Stereotactic radiosurgery for benign meningiomas
ABSTRACT Meningiomas are the second most common primary tumor of the brain. Surgical resection is the preferred treatment for easily accessible tumors that can be safely removed. However, many tumors arise deep within the skull base making complete surgical resection difficult or impossible. Stereotactic radiosurgery is a highly effective alternative to surgical resection that has been used as a primary therapy for benign meningiomas as well as an adjuvant treatment for residual or recurrent tumors. The 5-year tumor control rates for stereotactic radiosurgery are equivalent to gross-total resection with lower morbidity than surgery, especially for skull base lesions. Additionally, adjuvant treatment of subtotally resected tumors results in tumor control rates equivalent to gross-total resection. Stereotactic radiosurgery has been used extensively for the treatment of small and medium sized skull base meningiomas. This technique has also been applied to large meningiomas and superficial tumors such as convexity and parasagittal meningiomas. However, multiple studies demonstrate that tumor control is decreased for superficial lesions and with increasing tumor size. In addition, radiation toxicity increases with increasing tumor size and superficial location. Based on a thorough review of the literature, stereotactic radiosurgery should be considered the primary treatment for skull base meningiomas with high surgical risk and in cases of superficial meningiomas where surgery is contraindicated.
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ABSTRACT: While most meningiomas are benign, aggressive meningiomas are associated with high levels of recurrence and mortality. A single institution's Gamma Knife radiosurgical experience with atypical and malignant meningiomas is presented, stratified by the most recent WHO classification. Thirty-one patients with atypical and 4 patients with malignant meningiomas treated with Gamma Knife radiosurgery between July 2000 and July 2011 were retrospectively reviewed. All patients underwent prior surgical resection. Overall survival was the primary endpoint and rate of disease recurrence in the brain was a secondary endpoint. Patients who had previous radiotherapy or prior surgical resection were included. Kaplan-Meier and Cox proportional hazards models were used to estimate survival and identify factors predictive of recurrence and survival. Post-Gamma Knife recurrence was identified in 11 patients (31.4%) with a median overall survival of 36 months and progression-free survival of 25.8 months. Nine patients (25.7%) had died. Three-year overall survival (OS) and progression-free survival (PFS) rates were 78.0% and 65.0%, respectively. WHO grade II 3-year OS and PFS were 83.4% and 70.1%, while WHO grade III 3-year OS and PFS were 33.3% and 0%. Recurrence rate was significantly higher in patients with a prior history of benign meningioma, nuclear atypia, high mitotic rate, spontaneous necrosis, and WHO grade III diagnosis on univariate analysis; only WHO grade III diagnosis was significant on multivariate analysis. Overall survival was adversely affected in patients with WHO grade III diagnosis, prior history of benign meningioma, prior fractionated radiotherapy, larger tumor volume, and higher isocenter number on univariate analysis; WHO grade III diagnosis and larger treated tumor volume were significant on multivariate analysis. Atypical and anaplastic meningiomas remain difficult tumors to treat. WHO grade III diagnosis and treated tumor volume were significantly predictive of recurrence and survival on multivariate analysis in aggressive meningioma patients treated with radiosurgery. Larger tumor size predicts poor survival, while nuclear atypia, necrosis, and increased mitotic rate are risk factors for recurrence. Clinical and pathologic predictors may help identify patients that are at higher risk for recurrence.Radiation Oncology 01/2014; 9(1):38. DOI:10.1186/1748-717X-9-38 · 2.36 Impact FactorThis article is viewable in ResearchGate's enriched formatRG Format enables you to read in context with side-by-side figures, citations, and feedback from experts in your field.
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ABSTRACT: Objectif de l’étude L’objectif de l’étude était d’analyser la faisabilité, l’innocuité et l’efficacité à long terme de la radiothérapie stéréotaxique fractionnée de méningiomes de la base du crâne. Nous avons évalué les résultats à long terme et identifié les facteurs pronostiques. Patients et méthodes Entre octobre 1995 et mars 2009, 136 patients d’âge médian 57 ans ont été traités par irradiation stéréotaxique fractionnée pour un méningiome de la base du crâne. Trente-quatre patients étaient atteints d’un méningiome de grade I, tandis que pour les 102 autres patients l’histologie n’était pas disponible (grade 0). Sur ces 136 patients, l’irradiation était de première intention pour 57 et elle était postopératoire pour 79. Les patients ont reçu une dose totale moyenne de 56,95 Gy (32,4 Gy–63 Gy). Résultats Le suivi médian était de 44,9 mois. La probabilité de survie sans progression était de 96,9 % à 3 ans, 93,8 % à 5 ans et 91,5 % à 10 ans. Elle était en cas d’histologie indisponible, respectivement de 100 %, 98,7 %, et 93,5 % et en cas de méningiome de grade I, prouvé par biopsie, de 100 %, 91,7 % et 85,9 %. Si la radiothérapie était adjuvante, elle était significativement inférieure (p = 0,043), et elle était indépendante de la taille de la tumeur. Les symptômes aigus de grade I les plus courants étaient des céphalées, la fatigue, et l’alopécie locale, les symptômes chroniques de grade I les plus courants la fatigue et des céphalées. Conclusion Cette grande étude montre que la radiothérapie stéréotaxique fractionnée est un traitement efficace et sans danger pour les méningiomes de la base du crâne, avec des probabilités élevées de survie sans progression. De plus, nous avons mis en évidence que la chirurgie associée à la radiothérapie représente un facteur pronostique défavorable.Cancer/Radiothérapie 10/2014; DOI:10.1016/j.canrad.2014.07.159 · 1.11 Impact Factor
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ABSTRACT: Stereotactic radiosurgery (SRS) is often used as adjuvant treatment for residual or recurrent tumor following microsurgical resection of posterior fossa meningiomas. SRS is associated with excellent rates of local control, however long-term complications remain unclear. Secondary malignancy is an often discussed but rarely described complication of SRS. We present a 56-year-old woman who underwent near total resection of a petroclival meningioma, followed by two episodes of SRS over the ensuing 8years for local recurrence. She returned 14years after initial diagnosis with neurologic deterioration and was found to have massive recurrence. Pathology was consistent with high-grade chondrosarcoma. The tumor continued to progress despite debulking and proton-beam therapy and the patient died of medical complications. To our knowledge this is the first report of malignant transformation of a meningioma to high-grade chondrosarcoma, further notable due to the remarkable clinical course and delayed presentation after initial surgery and radiosurgery. Though this may have been a de novo tumor, it is also possible that this represents a case of radiation-induced neoplasm. Although SRS continues to gain favor as a treatment modality, delayed malignant degeneration is a potential complication and physicians should counsel patients of this risk.Journal of Clinical Neuroscience 12/2013; 21(7). DOI:10.1016/j.jocn.2013.11.015 · 1.32 Impact Factor