Does the Timing of Radiosurgery after Grade 1 Meningioma Resection Affect Long-Term Outcomes?

Bowden, Gregory; Mallella, Arka; Wei, Zhishuo; Patel, Kevin P.; Niranjan, Ajay; Lunsford, L. Dade

doi:10.1159/000517427

Cited by 10 publications

(4 citation statements)

References 21 publications

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“…Early surveillance and identification of intracranial disease, as well as The association between outcomes after SRS and the type of primary disease continues to be an area of focused research. Bowden et al 12 found that patients with breast cancer had median survival of 16 months, while those with lung cancer and melanoma had a median survival of 4.6 and 3.1 months, respectively. In patients treated with multiple sessions of SRS for a cumulative number of ≥25 metastases, Benjamin et al 3 reported similar differences survival by the type of cancer.…”

Section: Discussionmentioning

confidence: 99%

Single-Session Gamma Knife Radiosurgery for Patients With 20 or More Brain Metastases

et al. 2023

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BACKGROUND: Stereotactic radiosurgery (SRS) is a widely accepted treatment modality for brain metastases. The role of SRS in patients with higher numbers of metastases remains controversial. OBJECTIVES: To define outcomes in patients with ≥20 brain metastases managed using single-session SRS. METHODS: This single-institution retrospective cohort study studied 75 patients (26 non–small-cell lung cancer, 21 small-cell lung cancer, 14 breast cancer, and 14 melanoma) undergoing single-session SRS. The median number of tumors per patient was 24, and the median cumulative tumor volume was 3.70 cc. The median margin dose prescribed to each individual tumor was 16 Gy. The median integral cranial dose was 5492 mJ. The median beam on time was 160 minutes. Univariate and multivariate analyses were performed with significance set at P < .05. RESULTS: The median overall survival after SRS was 8.8 months (patients with non–small-cell lung cancer), 4.6 months (patients with small-cell lung cancer), 11.3 months (patients with breast cancer), and 4.1 months (patients with melanoma). Primary cancer type, number of brain metastases, and concurrent immunotherapy were significant factors in predicting survival. Local tumor control rate per patient was 97.3% and 94.6% at 6 and 12 months after SRS, respectively. Thirty-six patients underwent additional SRS for new tumor development with a median time after SRS of 5 months. Three patients experienced adverse radiation events. CONCLUSION: Single-session SRS is a well-tolerated palliative treatment option even in patients with ≥20 brain metastases, achieving local control rate >90% with low risks of neurotoxicity while continuing concurrent systemic oncological care.

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Section: Discussionmentioning

confidence: 99%

Single-Session Gamma Knife Radiosurgery for Patients With 20 or More Brain Metastases

et al. 2023

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“…Two strategies are usually proposed: an early treatment of the residue or an initial wait-and-see approach with serial MRI follow-ups with secondary treatment (in this case RRS) reserved only when recurrence is observed. Some studies support the role of an early postoperative radiosurgical treatment in improving PFS compared to a treatment at recurrence (11,(43)(44)(45). Frostell et al (46) published a study in which they confronted adjuvant radiosurgical treatment after subtotal resection of meningiomas involving the SSS.…”

Section: Timing Of Rrsmentioning

confidence: 99%

Meningioma involving the superior sagittal sinus: long-term outcome after robotic radiosurgery in primary and recurrent situation

et al. 2023

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ObjectiveTreatment for meningiomas involving the superior sagittal sinus (SSS) is challenging and proved to be associated with higher risks compared to other brain locations. Therapeutical strategies may be either microsurgical (sub-)total resection or adjuvant radiation, or a combination of both. Thrombosis or SSS occlusion following resection or radiosurgery needs to be further elucidated to assess whether single or combined treatment is superior. We here present tumor control and side effect data of robotic radiosurgery (RRS) in combination with or without microsurgery.MethodsFrom our prospective database, we identified 137 patients with WHO grade I meningioma involving the SSS consecutively treated between 2005 and 2020. Treatment decisions were interdisciplinary. Patients underwent RRS as initial/solitary treatment (group 1), as adjuvant treatment after subtotal resection (group 2), or due to recurrent tumor growth after preceding microsurgery (group 3). Positive tumor response was assessed by MRI and defined as reduction of more than 50% of volume. Study endpoints were time to recurrence (TTR), time to RRS, risk factors for decreased survival, and side effects. Overall and specific recurrence rates for treatment groups were analyzed. Side effect data included therapy-related morbidity during follow-up (FU).ResultsA total of 137 patients (median age, 58.3 years) with SSS meningiomas WHO grade I were analyzed: 51 patients (37.2%) in group 1, 15 patients (11.0%) in group 2, and 71 patients (51.8%) in group 3. Positive MR (morphological response) to therapy was achieved in 50 patients (36.4%), no response was observed in 25 patients (18.2%), and radiological tumor progression was detected in 8 patients (5.8%). Overall 5-year probability of tumor recurrence was 15.8% (median TTR, 41.6 months). Five-year probabilities of recurrence were 0%, 8.3.%, and 21.5% for groups 1–3 (p = 0.06). In multivariate analysis, tumor volume was significantly associated with extent of SSS occlusion (p = 0.026) and sex (p = 0.011). Tumor volume significantly correlated with TTR (p = 0.0046). Acute sinus venous thrombosis or venous congestion-associated bleedings did not occur in any of the groups.ConclusionRRS for grade I meningiomas with SSS involvement represents a good option as first-line treatment, occasionally also in recurrent and adjuvant scenarios as part of a multimodal treatment strategy.

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“…The details of Gamma Knife SRS procedures have been documented in previous publications. 7 To summarize, a Leksell stereotactic head frame was attached to the patient's head using mild conscious intravenous sedation and local anesthetic to help with skull pin placement. A high-resolution T1-weighted contrast-enhanced axial brain MRI (1.5 mm slice) was performed.…”

Section: Stereotactic Radiosurgery Techniquementioning

confidence: 99%

“…Previously reported studies have helped to clarify the role of SRS in patients with meningiomas. 7,18 Recently, radiosurgery emerged as a treatment option for orbital meningiomas and ONSMs. In a retrospective study of 7 patients with orbital meningioma who underwent Gamma Knife SRS, Kim et al 19 reported that local tumor control was achieved in 6 of 7 patients over the follow-up period of 7-50 months.…”

Section: The Role Of Stereotactic Radiosurgery As An Adjuvant Therapymentioning

confidence: 99%

Does Adjuvant Gamma Knife Stereotactic Radiosurgery Have a Role in Treating Optic Nerve Sheath Meningiomas?

Wei¹,

Taori²,

Song³

et al. 2023

Journal of Neuro-Ophthalmology

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Background: Meningiomas arising from or adjacent to the optic nerve sheath meningioma (ONSM) are management challenges because of their risk of visual loss. Stereotactic radiosurgery (SRS) is a minimally invasive modality that can be added as adjuvant treatment for patients whose tumor has progressed or recurred after initial resection. Methods: The authors retrospectively reviewed 2,030 meningioma patients who underwent SRS between 1987 and 2022. In total, 7 patients (4 females; median age = 49) were found with tumors originating from the optic nerve sheath. None of the patients had tumors that engulfed the optic nerve as such tumors typically undergo fractionated radiation therapy (FRT) to preserve vision. The clinical history, visual function, and radiographic and neurological findings were characterized. Outcome measures included visual status, tumor control, and the need for additional management. Results: All patients underwent either initial gross total (n = 1) or partial surgical resection (n = 6) before SRS. Two patients with progressive tumor growth also had SRS after failing additional fractionated radiation after surgery (54 Gy, 30 fractions for both patients). The median time between the date of surgery and the SRS procedure date was 38 months. The Leksell Gamma Knife was used to deliver a margin dose of 12 Gy (range: 8–14 Gy) to a median cumulative tumor volume of 3.3 cc (range: 1.2–18 cc). The median maximal optic nerve radiation dose was 6.5 Gy (range: 1.9–8.1 Gy). After SRS, the median follow-up time was 130 months (range: 26–169 months). Two patients showed local tumor progression at 20 and 55 months after SRS. Four had stable visual function, 2 experienced improved visual acuity, and 1 patient had visual deterioration. Conclusions: Meningiomas arising from (but not engulfing the optic nerve) represent management quandaries after failed initial surgical removal. In this experience, salvage SRS was associated with tumor control and vision preservation in 5 of 7 patients. Additional experience with this strategy may further define the role of SRS both as a salvage and primary option.

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Does the Timing of Radiosurgery after Grade 1 Meningioma Resection Affect Long-Term Outcomes?

Cited by 10 publications

References 21 publications

Single-Session Gamma Knife Radiosurgery for Patients With 20 or More Brain Metastases

Single-Session Gamma Knife Radiosurgery for Patients With 20 or More Brain Metastases

Meningioma involving the superior sagittal sinus: long-term outcome after robotic radiosurgery in primary and recurrent situation

Does Adjuvant Gamma Knife Stereotactic Radiosurgery Have a Role in Treating Optic Nerve Sheath Meningiomas?

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