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

Pinzi, Valentina; Marchetti, M.; Martin, E. De; Cuccarini, Valeria; Tramacere, Irene; Ghielmetti, F.; Fumagalli, M.L.; Iezzoni, C.; Fariselli, Laura

doi:10.1186/s13014-020-1478-7

Cited by 6 publications

(3 citation statements)

References 33 publications

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“…Utilization of single fraction SRS has been increasing employed in the treatment of small to medium size meningiomas. Although multi-fraction SRS regimens are used, only one prospective trial examining this has been performed, for which long-term results have not yet been published [ 4 ]. Other studies using the National Cancer Database (NCDB) and Surveillance, Epidemiology, and End Results (SEER) databases have been performed recently to analyze trends in treatment and outcomes for the disease entity as a whole, however none have done this with a focus on radiotherapy and the use of SRS [ 5 - 7 ].…”

Section: Introductionmentioning

confidence: 99%

Trends in the use of radiation for meningioma across the United States

Matani

Abel

et al. 2022

Radiat Oncol J

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Purpose: Meningiomas are tumors originating from arachnoid cap cells on the surface of the brain or spinal cord. Treatment differs by grade but can consist of observation, surgery, radiation therapy or both. We utilized the National Cancer Database (NCDB) to compare trends in the use stereotactic radiosurgery (SRS) and external beam radiation therapy (EBRT) in the management of meningioma. Materials and Methods: We queried the NCDB from 2004–2015 for meningioma patients (grade 1–3) treated with radiation therapy, either SRS or EBRT. Multivariable logistic regression was used to identify predictors of each treatment and to generate a propensity score. Propensity adjusted Kaplan-Meier survival curve analysis and multivariable Cox hazards ratios were used to identify predictors of survival. Results: We identified 5,406 patients with meningioma meeting above criteria with 45%, 44%, and 11% having World Health Organization (WHO) grade 1, 2, and 3 disease, respectively. Median follow up was 43 months. Predictors for SRS were grade 1 disease, distance from treatment facility, and histology. The only predictor of EBRT was grade 3 disease. Treatment year, histology, race and female sex were associated with improved survival. Five- and 10-year survival rates were 89.2% versus 72.6% (p < 0.0001) and 80.3% versus 61.4% (p = 0.29) for SRS and EBRT respectively. After propensity matching 226 pairs were generated. For SRS, 5-year survival was not significantly improved at 88.2% compared with EBRT (p = 0.056).Conclusion: In the present analysis, predictors of SRS utilization in management of meningioma include WHO grade 1 disease, distance from treatment facility and histology whereas conventional EBRT utilization was associated with grade 2 and 3 disease. Future studies need to be performed in order to optimize management of atypical and malignant meningioma.

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Section: Introductionmentioning

confidence: 99%

Trends in the use of radiation for meningioma across the United States

Matani

Abel

et al. 2022

Radiat Oncol J

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“…Patients were scheduled to undergo CyberKnife multisession radiosurgery (mRS): a dose fraction of 6–8 Gy with a total dose of 24–32 Gy was planned to be delivered in 4 fractions (consecutive days) to an isodose line encompassing 95% of the planning target volume (PTV) to the 80% ± 5% prescription isodose line. The mRS treatments were performed with CyberKnife, as previously described [ 29 ]. The target was delineated on high-resolution (1 mm thickness) contrast-enhanced computed tomography (CT) and co-registered high-resolution MR (1 mm thickness), always using T2 and T1-weighted contrast-enhanced sequences, as well as fat-saturated sequences whenever necessary.…”

Section: Methods and Designmentioning

confidence: 99%

Multisession radiosurgery for grade 2 (WHO), high risk meningiomas. A phase II clinical trial

et al. 2022

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Purpose Patients suffering from recurrent and residual grade 2 (WHO) meningiomas after subtotal excision should be considered as high-risk groups with an uncertain prognosis. Adjuvant radiotherapy seems to be the best approach to reduce disease progression. The primary aim of this phase II explorative, monocentric, single arm study was to evaluate the safety of adjuvant multisession radiosurgery (mRS) in this group of patients; the efficacy in terms of tumour local control was the secondary endpoint. Methods Patients recruited from April 2017 to May 2019 were over 18 years old, had a histologically-documented intracranial recurrent or residual Grade 2 meningioma (WHO 2016) and a KPS > 70. Patients with NF2, concomitant neoplasm or pregnancy were excluded. Descriptive statistics were provided for categorical variables. Progression free survival (PFS) was modelled using the Kaplan–Meier method. Results Twenty-four patients were enrolled. All 24 patients underwent mRS: twenty-two patients received 28 Gy in 4 fractions, 2 patients received 24 Gy in 4 Treatment related adverse events (CTCAE 4.3) were limited to grade 2 in 1 patient (4.1%). At a median follow-up of 28 months, 8 patients (33.3%) had disease progression, either out-of-field or infield, compared with the planning target volume. Considering both infield and out-of-field progressions, 3-year PFS was 47% (95% confidence interval, CI, 22–69%); considering only the infield ones, 3-year PFS was 86% (95% CI 55–96%), and local control at last follow-up was 92%. Conclusion mRS provides good local control of the tumour volume (TV) and is associated with a low rate of toxicity. These results call for further investigation to confirm favourable outcomes in patients with high-risk meningioma. Trial information NCT05081908, October 18, 2021, retrospectively registered.

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“…Telephone interviews were performed if the patients failed to visit our clinic at the scheduled time. In addition to other CN complications, we primarily evaluated the initial pain relief, pain recurrence, and any type of sensory disturbance using the Barrow Neurological Institute (BNI) pain intensity score and the facial numbness score (14). Complete pain relief was defined as a BNI pain score of I.…”

Section: Type IImentioning

confidence: 99%

Strategies for intraoperative management of the trigeminal nerve and long-term follow-up outcomes in patients with trigeminal neuralgia secondary to an intracranial epidermoid cyst

Zhang

Wang

et al. 2022

Front. Surg.

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BackgroundEpidermoid cysts (ECs) are one of the most common causes of secondary trigeminal neuralgia (TGN). However, most previous studies have primarily focused on whether complete tumor resection was achieved, and few studies have discussed the primary goal of pain relief.ObjectiveThe present study provides intraoperative strategies for trigeminal nerve (TN) management in patients with TGN secondary to an EC and observed long-term follow-up outcomes.MethodsA total of 69 patients with TGN secondary to an EC at our hospitals were included (January 2011–June 2021). The same surgical team performed all surgeries using a retrosigmoid approach. After EC removal, different methods for TN management were used, including microvascular decompression (MVD), sharp capsulectomy, nerve combing and embedded cholesterol crystal excision. The epidemiological, clinical, and surgical data were extracted.ResultsThe total EC removal rate was 92.8% (64/69). All patients achieved initial pain relief postoperatively, and 12 patients (17.4%) experienced varying degrees of hemifacial hypesthesia, which was relieved within 3–6 months. Three patients (4.3%) reported partial pain recurrence within a median follow-up period of 5.5 (0.5–10.5) years, which was relieved completely after low-dose carbamazepine administration.ConclusionThe primary goal of surgical tumor removal for patients with TGN secondary to an EC is relief of the main symptom of tormenting pain. The selection of an appropriate strategy for TN, including MVD, sharp capsulectomy, nerve combing or embedded cholesterol crystal excision, should depend on the patient's situation.

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

Cited by 6 publications

References 33 publications

Trends in the use of radiation for meningioma across the United States

Trends in the use of radiation for meningioma across the United States

Multisession radiosurgery for grade 2 (WHO), high risk meningiomas. A phase II clinical trial

Strategies for intraoperative management of the trigeminal nerve and long-term follow-up outcomes in patients with trigeminal neuralgia secondary to an intracranial epidermoid cyst

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