Fractionated radiation therapy in the treatment of intracranial meningiomas: Local control, functional efficacy, and tolerance in 91 patients

Maire, Jean-Philippe; Caudry, M; Guérin, J.; Celerier, D.; Galli, F. San; Causse, N.; Trouette, R.; Dautheribes, M.

doi:10.1016/0360-3016(94)00661-4

Cited by 91 publications

(44 citation statements)

References 14 publications

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“…Also in these tumors, RT has been suggested as an effective treatment. A 5-year tumor control in the range of 90 to 97% has been reported for skull base meningiomas up to 5 cm in greatest dimension 53,56,57 ; however, meningiomas larger than 5 cm in size seem to be associated with worse local control 58,59 . There is little evidence that timing of RT is important, as local control and survival rates are similar whether the treatment is given as a part of the primary treatment or at the time of recurrence [51][52][53]60 .…”

Section: Surgerymentioning

confidence: 99%

EANO guidelines for the diagnosis and treatment of meningiomas

Goldbrunner

Minniti

Preusser

et al. 2016

The Lancet Oncology

715

599

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Although meningiomas are the most common intracranial tumours, the level of evidence to provide recommendations for the diagnosis and treatment of meningiomas is low compared with other tumours such as high-grade gliomas. The meningioma task force of the European Association of NeuroOncology (EANO) assessed the scientific literature and composed a framework of the best possible evidence-based recommendations for health professionals. The provisional diagnosis of meningioma is mainly made by MRI. Definitive diagnosis, including histological classification, grading, and molecular profiling, requires a surgical procedure to obtain tumour tissue. Therefore, in many elderly patients, observation is the best therapeutic option. If therapy is deemed necessary, the standard treatment is gross total surgical resection including the involved dura. As an alternative, radiosurgery can be done for small tumours, or fractionated radiotherapy in large or previously treated tumours. Treatment concepts combining surgery and radiosurgery or fractionated radiotherapy, which enable treatment of the complete tumour volume with low morbidity, are being developed. Pharmacotherapy for meningiomas has remained largely experimental. However, antiangiogenic drugs, peptide receptor radionuclide therapy, and targeted agents are promising candidates for future pharmacological approaches to treat refractory meningiomas across all WHO grades.

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Section: Surgerymentioning

confidence: 99%

EANO guidelines for the diagnosis and treatment of meningiomas

Goldbrunner

Minniti

Preusser

et al. 2016

The Lancet Oncology

715

599

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“…7,11,17,32,38 Neurological deficits associated with skull base meningiomas have been noted to improve or remain stable in 69%-100% of patients who undergo conventional fractionated radiation therapy. 11,31,32,38 Complication rates associated with radiation therapy range from 0% to 24%. 34 Injury to adjacent CNs is one of the most commonly reported complications.…”

Section: Resection and Radiation Therapymentioning

confidence: 99%

Gamma Knife radiosurgery for sellar and parasellar meningiomas: a multicenter study

Sheehan

Starke

Kano

et al. 2014

JNS

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Object Parasellar and sellar meningiomas are challenging tumors owing in part to their proximity to important neurovascular and endocrine structures. Complete resection can be associated with significant morbidity, and incomplete resections are common. In this study, the authors evaluated the outcomes of parasellar and sellar meningiomas managed with Gamma Knife radiosurgery (GKRS) both as an adjunct to microsurgical removal or conventional radiation therapy and as a primary treatment modality. Methods A multicenter study of patients with benign sellar and parasellar meningiomas was conducted through the North American Gamma Knife Consortium. For the period spanning 1988 to 2011 at 10 centers, the authors identified all patients with sellar and/or parasellar meningiomas treated with GKRS. Patients were also required to have a minimum of 6 months of imaging and clinical follow-up after GKRS. Factors predictive of new neurological deficits following GKRS were assessed via univariate and multivariate analyses. Kaplan-Meier analysis and Cox multivariate regression analysis were used to assess factors predictive of tumor progression. Results The authors identified 763 patients with sellar and/or parasellar meningiomas treated with GKRS. Patients were assessed clinically and with neuroimaging at routine intervals following GKRS. There were 567 females (74.3%) and 196 males (25.7%) with a median age of 56 years (range 8–90 years). Three hundred fifty-five patients (50.7%) had undergone at least one resection before GKRS, and 3.8% had undergone prior radiation therapy. The median follow-up after GKRS was 66.7 months (range 6–216 months). At the last follow-up, tumor volumes remained stable or decreased in 90.2% of patients. Actuarial progression-free survival rates at 3, 5, 8, and 10 years were 98%, 95%, 88%, and 82%, respectively. More than one prior surgery, prior radiation therapy, or a tumor margin dose < 13 Gy significantly increased the likelihood of tumor progression after GKRS. At the last clinical follow-up, 86.2% of patients demonstrated no change or improvement in their neurological condition, whereas 13.8% of patients experienced symptom progression. New or worsening cranial nerve deficits were seen in 9.6% of patients, with cranial nerve (CN) V being the most adversely affected nerve. Functional improvements in CNs, especially in CNs V and VI, were observed in 34% of patients with preexisting deficits. New or worsened endocrinopathies were demonstrated in 1.6% of patients; hypothyroidism was the most frequent deficiency. Unfavorable outcome with tumor growth and accompanying neurological decline was statistically more likely in patients with larger tumor volumes (p = 0.022) and more than 1 prior surgery (p = 0.021). Conclusions Gamma Knife radiosurgery provides a high rate of tumor control for patients with parasellar or sellar meningiomas, and tumor control is accompanied by neurological preservation or improvement in most patients.

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“…[3][4][5][6][7][8][9][26][27][28][29] Multiple series showed that postoperative radiation therapy could substantially improve the local control and overall survival for subtotally resected meningiomas. Eight to ten-year local control rates of about 80% or above were achieved in multiple series with radiation therapy.…”

Section: Conventional External Beam Radiotherapymentioning

confidence: 99%

Single Dose versus Fractionated Stereotactic Radiotherapy for Meningiomas

Cho

Hall

et al. 2002

Can. j. neurol. sci.

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240Meningiomas constitute approximately 20% of all primary intracranial tumors.1,2 Tumor grade rather than histologic subtype bears clear prognostic importance. [3][4][5][6][7][8][9] Complete surgical excision, if achievable, can produce excellent results without adjunctive therapy. [9][10][11] However, meningiomas may recur after surgery and curative resection can result in significant morbidity because of strategic tumor location and old age. [12][13][14][15] Stereotactic radiosurgery (SRS) can deliver a single high dose of radiation to a localized area in the brain for the treatment of meningiomas that are unresectable, recurrent or residual after surgery. However, large tumors and tumors adjacent to vital ABSTRACT: Objective: To evaluate the safety and efficacy of stereotactic radiosurgery (SRS) compared to fractionated stereotactic radiation therapy (FSRT) for meningiomas treated over a seven year period. Methods and materials: Of the 53 patients (15 male and 38 female) with 63 meningiomas, 35 were treated with SRS and the 18 patients with tumors adjacent to critical structures or with large tumors were treated with FSRT. The median doses for the SRS and the FSRT groups were 1400 cGy (500-4500 cGy) and 5400 cGy (4000-6000 cGy) respectively. Median target volumes for SRS and FSRT were 6.8 ml and 8.8 ml respectively. The median follow-up for the SRS and FSRT groups were 38 months (4.1-97 months) and 30.5 months (6.0-63 months) respectively. Results: The five-year tumor control probability (TC) for benign versus atypical meningiomas were 92.7% vs. 31% (P=.006). The three-year TC were 92.7% vs. 93.3% for SRS vs. FSRT groups respectively (P=.62). For benign meningiomas, the three-year TC were 92.9% vs. 92.3% for the SRS group (29 patients) vs. FSRT group (14 patients) respectively (P=.77). Two patients in the SRS group and one in the FSRT group developed late complications. Conclusion: Preliminary data suggest that SRS is a safe and effective treatment for patients with benign meningiomas. Fractionated stereotactic radiation therapy with conventional fractionation appeared to be an effective and safe treatment alternative for patients not appropriate for SRS. A longer follow-up is required to determine the long-term efficacy and the toxicity of these treatment modalities.RÉSUMÉ: Dose unique versus radiothérapie stéréotaxique fractionnée dans le traitement des méningiomes. Objectif: Évaluer la sécurité et l'efficacité de la radiochirurgie stéréotaxique (RCS) comparée à la radiothérapie stétéotaxique fractionnée (RTSF) dans le traitement des méningiomes sur une période de sept ans. Méthodes et matériels: Parmi les 53 patients (15 hommes et 38 femmes) atteints de 63 méningiomes, 35 ont été traités par RCS et 18, dont la tumeur était adjacente à des structures critiques ou était volumineuse, ont été traités par RTSF. Les doses médianes pour le groupe RCS et le groupe RTSF étaient de 1400 cGy (500 à 4500 cGy) et 5400 cGy (4000 à 6000 cGy) respectivement. Les volumes cibles médians pour les groupes RCS et RTSF étaient...

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Fractionated radiation therapy in the treatment of intracranial meningiomas: Local control, functional efficacy, and tolerance in 91 patients

Cited by 91 publications

References 14 publications

EANO guidelines for the diagnosis and treatment of meningiomas

EANO guidelines for the diagnosis and treatment of meningiomas

Gamma Knife radiosurgery for sellar and parasellar meningiomas: a multicenter study

Single Dose versus Fractionated Stereotactic Radiotherapy for Meningiomas

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