Glioblastoma multiforme as a secondary malignancy following stereotactic radiosurgery of a meningioma: case report

Labuschagne, Jason; Chetty, Dinoshan

doi:10.3171/2019.3.focus1948

Cited by 12 publications

(9 citation statements)

References 69 publications

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“…The survival of benign meningioma patients is substantial and secondary tumors may be observed after the delivery of adjuvant or radical radiation therapy (44). As such, any therapeutic modality that decreases the risk of radiation-induced tumors should be offered when appropriate.…”

Section: Discussionmentioning

confidence: 99%

Proton Therapy for Intracranial Meningioma for the Treatment of Primary/Recurrent Disease Including Re-Irradiation

et al. 2020

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Meningeal tumors represent approximately 10–25% of primary brain tumors and occur usually in elderly female patients. Most meningiomas are benign (80–85%) and for symptomatic and/or large tumors, surgery, with or without radiation therapy (RT), has been long established as an effective means of local tumor control. RT can be delivered to inoperable lesions or to those with non-benign histology and for Simpson I–III and IV–V resection. RT can be delivered with photons or particles (protons or carbon ions) in stereotactic or non-stereotactic conditions. Particle therapy delivered for these tumors uses the physical properties of charged carbon ions or protons to spare normal brain tissue (i.e. Bragg peak), with or without or a dose-escalation paradigm for non-benign lesions. PT can substantially decrease the dose delivered to the non-target brain tissues, including but not limited to the hippocampi, optic apparatus or cochlea. Only a limited number of meningioma patients have been treated with PT in the adjuvant or recurrent setting, as well as for inoperable lesions with pencil beam scanning and with protons only. Approximately 500 patients with image-defined or WHO grade I meningioma have been treated with protons. The reported outcome, usually 5-year local tumor control, ranges from 85 to 99% (median, 96%). For WHO grade II or III patients, the outcome of only 97 patients has been published, reporting a median tumor local control rate of 52% (range, 38–71.1). Only 24 recurring patients treated previously with photon radiotherapy and re-treated with PT were reported. The clinical outcome of these challenging patients seems interesting, provided that they presented initially with benign tumors, are not in the elderly category and have been treated previously with conventional radiation dose of photons. Overall, the number of meningioma patients treated or-re-irradiated with this treatment modality is small and the clinical evidence level is somewhat low (i.e. 3b–5). In this review, we detail the results of upfront PT delivered to patients with meningioma in the adjuvant setting and for inoperable tumors. The outcome of meningioma patients treated with this radiation modality for recurrent tumors, with or without previous RT, will also be reviewed.

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Section: Discussionmentioning

confidence: 99%

Proton Therapy for Intracranial Meningioma for the Treatment of Primary/Recurrent Disease Including Re-Irradiation

et al. 2020

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“…Timing of following scan consistently varies (6, 9, or 12 months) between authors according to a recent systematic review and metaanalysis [58]. The rationale for avoiding SRS as the primary treatment is to eliminate the risk, although very limited, of delayed cranial neuropathies and ischemic deficits induced by SRS [121] and also to avoid the rare occurrence of radiation-induced tumors [78,81,134] or transformation into more aggressive tumors [118]. The strategy of a close observation is largely represented in the modern management of small, asymptomatic meningiomas [5].…”

Section: Small Asymptomatic Pcmsmentioning

confidence: 99%

“…Other authors instead propose SRS only for residual tumor growth [130,155]. The rationale of the latter attitude is supported by the fact that PCMs are usually slow-growing lesions, concerns about radiation injury [10,78,79,87] and also in surgical difficulties in operating an irradiated tumor in the case of failure of radiosurgery [7]. The debate between the superiority of surgery aiming to GTR or planned STR plus SRS is still open, also considering the paucity of literature focused on this relatively new strategy in skull base pathology [140].…”

Section: Multimodal Treatment Of Pcmmentioning

confidence: 99%

Petroclival meningiomas: update of current treatment and consensus by the EANS skull base section

et al. 2021

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Background The optimal management of petroclival meningiomas (PCMs) continues to be debated along with several controversies that persist. Methods A task force was created by the EANS skull base section along with its members and other renowned experts in the field to generate recommendations for the management of these tumors. To achieve this, the task force reviewed in detail the literature in this field and had formal discussions within the group. Results The constituted task force dealt with the existing definitions and classifications, pre-operative radiological investigations, management of small and asymptomatic PCMs, radiosurgery, optimal surgical strategies, multimodal treatment, decision-making, and patient's counselling. Conclusion This article represents the consensually derived opinion of the task force with respect to the management of PCMs.

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“…The risk of intracranial tumors or malignancies resulting from SRS is controversial; reported risks for radiation-induced tumorigenesis range from 0.0% to 2.6% at 15-year follow-up [1,7], and 0.9% for malignant transformation of benign tumors [1]. More specifically, SRS-induced glioma has been reported after SRS for various lesions, including AVMs [8][9][10], melanoma metastases [11], meningioma [12,13], and other pathologies, with a reported risk of 0.04% at 15-year follow-up [7]. Thus, though the risk for SRS-induced glioma is likely low, it remains a valid concern that should be considered when discussing treatment methods with patients, especially for benign pathologies and in patients with longer life expectancies.…”

Section: Introductionmentioning

confidence: 99%

Glioblastoma Adjacent to Radiosurgically Treated Arteriovenous Malformation: A Case Report and Review of the Literature

Richter¹,

Richter²,

Griessenauer³

et al. 2022

Cureus

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Stereotactic radiosurgery (SRS) is a noninvasive therapy for patients suffering from both benign and malignant intracranial pathologies. While SRS allows for increased precision and efficacy, significant risks have been reported, such as radiation necrosis. Although traditional radiation therapies are associated with a well-understood risk of causing tumors or inducing malignancy, the risks associated with SRS are not well understood. Here, we present the case of a patient who underwent SRS post-Onyx embolization of a Spetzler-Martin grade 4 left parasagittal arteriovenous malformation. Four years later, the patient presented with a high-grade glioma adjacent to where the SRS was targeted. SRS has fundamentally altered the way we treat intracranial pathologies. While the risks for SRS-induced glioma appear to be extremely low, this case illustrates that they ought to be considered. Here, we discuss the details of our case and explore the currently available literature. Knowing these potential risks will further aid physicians and patients balance the associated benefits and risks.

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Glioblastoma multiforme as a secondary malignancy following stereotactic radiosurgery of a meningioma: case report

Cited by 12 publications

References 69 publications

Proton Therapy for Intracranial Meningioma for the Treatment of Primary/Recurrent Disease Including Re-Irradiation

Proton Therapy for Intracranial Meningioma for the Treatment of Primary/Recurrent Disease Including Re-Irradiation

Petroclival meningiomas: update of current treatment and consensus by the EANS skull base section

Glioblastoma Adjacent to Radiosurgically Treated Arteriovenous Malformation: A Case Report and Review of the Literature

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