Stereotactic Radiosurgery of Central Skull Base Meningiomas—Volumetric Evaluation and Long-Term Outcomes

Patibandla, Mohana Rao; Lee, Cheng-chia; Sheehan, Jason P.

doi:10.1016/j.wneu.2017.08.166

Cited by 26 publications

(24 citation statements)

References 54 publications

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“…The present study provides the outcome data of patients with benign meningiomas treated with stereotactic Gamma Knife radiosurgery with a median radiological follow-up of 10 years (1.8–16.5 years) and a median clinical follow-up of 9.4 years (2.1–17.4 years) and provides evidence for the efficacy of radiosurgery in a long-term perspective. This is among the longest follow-up studies available in the literature of radiosurgically treated meningioma [ 2 , 4 , 5 , 7 , 9 – 11 , 13 , 14 , 16 – 18 , 20 , 21 , 23 , 25 , 26 , 28 , 30 , 31 , 35 , 36 , 38 , 44 , 45 , 48 , 49 , 51 , 52 , 54 , 56 – 59 , 61 ] documenting a local tumor (in-field) control of 87.8%, which is slightly lower than control rates that have been published in other studies with a shorter observation time: in 39 Gamma Knife series comprising a total of 12,431 patients published between 2000 and 2018, the meningioma control rates ranged between 70 and 98.5% [ 2 , 4 , 5 , 7 – 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 ). The analysis of 3768 meningiomas in the European retrospective multicentre me...…”

Section: Discussionmentioning

confidence: 73%

“…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%

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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: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

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

2020

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“…9,15,25 Some recent studies that were focused on the treatment of intracranial meningiomas with radiosurgery reported that the local tumor control rates ranged from 88% to 100%, in which 19%-74% of tumors shrank during a mean follow-up of 36-78 months. 3,7,12,21,22,[30][31][32][33][34]37,[39][40][41] In a single-center study, Hasegawa et al 12 reported an actuarial PFS rate of 92%, 86%, and 72% at 3, 5, and 10 years, respectively, in 67 patients. In a meta-analysis of SRS for skull base meningiomas, Starke et al 41 reviewed the outcome in 469 patients with large skull base meningiomas (> 8 cm) from several centers, and reported that the actuarial tumor PFS rates at 3, 5, and 10 years were 90.3%, 88.6%, and 77.2%, respectively.…”

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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“…Radiation treatment alone may be offered if imaging is typical and surgery not feasible. Fractioned and hypofractioned stereotactic radiotherapy and radiosurgery, single or multiple doses, have all proved beneficial to patients with a high tumor control rate varying from 85 to 100% at 5 years [49,50]. Those results, alongside with radiation-induced toxicity, make these treatments particularly relevant for intractable tumors <3 cm.…”

Section: Radiation Therapy As a First-line Treatmentmentioning

confidence: 99%

Current treatment options for meningioma

Apra

Peyre

Kalamaridès

2018

Expert Review of Neurotherapeutics

160

125

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With an annual incidence of 5/100,000, meningioma is the most frequent primary tumor of the central nervous system. Risk factors are radiotherapy and hormone intake. Most meningiomas are grade I benign tumors, but up to 15% are atypical and 2% anaplastic according to the WHO 2016 histological criteria. Areas covered: This review details the current standard therapy based on international guidelines and recent literature, and describes new approaches developed to treat refractory cases. First-line treatments are observation and surgery, but adjuvant radiotherapy/radiosurgery is discussed for atypical and indicated for anaplastic meningiomas. The most problematic cases include skull base meningiomas that enclose vasculo-nervous structures and surgery- and radiation-refractory tumors that present with significant morbidity and mortality. The treatment of recurrent tumors is based on radiotherapy and repeated surgery. Systematic therapies are not effective in general but several clinical trials are ongoing. Expert commentary: Molecular characterization of the tumors, based on genetic mutations such as NF2, SMO, TERT, TRAF7, and on the methylation profile are developing, completing the histological classification and giving new insights into prognosis and treatment options.

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Stereotactic Radiosurgery of Central Skull Base Meningiomas—Volumetric Evaluation and Long-Term Outcomes

Cited by 26 publications

References 54 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

Current treatment options for meningioma

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