Article

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.

2 Followers
 · 
147 Views
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: For this article a comprehensive and politically legitimate list of criteria to evaluate energy systems was constructed from interviews with leading representatives of a broad spectrum of West German society. In the interviews, we probed the fundamental values of nine political and social organizations, including the Catholic and Lutheran Churches, the Federation of German Labour Unions, the Association of German Industries and the German Nature Society. A hierarchical representation of value criteria was logically structured for each group separately, and then aggregated into a combined ‘value tree’. The result facilitates communication and constructive compromise, promotes the creation of policy options and helps evaluate future energy systems.
    Energy Policy 08/1987; 15(4-15):352-362. DOI:10.1016/0301-4215(87)90025-5 · 2.70 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Stereotactic radiosurgery and fractionated Stereotactic radiotherapy (SR) offer precise localization of radiation dose (Gy) for the treatment of meningioma (M). For the multimodal treatment with preservation of function, SR is complementary to both microsurgery (S) and conventional external beam radiotherapy (XRT). The role of SR in the management of atypical and malignant meningiomas, however, remains unexplored. Fifty consecutive patients with meningioma: 18 males (60.1 +/– 2.3 years) and 32 females (56.9 +/– 2.2 years) (p = NS) received SR. Thirty-one patients had surgery 69.6 +/– 13.9 months (95% CI: 53.3–98.0) prior to SR. For patients having S, the incidence of atypical or malignant versus benign meningiomas (14 versus 17 patients) increased with age (p = 0.03). Twenty patients had XRT approximately 18 months prior to SR. For antecedent XRT, the range of doses was 3600–6400 cGy (median: 5040 cGy). Following failure of S and/or XRT, patients had SR. Compared to other series, the mean tumor volumes for SR were comparatively large: 9.8 +/– 1.3 cm3 (range 0.3–37.1 cm3). The median SR dose was 3500 cGy (range 540–5400 cGy) administered in seven fractions (range 1–30). Linear regression analysis showed a consistent method for fractionation: the number of administered fractions increased (p = 0.053) and the total dose increased (p = 0.054) with tumor size. During the interval for follow–up (17.9 +/– 2.9 months), one patient with malignant meningioma required surgery for progression 8 months after SR. In the remaining patients, post-SR MRIs showed control (unchanged or smaller tumor volume) regardless of histology. These results show that SR may provide control of M regardless of grade.
    Journal of Radiosurgery 11/1999; 2(4):207-213. DOI:10.1023/A:1022984925249
Show more