Stereotactic Radiotherapy of Meningiomas

Philipps University of Marburg, Marburg, Hesse, Germany
Strahlentherapie und Onkologie (Impact Factor: 2.91). 08/2006; 182(7):382-8. DOI: 10.1007/s00066-006-1535-7
Source: PubMed


Stereotactic radiosurgery (SRS) is well established in the treatment of skull base meningiomas, but this therapy approach is limited to small tumors only. The fractionated stereotactic radiotherapy (SRT) offers an alternative treatment option. This study aims at local control, symptomatology, and toxicity.
Between 1997-2003, 224 patients were treated with SRT (n = 183), hypofractionated SRT (n = 30), and SRS (n = 11). 95/224 were treated with SRT/SRS alone. 129/224 patients underwent previous operations. Freedom from progression and overall survival, toxicity, and symptomatology were evaluated systematically. Additionally, tumor volume (TV) shrinkage was analyzed three-dimensionally within the planning system.
The median follow-up was 36 months (range, 12-100 months). Overall survival and freedom from progression for 5 years were 92.9% and 96.9%. Quantitative TV reduction was 26.2% and 30.3% 12 and 18 months after SRT/SRS (p < 0.0001). 95.9% of the patients improved their symptoms or were stable. Clinically significant acute toxicity (CTC III degrees ) was rarely seen (2.5%). Clinically significant late morbidity (III degrees -IV degrees ) or new cranial nerve palsies did not occur.
SRT offers an additional treatment option of high efficacy with only few side effects. In the case of large tumor size (> 4 ml) and adjacent critical structures (< 2 mm), SRT is highly recommended.

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    • "The 5 year tumor control rate of 88.4 % for the anterior skull base meningiomas did not differ significantly from that of other FSRT series reporting a tumor control rate of 88–98 % [14, 16, 30, 32, 35, 36] and the 5 year tumor control rate for the pituitary adenomas of 98.2 %, compared favorably with the rates of 93–99 % reported in other FSRT series [21–24, 27]. Furthermore, although tumors close to the visual pathways treated with FSRT tend to be larger, our 5 syear tumor control rates seem to be comparable even with those reported for large LINAC-SRS [10–12, 37] or GK-SRS series [7, 38, 39]. "
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    ABSTRACT: To determine visual outcome including the occurrence of radiation induced optic neuropathy (RION) as well as tumor control after fractionated stereotactic radiation therapy (FSRT) of benign anterior skull base meningiomas or pituitary adenomas. Thirty-nine patients treated with FSRT for anterior skull base meningiomas and 55 patients treated with FSRT for pituitary adenomas between January 1999 and December 2009 with at least 2 years follow-up were included. Patients were followed up prospectively with magnetic resonance imaging scans, visual acuity and visual field examinations. RION was found in four (10 %) patients with anterior skull base meningiomas and seven patients (13 %) with pituitary adenomas. The five-year actuarial freedom from 25 % RION visual field loss was 94 % following FSRT. Actuarial 2-, 5- and 10-year tumor control rates were 100, 88.4 and 64.5 % for anterior skull base meningiomas and 100, 98.2 and 94.9 % for pituitary adenomas, respectively. Patients with an impaired visual field function pre-FSRT were more likely to experience worsened function (p = 0.016). We found that RION, was a relatively uncommon event, in a large prospective cohort of patients that were systematically monitored following FSRT of benign anterior skull base tumors. Long term tumor control was favorable, especially for pituitary adenomas.
    Full-text · Article · Feb 2014 · Journal of Neuro-Oncology
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    • "Stereotactic radiotherapy and radiosurgery (SRS) is well established for the treatment of brain tumors [5, 13, 15]. Given the ability to perform stereotactic radiosurgery and fractionated stereotactic treatment with the Novalis™ system (Brain-LAB AG, Heimstetten, Germany), we decided to translate the technique into body stereotactic treatment. "
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    ABSTRACT: To evaluate the feasibility, efficacy, and side effects of dose escalation in hypofractionated stereotactic radiotherapy (hfSRT) for intrapulmonary tumors with the Novalis system (BrainLAB AG, Heimstetten, Germany). From 07/2003 to 01/2005, 21 patients/39 tumors were treated with 5 x 7 Gy (n = 21; total dose 35 Gy) or 5 x 8 Gy (n = 18; total dose 40 Gy). There were three cases of primary lung cancer, the remainder were metastases. Median gross tumor volume (GTV) and planning target volume (PTV) were 2.89 cm(3) (range, 0.15-67.94 cm(3)) and 25.75 cm(3) (range, 7.18-124.04 cm(3)), respectively. Rates of complete remission, partial remission, no change, and progressive disease were 51%, 33%, 3%, and 13%, respectively. No grade 4 toxicity occurred, nearly all patients had grade 1 initially. One grade 3 toxicity, i.e., dyspnea, was documented for a period of 6 months after therapy. Radiosurgery quality assurance guidelines could be met. hfSRT of primary and secondary lung tumors using a schedule of five fractions at 7-8 Gy each was well tolerated. Further dose escalation is planned.
    Full-text · Article · Jan 2007 · Strahlentherapie und Onkologie
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