Single Dose versus Fractionated Stereotactic Radiotherapy for Meningiomas

Lo, Simon S.; Cho, Kwan H.; Hall, Walter A.; Kossow, Ronald J.; Hernandez, Wilson L.; McCollow, Kim K.; Gerbi, Bruce J.; Higgins, Patrick D.; Lee, Chung K.; Dusenbery, Kathryn E.

doi:10.1017/s0317167100002018

Cited by 41 publications

(27 citation statements)

References 55 publications

(84 reference statements)

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“…Adjuvant RT for atypical meningiomas has mainly been utilized in the management of residual disease following subtotal resection[9, 21-23]. Given the increased rates of tumor recurrence compared to benign meningiomas, some authors have advocated the use of postoperative RT regardless of EOR to minimize risk of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Predictors of recurrence in the management of chordoid meningioma

et al. 2015

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Introduction Management of chordoid meningiomas (CMs) is complicated by high rates of recurrence, particularly following subtotal resection. Optimal management is not established given the paucity of published experience. To identify prognostic factors for recurrence following resection, the authors conducted the largest systematic review of CMs to date. Methods A comprehensive search on MEDLINE (OVID and Pubmed), Scopus, Embase, and Web of Science utilizing the search terms “chordoid” AND “meningioma” was performed to identify all reports of pathologically confirmed intracranial CMs. Results A total of 221 patients were included, comprising 120 females and 101 males. Mean age, MIB-1/Ki67, and tumor size was 45.5 years, 4.3% (range:0.1-26.6%), and 4.1 cm (range: 0.8-10 cm), respectively. 5-, and 10- year progression free survival (PFS) was 67.5%, and 54.4%, respectively. Gross total resection (GTR) and subtotal resection (STR) was achieved in 172 and 48 patients, respectively. Adjuvant radiotherapy (RT) was given to 30 patients. Multivariate analysis found GTR was strongly correlated with decreased recurrence rates (HR 0.04, p =<0.0001), while higher MIB-1 labeling index (≥5% vs <5%) was associated with increased recurrence (HR 7.08; p=0.016). Adjuvant RT, age, gender, and tumor location were not associated with recurrence. Conclusion GTR resection is the strongest predictor of tumor control, and should be the goal to minimize local progression. Additionally, higher MIB-1 labeling was associated with increased rates of tumor recurrence. Tumors that are subtotally resected or demonstrate higher MIB-1 are at greater recurrence and warrant consideration for RT and close long term follow up.

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Section: Discussionmentioning

confidence: 99%

Predictors of recurrence in the management of chordoid meningioma

et al. 2015

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“…34 Recent advances in the use of both photon and proton radiation techniques, intensity-modulated radiation therapy (IMRT), or image-guided radiation therapy (IGRT) have demonstrated no substantive improvement in tumor con- trol or any reduction in complications in the management of meningiomas. 29,33,34,57,59,60 …”

Section: Resection and Radiation Therapymentioning

confidence: 99%

Gamma Knife radiosurgery for sellar and parasellar meningiomas: a multicenter study

Sheehan

Starke

Kano

et al. 2014

JNS

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Object Parasellar and sellar meningiomas are challenging tumors owing in part to their proximity to important neurovascular and endocrine structures. Complete resection can be associated with significant morbidity, and incomplete resections are common. In this study, the authors evaluated the outcomes of parasellar and sellar meningiomas managed with Gamma Knife radiosurgery (GKRS) both as an adjunct to microsurgical removal or conventional radiation therapy and as a primary treatment modality. Methods A multicenter study of patients with benign sellar and parasellar meningiomas was conducted through the North American Gamma Knife Consortium. For the period spanning 1988 to 2011 at 10 centers, the authors identified all patients with sellar and/or parasellar meningiomas treated with GKRS. Patients were also required to have a minimum of 6 months of imaging and clinical follow-up after GKRS. Factors predictive of new neurological deficits following GKRS were assessed via univariate and multivariate analyses. Kaplan-Meier analysis and Cox multivariate regression analysis were used to assess factors predictive of tumor progression. Results The authors identified 763 patients with sellar and/or parasellar meningiomas treated with GKRS. Patients were assessed clinically and with neuroimaging at routine intervals following GKRS. There were 567 females (74.3%) and 196 males (25.7%) with a median age of 56 years (range 8–90 years). Three hundred fifty-five patients (50.7%) had undergone at least one resection before GKRS, and 3.8% had undergone prior radiation therapy. The median follow-up after GKRS was 66.7 months (range 6–216 months). At the last follow-up, tumor volumes remained stable or decreased in 90.2% of patients. Actuarial progression-free survival rates at 3, 5, 8, and 10 years were 98%, 95%, 88%, and 82%, respectively. More than one prior surgery, prior radiation therapy, or a tumor margin dose < 13 Gy significantly increased the likelihood of tumor progression after GKRS. At the last clinical follow-up, 86.2% of patients demonstrated no change or improvement in their neurological condition, whereas 13.8% of patients experienced symptom progression. New or worsening cranial nerve deficits were seen in 9.6% of patients, with cranial nerve (CN) V being the most adversely affected nerve. Functional improvements in CNs, especially in CNs V and VI, were observed in 34% of patients with preexisting deficits. New or worsened endocrinopathies were demonstrated in 1.6% of patients; hypothyroidism was the most frequent deficiency. Unfavorable outcome with tumor growth and accompanying neurological decline was statistically more likely in patients with larger tumor volumes (p = 0.022) and more than 1 prior surgery (p = 0.021). Conclusions Gamma Knife radiosurgery provides a high rate of tumor control for patients with parasellar or sellar meningiomas, and tumor control is accompanied by neurological preservation or improvement in most patients.

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“…The results of several studies directly comparing the outcomes of FSRT and SRS suggest that both are safe and fairly effective techniques in the treatment of skull base meningiomas, affording comparable satisfactory long-term tumor control. 38,43,44,68 Local tumor control rates with FSRT and SRS were reported to be 93%-97% and 90%-94%, respectively. 38,43,68 The rates of permanent morbidity were also similar-between 0% and 2.6% for both FSRT and SRS.…”

Section: Fractionated Radiation Therapymentioning

confidence: 99%