Grade 2 meningioma and radiosurgery

Abstract

OBJECT World Health Organization Grade 2 meningiomas are aggressive tumors associated with a high recurrence rate leading to repeated surgical procedures, which can seriously worsen a patient's neurological status. Although radiosurgery is an increasingly popular technique, its role in the management of Grade 2 meningiomas has yet to be defined. In this study the authors aimed to evaluate radiosurgery in achieving control of proven tumor progression occurring after resection of Grade 2 meningioma. METHODS This retrospective study included consecutive patients who, between 2000 and 2012, had undergone radiosurgery for radiologically proven progression of a previously surgically treated Grade 2 meningioma. RESULTS Twenty-seven patients were eligible for analysis. There were 9 men and 18 women with a mean age of 59 years. The mean radiation dose was 15.2 Gy (range 12–21 Gy), and the mean target volume was 5.4 cm3 (range 0.194–14.2 cm3). Thirty-four radiosurgical procedures were performed in the 27 patients. The mean progression-free survival after radiosurgery was 32.4 months among those with progression in a target irradiated volume and 26.4 months among those with progression in any intracranial meninges. With a mean follow-up of 56.4 months (range 12–108 months), the 12-, 24-, and 36-month actuarial local control rates for all patients were 75%, 52%, and 40%, respectively, and the regional control rates were 75%, 48%, and 33%. A single case of transient hemiparesis completely resolved without sequelae. CONCLUSIONS Radiosurgery appears to be a safe and effective treatment for the local control of delayed progression after resection of a Grade 2 meningioma. Higher radiation doses similar to those applied for malignant tumors should be recommended when possible.

Gamma Knife Stereotactic Radiosurgery for Grade 2 Meningiomas

“…[9][10][11]13,14 As salvage surgical interventions after tumor recurrence are accompanied by high morbidity and possible neurological dysfunction, many neuro-oncologists advocate for adjuvant early radiation therapy in patients with grade 2 meningiomas. 9 There have not been many studies analyzing histopathologically confirmed WHO grade 2 meningiomas with a large sample size of patients. To our knowledge, this is the biggest cohort of homogenous histopathologically confirmed grade 2 meningiomas treated with GK RS.…”

“…Most of the studies utilized local-regional control as an end point, while a few others used OS. [9][10][11]13,14 Our study analyzed both the LC and OS.…”

“…(https://www.nccn.org/professionals/physi-cian_gls/pdf/cns_blocks.pdf). 5,6,[9][10][11][12][13][14] Stereotactic radiosurgery (SRS) refers to the delivery of large doses of radiation targeting a precisely defined target, utilizing multiple, nonparallel radiation beams that converge on the target lesion. The Gamma Knife (GK) system consists of an array of more than 192 cobalt-60 sources that has a treatment delivery accuracy of between 0.1 and 1 mm.…”

“…15 There have been a considerable number of studies reporting the role of SRS as an effective and safe treatment modality for patients with meningiomas [15][16][17][18][19] ; however, very few have reported the treatment outcomes of postoperative GK SRS for grade 2 meningiomas. 5,6,[9][10][11][12][13][14] Furthermore, most of the studies reporting SRS treatment outcomes for grade 2 meningiomas included small sample sizes ranging from 25 to 35 patients. [9][10][11][12][13][14] In this study, we report the long-term clinical outcomes and treatment-induced adverse events among patients with histopathologically confirmed grade 2 meningiomas treated consecutively with GK SRS from 1998 to 2014.…”

Assessment of Target Volume Definition for Radiosurgery of Atypical Meningiomas with Multimodality Imaging

“…Radiosurgery has been utilized for management of atypical meningiomas with encouraging outcomes [45][46][47][48][49][50][51] . Radiosurgery may be utilized for improved precision in RT delivery by use of stereotactic localization and optimized normal tissue sparing with steeper dose gradients around the target volume.…”