Letter to the Editor: Nonsurgical acute traumatic subdural hematoma

Abstract

authors report on 27 patients with recurrent Grade 2 meningioma treated with radiosurgery alone. Patients were treated with a mean of 15.2 Gy. The actuarial local control rates were 75%, 52%, and 40% at 12, 24, and 36 months, respectively. The results of this study do not significantly differ from those of other series (recently reviewed in rogers et al., 2015 2), with the exception that increased treatment doses appear to yield somewhat higher control rates than those seen in this study, as noted by the authors. The authors conclude that radiosurgery is safe and effective for local control of recurrent atypical meningiomas. While we do not dispute the lessened short-term morbidity of radiosurgery compared with surgery, particularly at the doses used in this study, we would suggest that a 40% local control rate (i.e., a 60% failure rate) at 3 years does not indicate efficacy , as suggested by the authors. For reference, we have overlaid the authors' progression-free survival Kaplan-Meier plot on the recurrence-free survival plot of Grade 2 meningiomas, which shows the course of these tumors with no treatment (Fig. 1). We acknowledge that there are limitations in this comparison, but to us, it calls into question the effect of radiosurgery on the tumor in that it does not seem to alter the natural history of the disease. Based on this study and others, we would argue that radiosurgery alone is not sufficient therapy for Grade 2 meningiomas and should be reserved for the treatment of recurrence in patients who cannot undergo a second resection.