Stereotactic radiosurgery for benign meningiomas

Department of Neurological Surgery, University of California San, Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143-0112, USA.
Journal of Neuro-Oncology (Impact Factor: 2.79). 03/2012; 107(1):13-20. DOI: 10.1007/s11060-011-0720-4
Source: PubMed

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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    • "This safety is derived from delivering highly precise radiation using a stereotactic frame with judicious dose selection and image guidance systems [1] [14] [23]. Large data sets have been generated demonstrating the feasibility, safety, and efficacy of stereotactic radiosurgery and fractionated stereotactic radiotherapy for meningioma [2] [4] [6] [10] [18] [22] [24]. These data sets include the use of different machines, typically Gamma Knife or linear accelerators, and different techniques and anatomic locations. "
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