Initial Gamma Knife Radiosurgery for Large or Documented Growth Asymptomatic Meningiomas: Long-Term Results From a 27-Year Experience

Abstract

ObjectiveThe aims of this study were to investigate the long-term outcomes of initial Gamma Knife radiosurgery (GKRS) for large (≥20 mm) or documented growth asymptomatic meningiomas.Design and MethodsThis was a single-center retrospective study. Fifty-nine patients with large (≥20 mm) or documented growth asymptomatic meningiomas undergoing initial GKRS were enrolled. The median age was 56 (range, 27–83) years. The median time of follow-up was 66.8 (range, 24.6–245.6) months, and the median tumor margin dose was 13.0 Gy (range, 11.6–22.0 Gy).ResultsTumors shrunk in 35 patients (59.3%) and remained stable in 23 (39.0%). One patient (1.7%) experienced radiological progression at 54 months after GKRS. The PFS was 100%, 97%, and 97% at 3, 5, and 10 years, respectively. Nine patients (15.3%) occurred new neurological symptoms or signs at a median time of 8.1 (range, 3.0–81.6) months. The symptom PFS was 90% and 78% at 5 and 10 years, respectively. Fifteen patients (25.4%) occurred peritumoral edema (PTE) at a median time of 7.2 (range, 2.0–81.6) months. One patient underwent surgical resection for severe PTE. In univariate and multivariate analysis, Only tumor size (≥25 mm) and maximum dose (≥34 Gy) were significantly associated with PTE [hazard ratio (HR)= 3.461, 95% confidence interval (CI)=1.157-10.356, p=0.026 and HR=3.067, 95% CI=1.068-8.809, P=0.037, respectively].ConclusionsIn this study, initial GKRS can provide a high tumor control rate as well as an acceptable rate of complications in large or documented growth asymptomatic meningiomas. GKRS may be an alternative initial treatment for asymptomatic meningiomas.

Factors Influencing Long-Term Outcomes of Single-Session Gamma Knife Radiosurgery in Large-Volume Meningiomas >10 cc

“…Part of the ambiguity may be attributed to a lack of consensus regarding the volume that is too large to be treated with radiosurgery safely. Fu et al [27] in a long-term follow-up series of 59 meningiomas treated with GKRS greater than 20 mm in size reported PFS of 100%, 97%, and 97% at 3, 5, and 10 years, and that dimension exceeding 25 mm was significantly associated with development of PTE. Bledsoe et al reported more modest figures, with 92% 7-year tumour control rate following SRS in a cohort of WHO Grade 1 meningiomas that exceeded 10 cc.…”

Gamma knife radiosurgery as primary management for intracranial meningioma identified as growing on serial imaging

“…Fu et al depicted 59 large or documented growth asymptomatic meningiomas underwent GKRS with mean follow-up of 66 months. [ 9 ] One patient (1.7%) experienced radiologic progression after GKRS. The clinical PFS was 90% and 78% at 5 and 10 years, respectively.…”

“…Regrettably, a dedicated exploration of GKRS exclusively for growing meningiomas remains conspicuously absent in the scientific landscape. [8][9][10] To address this critical knowledge gap, we embarked on a retrospective study at our single-center institution, focusing exclusively on patients with previously untreated, growing meningiomas. This study aims to provide a comprehensive evaluation of the efficacy and safety of GKRS as an intervention for growing meningiomas, shedding light on the optimal management strategy for this specific clinical scenario.…”

“…Regrettably, a dedicated exploration of GKRS exclusively for growing meningiomas remains conspicuously absent in the scientific landscape. [8–10]…”