracranial objective response rate (iORR), intracranial progression-free survival (iPFS), objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), safety, and the rate of SRS after anlotinib treatment. Discussion: This study is a multicenter, prospective, single-arm, phase II clinical study, and explores the efficacy and tolerability of SRS with anlotinib in NSCLC patients with limited brain metastases. The aim of the study is to provide new treatment options for NSCLC patients with brain metastases.

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“…Fifth, several previously reported risk factors for PTBE after radiosurgery for meningioma were not included for the study. These include adjacency to vein or sinus, tight vs smooth brain-tumor interface, plasma levels of vascular endothelial growth factor, or a few others [5]. Lastly, the small number of cases may have reduced the statistical power and validation.…”

Section: Fig 2 Comparisons Of Age Mean Frontal Skull Hu Value Gtv mentioning

confidence: 99%

“…Previously, several risk factors associated with peritumoral brain edema (PTBE) after radiosurgery in meningioma were reported. These include greater radiation dose, greater tumor size or volume, tumor location, brain-tumor interface, no prior resection for meningioma, and presence of pretreatment edema [5]. Disruption of the tumor-brain barrier in meningioma plays a critical role in the development of PTBE [6].…”

Section: Introductionmentioning

confidence: 99%

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Significance of skull osteoporosis to the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma

et al. 2020

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Background and purposeDisruption of the tumor-brain barrier in meningioma plays a critical role in the development of peritumoral brain edema (PTBE). We hypothesized that osteoporotic conditions may be associated with PTBE occurrence after radiation in patients with intracranial meningioma. OPEN ACCESS Citation: Lee R-H, Kim JM, Cheong JH, Ryu JI, Kim YS, Han M-H (2020) Significance of skull osteoporosis to the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma. PLoS ONE 15(2): e0226312. https://doi.org/10.

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Radiation-Induced Edema After Single-Fraction or Multifraction Stereotactic Radiosurgery for Meningioma: A Critical Review

Cited by 39 publications

References 45 publications

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

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

Stereotactic radiosurgery combined with anlotinib for limited brain metastases with perilesional edema in non‐small cell lung cancer: Rvision‐001 study protocol

Significance of skull osteoporosis to the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma

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