Fractionated Gamma Knife Radiosurgery as Initial Treatment for Large Skull Base Meningioma

Park, Hye Ran; Lee, Jae Meen; Park, Kwang-Woo; Jeong, Sang Soon; Kim, Jin Wook; Chung, Hyun‐Tai; Kim, Dong Gyu; Paek, Sun Ha

doi:10.5607/en.2018.27.3.245

Cited by 21 publications

(18 citation statements)

References 66 publications

(74 reference statements)

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“…For the predictors of tumor recurrence or progression, some studies revealed that increasing tumor volume was an independent predictor, which was also proved in our study. 10,16,29 In this study, many patients with intracranial meningiomas had low subjective acceptance of craniotomy; even though there were significant mass effect or neurological symptoms or signs, they preferred GKRS instead of craniotomy, which resulted in a high rate of large tumor (≥ 10 cm 3 ) in proportion at the time of GKRS, and reduced the treatment effect of GKRS in the cohort. In addition, a GKRS dose-plan defect may also influence local tumor control.…”

Section: Discussionmentioning

confidence: 77%

Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients

Ge¹,

Liu²,

Zhang³

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe authors retrospectively analyzed the follow-up data in 130 patients with intracranial benign meningiomas after Gamma Knife radiosurgery (GKRS), evaluated the tumor progression-free survival (PFS) rate and neurological function preservation rate, and determined the predictors by univariate and multivariate survival analysis.METHODSThis cohort of 130 patients with intracranial benign meningiomas underwent GKRS between May 2012 and May 2015 at the Second Hospital of Tianjin Medical University. The median age was 54.5 years (range 25–81 years), and women outnumbered men at a ratio of 4.65:1. All clinical and radiological data were obtained for analysis. No patient had undergone prior traditional radiotherapy or chemotherapy. The median tumor volume was 3.68 cm3 (range 0.23–45.78 cm3). A median margin dose of 12.0 Gy (range 10.0–16.0 Gy) was delivered to the tumor with a median isodose line of 50% (range 50%–60%).RESULTSDuring a median follow-up of 36.5 months (range 12–80 months), tumor volume regressed in 37 patients (28.5%), was unchanged in 86 patients (66.2%), and increased in 7 patients (5.4%). The actuarial tumor progression-free survival (PFS) rate was 98%, 94%, and 87% at 1, 3, and 5 years, respectively, after GKRS. Tumor recurred in 7 patients at a median follow-up of 32 months (range 12–56 months). Tumor volume ≥ 10 cm3 (p = 0.012, hazard ratio [HR] 8.25, 95% CI 1.60–42.65) and pre-GKRS Karnofsky Performance Scale score < 90 (p = 0.006, HR 9.31, 95% CI 1.88–46.22) were independent unfavorable predictors of PFS rate after GKRS. Of the 130 patients, 101 (77.7%) presented with one or more neurological symptoms or signs before GKRS. Neurological symptoms or signs improved in 40 (30.8%) patients, remained stable in 83 (63.8%), and deteriorated in 7 (5.4%) after GKRS. Two (1.5%) patients developed new cranial nerve (CN) deficit. Tumor volume ≥ 10 cm3 (p = 0.042, HR = 4.73, 95% CI 1.06–21.17) and pre-GKRS CN deficit (p = 0.045, HR = 4.35, 95% CI 0.84–22.48) were independent unfavorable predictors for improvement in neurological symptoms or signs. Six (4.6%) patients developed new or worsening peritumoral edema with a median follow-up of 4.5 months (range 2–7 months).CONCLUSIONSGKRS provided good local tumor control and high neurological function preservation in patients with intracranial benign meningiomas. Patients with tumor volume < 10 cm3, pre-GKRS Karnofsky Performance Scale score ≥ 90, and no pre-GKRS CN deficit (I–VIII) can benefit from stereotactic radiosurgery. It can be considered as the primary or adjuvant management of intracranial benign meningiomas.

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Section: Discussionmentioning

confidence: 77%

Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients

Ge¹,

Liu²,

Zhang³

et al. 2019

Neurosurgical Focus

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“…More recently, the GK which has traditionally been a single-fraction device (outside of staged treatments which are 1 month apart), has been increasingly used in a hypofractionated manner. 12,13 A group from South Korea reported on outcomes in 70 patients with tumors >10 cm 3 . 12 Of those patients, 60% were treated in a single fraction to 12 Gy, and the remaining patients were treated in two to four fractions, total doses ranging from 15 to 18 Gy.…”

Section: Discussionmentioning

confidence: 99%

“…Available data on this approach are limited compared to SRS; however, results appear to be promising in terms of safety and efficacy. 11–13 Over the last decade, patients diagnosed with meningioma and treated with radiotherapy have typically been managed with this hypofractionated approach at our institution. Herein, we present the results of our experience using SRT in the management of meningioma.…”

Section: Background and Purposementioning

confidence: 99%

Linear Accelerator-Based Stereotactic Radiotherapy for Low-Grade Meningiomas: Improved Local Control With Hypofractionation

Wegner

Hasan

Abel

et al. 2019

J Cent Nerv Syst Dis

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Background and purpose: Meningioma is a common type of benign tumor that can be managed in several ways, ranging from close observation, surgical resection, and various types of radiation. We present here results from a 10-year experience treating meningiomas with a hypofractionated approach. Materials and methods: We reviewed the charts of 56 patients treated with stereotactic radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (SRT) from 2008 to 2017. A total of 46 (82%) patients had WHO Grade 1 disease and 10 (18%) had Grade 2. Outcomes that were analyzed included local control rates and the rate and grade of any reported toxicity. Results: A total of 38 women and 18 men underwent SRS to a median dose of 15 Gy (n = 24) or hypofractionated SRT with a median dose of 25 Gy in five fractions (n = 34). Of the 56 patients, 22 had surgery before receiving treatment. The median follow-up was 36 (6-110) months. Local control at 2 and 5 years for all patients was 90% and 88%, respectively. Comparing fractionated to single-fraction treatment, there was improved local control with fractionation (91% vs 80% local control at 2 years, P = .009). There was one episode of late radionecrosis on imaging with associated symptoms after single-fraction treatment and one patient requiring resection of meningioma related to worsening symptoms (and local recurrence) after five-fraction SRT. Conclusions: This study provides further evidence for high rates of local control and minimal toxicity using a hypofractionated SRT approach, with improvement in local control through use of hypofractionation.

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“…Park et al found fractionated radiosurgery using the Gamma Knife Perfexion for large (> 10 cm 3 ) SBMs to be safe and effective, with only 17% of patients experiencing new-onset cranial neuropathy. 36 The median tumor volume in our series was 7.62 cm 3 (range 4.57-13.07 cm 3 ) with an overall progression-free survival of 82.5% at 1 year. Four of these patients were followed up to 40 months and had a median reduction in volume of 30% (−39.3 to −12.3).…”

Section: Fgkrs In Large Tumorsmentioning

confidence: 58%

“…32 To the best of our knowledge, there are only 4 institutional experiences previously published that describe this technique. 10,18,32,36 We present a retrospective review of 25 cases of SBM treated with fGKRS: 6 patients treated with the Extend system and 19 patients with the Icon system. This article presents the unique experience of using fGKRS in cases of SBM and represents the largest experience to date of using the Icon system.…”

mentioning

confidence: 99%

Fractionated Gamma Knife radiosurgery for skull base meningiomas: a single-institution experience

Joshi

Raghavan

Muhsen

et al. 2019

Neurosurgical Focus

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OBJECTIVEGamma Knife radiosurgery (GKRS) has been successfully used for the treatment of intracranial meningiomas given its steep dose gradients and high-dose conformality. However, treatment of skull base meningiomas (SBMs) may pose significant risk to adjacent radiation-sensitive structures such as the cranial nerves. Fractionated GKRS (fGKRS) may decrease this risk, but until recently it has not been practical with traditional pin-based systems. This study reports the authors’ experience in treating SBMs with fGKRS, using a relocatable, noninvasive immobilization system.METHODSThe authors performed a retrospective review of all patients who underwent fGKRS for SBMs between 2013 and 2018 delivered using the Extend relocatable frame system or the Icon system. Patient demographics, pre- and post-GKRS tumor characteristics, perilesional edema, prior treatment details, and clinical symptoms were evaluated. Volumetric analysis of pre-GKRS, post-GKRS, and subsequent follow-up visits was performed.RESULTSTwenty-five patients met inclusion criteria. Nineteen patients were treated with the Icon system, and 6 patients were treated with the Extend system. The mean pre-fGKRS tumor volume was 7.62 cm3 (range 4.57–13.07 cm3). The median margin dose was 25 Gy delivered in 4 (8%) or 5 (92%) fractions. The median follow-up time was 12.4 months (range 4.7–17.4 months). Two patients (9%) experienced new-onset cranial neuropathy at the first follow-up. The mean postoperative tumor volume reduction was 15.9% with 6 patients (27%) experiencing improvement of cranial neuropathy at the first follow-up. Median first follow-up scans were obtained at 3.4 months (range 2.8–4.3 months). Three patients (12%) developed asymptomatic, mild perilesional edema by the first follow-up, which remained stable subsequently.CONCLUSIONSfGKRS with relocatable, noninvasive immobilization systems is well tolerated in patients with SBMs and demonstrated satisfactory tumor control as well as limited radiation toxicity. Future prospective studies with long-term follow-up and comparison to single-session GKRS or fractionated stereotactic radiotherapy are necessary to validate these findings and determine the efficacy of this approach in the management of SBMs.

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Fractionated Gamma Knife Radiosurgery as Initial Treatment for Large Skull Base Meningioma

Cited by 21 publications

References 66 publications

Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients

Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients

Linear Accelerator-Based Stereotactic Radiotherapy for Low-Grade Meningiomas: Improved Local Control With Hypofractionation

Fractionated Gamma Knife radiosurgery for skull base meningiomas: a single-institution experience

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