The Meningioma Controversy: Postoperative radiation therapy

Taylor, Bron; Marcus, Robert B.; Friedman, William A.; Ballinger, Walter F.; Million, Rodney R.

doi:10.1016/s0360-3016(98)90008-6

Cited by 279 publications

(100 citation statements)

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“…Conventional fractionated radiation therapy may be of value for residual meningiomas.1,6,7,11,17,19) Taylor et al 17) reported that the recurrence rate after subtotal resection alone was 69%, which was re duced to 15% by postoperative radiation therapy us ing the single fraction method. Patients who received surgery alone for recurrent meningiomas achieved a local control rate of 30% after 10 years, whereas patients who received additional radiation after re section had a local control rate of 89%.17) Carella et a1.3) and others ', 6,7,11,17,19) also showed that radia tion therapy by the single fraction method has an established role in the treatment of incompletely ex cised, recurrent, or malignant meningiomas, and in some cases, as the initial management of menin giomas.…”

Section: Discussionmentioning

confidence: 99%

Growth Control of Cranial Base Meningiomas by Stereotactic Radiosurgery with a Gamma Knife Unit

Tanaka

Kobayashi

Kida

1996

Neurol. Med. Chir.(Tokyo)

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The effect of gamma knife radiosurgery for cranial base meningiomas was analyzed using magnetic resonance (MR) imaging in 33 patients followed up for a mean 26.5 months. There were 10 male and 23 female patients aged from 38 to 87 years (mean 54.5 yrs). Twenty-three patients had already had more than one open surgery before radiosurgery.The mean tumor volume was 16.8 cm3. The mean maximum dose was 29 Gy and the mean marginal dose was 15.1 Gy. Four patients were treated by two-stage treatment at 1 to 4-month intervals. Follow-up MR imaging revealed a decrease in tumor size in 10 patients, a small low intensity area in the tumor center in three, increase in tumor size in two, and no change in 18. After radiosurgery one patient had marked edema on MR imaging and showed cognitive deficits, and another three patients had neurological deterioration. All other pa tients were unchanged or improved. Growth control of cranial base meningiomas without severe neurological deficits can be achieved by radiosurgery.

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Section: Discussionmentioning

confidence: 99%

Growth Control of Cranial Base Meningiomas by Stereotactic Radiosurgery with a Gamma Knife Unit

Tanaka

Kobayashi

Kida

1996

Neurol. Med. Chir.(Tokyo)

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“…Progression-free survival rates at 5 and 10 years after conventional radiotherapy range from 73% to 92% and 61% to 83%, respectively. 23,25,26,35,40,57 More contemporary techniques such as intensity-modulated radiation therapy and proton therapy offer increased conformality and more sparing of critical structures compared with conventional techniques. 44,58 The lower integral dose and higher conformality that are touted as the advantages of intensity-modulated radiation therapy and proton beam over conventional radiotherapy techniques for meningiomas have been longstanding features of radiosurgery.…”

Section: Radiation Therapymentioning

confidence: 99%

Gamma Knife radiosurgery for posterior fossa meningiomas: a multicenter study

Sheehan

Starke

Kano

et al. 2015

JNS

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abbreviatioNs CI = confidence interval; CN = cranial nerve; CPA = cerebellopontine angle; GKRS = Gamma Knife radiosurgery; HR = hazard ratio; OR = odds ratio; SRS = stereotactic radiosurgery. obJect Posterior fossa meningiomas represent a common yet challenging clinical entity. They are often associated with neurovascular structures and adjacent to the brainstem. Resection can be undertaken for posterior fossa meningiomas, but residual or recurrent tumor is frequent. Stereotactic radiosurgery (SRS) has been used to treat meningiomas, and this study evaluates the outcome of this approach for those located in the posterior fossa.methods At 7 medical centers participating in the North American Gamma Knife Consortium, 675 patients undergoing SRS for a posterior fossa meningioma were identified, and clinical and radiological data were obtained for these cases. Females outnumbered males at a ratio of 3.8 to 1, and the median patient age was 57.6 years (range 12-89 years). Prior resection was performed in 43.3% of the patient sample. The mean tumor volume was 6.5 cm 3 , and a median margin dose of 13.6 Gy (range 8-40 Gy) was delivered to the tumor.results At a mean follow-up of 60.1 months, tumor control was achieved in 91.2% of cases. Actuarial tumor control was 95%, 92%, and 81% at 3, 5, and 10 years after radiosurgery. Factors predictive of tumor progression included age greater than 65 years (hazard ratio [HR] 2.36, 95% CI 1.30-4.29, p = 0.005), prior history of radiotherapy (HR 5.19, 95% CI 1.69-15.94, p = 0.004), and increasing tumor volume (HR 1.05, 95% CI 1.01-1.08, p = 0.005). Clinical stability or improvement was achieved in 92.3% of patients. Increasing tumor volume (odds ratio [OR] 1.06, 95% CI 1.01-1.10, p = 0.009) and clival, petrous, or cerebellopontine angle location as compared with petroclival, tentorial, and foramen magnum location (OR 1.95, 95% CI 1.05-3.65, p = 0.036) were predictive of neurological decline after radiosurgery. After radiosurgery, ventriculoperitoneal shunt placement, resection, and radiation therapy were performed in 1.6%, 3.6%, and 1.5%, respectively.coNclusioNs Stereotactic radiosurgery affords a high rate of tumor control and neurological preservation for patients with posterior fossa meningiomas. Those with a smaller tumor volume and no prior radiation therapy were more likely to have a favorable response after radiosurgery. Rarely, additional procedures may be required for hydrocephalus or tumor progression.

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confidence: 99%

“…[3][4][5][6][7][8][9] Complete surgical excision, if achievable, can produce excellent results without adjunctive therapy. [9][10][11] However, meningiomas may recur after surgery and curative resection can result in significant morbidity because of strategic tumor location and old age. [12][13][14][15] Stereotactic radiosurgery (SRS) can deliver a single high dose of radiation to a localized area in the brain for the treatment of meningiomas that are unresectable, recurrent or residual after surgery.…”

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confidence: 99%

Single Dose versus Fractionated Stereotactic Radiotherapy for Meningiomas

Cho

Hall

et al. 2002

Can. j. neurol. sci.

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240Meningiomas constitute approximately 20% of all primary intracranial tumors.1,2 Tumor grade rather than histologic subtype bears clear prognostic importance. [3][4][5][6][7][8][9] Complete surgical excision, if achievable, can produce excellent results without adjunctive therapy. [9][10][11] However, meningiomas may recur after surgery and curative resection can result in significant morbidity because of strategic tumor location and old age. [12][13][14][15] Stereotactic radiosurgery (SRS) can deliver a single high dose of radiation to a localized area in the brain for the treatment of meningiomas that are unresectable, recurrent or residual after surgery. However, large tumors and tumors adjacent to vital ABSTRACT: Objective: To evaluate the safety and efficacy of stereotactic radiosurgery (SRS) compared to fractionated stereotactic radiation therapy (FSRT) for meningiomas treated over a seven year period. Methods and materials: Of the 53 patients (15 male and 38 female) with 63 meningiomas, 35 were treated with SRS and the 18 patients with tumors adjacent to critical structures or with large tumors were treated with FSRT. The median doses for the SRS and the FSRT groups were 1400 cGy (500-4500 cGy) and 5400 cGy (4000-6000 cGy) respectively. Median target volumes for SRS and FSRT were 6.8 ml and 8.8 ml respectively. The median follow-up for the SRS and FSRT groups were 38 months (4.1-97 months) and 30.5 months (6.0-63 months) respectively. Results: The five-year tumor control probability (TC) for benign versus atypical meningiomas were 92.7% vs. 31% (P=.006). The three-year TC were 92.7% vs. 93.3% for SRS vs. FSRT groups respectively (P=.62). For benign meningiomas, the three-year TC were 92.9% vs. 92.3% for the SRS group (29 patients) vs. FSRT group (14 patients) respectively (P=.77). Two patients in the SRS group and one in the FSRT group developed late complications. Conclusion: Preliminary data suggest that SRS is a safe and effective treatment for patients with benign meningiomas. Fractionated stereotactic radiation therapy with conventional fractionation appeared to be an effective and safe treatment alternative for patients not appropriate for SRS. A longer follow-up is required to determine the long-term efficacy and the toxicity of these treatment modalities.RÉSUMÉ: Dose unique versus radiothérapie stéréotaxique fractionnée dans le traitement des méningiomes. Objectif: Évaluer la sécurité et l'efficacité de la radiochirurgie stéréotaxique (RCS) comparée à la radiothérapie stétéotaxique fractionnée (RTSF) dans le traitement des méningiomes sur une période de sept ans. Méthodes et matériels: Parmi les 53 patients (15 hommes et 38 femmes) atteints de 63 méningiomes, 35 ont été traités par RCS et 18, dont la tumeur était adjacente à des structures critiques ou était volumineuse, ont été traités par RTSF. Les doses médianes pour le groupe RCS et le groupe RTSF étaient de 1400 cGy (500 à 4500 cGy) et 5400 cGy (4000 à 6000 cGy) respectivement. Les volumes cibles médians pour les groupes RCS et RTSF étaient...

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The Meningioma Controversy: Postoperative radiation therapy

Cited by 279 publications

References 13 publications

Growth Control of Cranial Base Meningiomas by Stereotactic Radiosurgery with a Gamma Knife Unit

Growth Control of Cranial Base Meningiomas by Stereotactic Radiosurgery with a Gamma Knife Unit

Gamma Knife radiosurgery for posterior fossa meningiomas: a multicenter study

Single Dose versus Fractionated Stereotactic Radiotherapy for Meningiomas

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