Hypofractionated stereotactic radiotherapy for intracranial meningioma: a systematic review

Abstract

Background The availability of image guidance and intensity modulation has led to the increasing use of hypofractionated stereotactic radiotherapy (hSRT) as an alternative to conventionally fractionated radiotherapy or radiosurgery for intracranial meningiomas (ICMs). As the safety and efficacy of this approach is not well characterized, we conducted a systematic review of the literature to assess the clinical outcomes of hSRT in the setting of ICMs. Methods A systematic review of Medline and EMBASE databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies were retrospective or prospective series that examined an ICM population of ≥10 patients, delivered >1 fraction of photon hSRT (≥2.5 Gy per fraction), and had a median follow-up of ≥2 years. Descriptive statistics were generated for included studies. Results Of 1480 initial studies, 14 met eligibility criteria for inclusion, reporting on 630 patients (age range, 18-90) treated for 638 tumors. Primary radiotherapy was delivered in 37% of patients, 36% had radiation following surgery, and surgical details were unavailable for 27%. In 474 tumors assessed for radiologic response, 78% remained stable, 18% decreased in size, and 4% increased in size. Crude local control was 90%-100% as reported in 10 studies. The median late toxicity rate was 10%. The most common significant late toxicities were decreased visual acuity and new cranial neuropathy. Conclusions With limited follow-up, the available literature suggests hSRT for ICMs has local control and toxicity profiles comparable to other radiotherapy approaches. Confirmation in larger patient cohorts with a longer duration of follow-up is required.

Multisession radiosurgery for intracranial meningioma treatment: study protocol of a single arm, monocenter, prospective trial

“…So far, several studies focused on a hypofractionated approach have been published with good results and low toxicity rate [8-14, 30, 31]. Nevertheless, safety and efficacy of this approach is not well characterized and the reported follow-up is too short for drawing any definitive conclusion [34].…”

Short Course Hypofractionated Radiotherapy for Frail or Elderly Patients With Meningioma

“…There are limited prior reports on the use of hypofractionated RT for meningioma, though none have focused exclusively on the elderly subgroup and most had evaluated 5-fraction regimens. Nguyen et al performed a systematic review of hypofractionated stereotactic radiotherapy and found low rates of late toxicity and high grades of crude local control [ 9 ]. Radiologic response was reported; 96% of tumors treated remained stable or decreased in size, while an increase in size occurred in 4%.…”

“…However, neurosurgical intervention or fractionated radiation treatment (up to six weeks) can be challenging for elderly or frail patients. A systematic review of hypofractionated radiotherapy (RT) revealed high local control of 90% or higher, as well as a low probability of late toxicities (10%) [ 9 ]. However, there is little reported data regarding hypofractionated RT in elderly or frail patients with meningioma.…”

Advances in Multidisciplinary Management of Skull Base Meningiomas

“…In a large retrospective series of 168 patients receiving CyberKnife-based hypofractionated SRT for SBMs, Marchetti et al [ 111 ] showed a local control rate of 95% at 5 years with a toxicity rate of 3.7%, and similar results have been observed in a few other studies using either CyberKnife or LINAC technologies. In a systematic review on the clinical outcomes of hypofractionated SRT for intracranial meningiomas including 630 patients reported in fourteen studies published between 2004 and 2016, Nguyen et al [ 112 ] reported a crude control of 90–100% with median late toxicity rates of about 10%.…”