Post-operative gamma knife radiosurgery for WHO grade I intracranial meningiomas: A single-center, retrospective study

Abstract

ObjectiveTo explore the results of the Gamma Knife radiosurgery (GKRS) for World Health Organization (WHO) grade I intracranial meningiomas after surgical resection.MethodsA total of 130 patients who were pathologically diagnosed as having WHO grade I meningiomas and who underwent post-operative GKRS were retrospectively reviewed in a single center.ResultsOf the 130 patients, 51 patients (39.2%) presented with radiological tumor progression with a median follow-up time of 79.7 months (ranging from 24.0 to 291.3 months). The median time to radiological tumor progression was 73.4 months (ranging from 21.4 to 285.3 months), whereas 1-, 3-, 5-, and 10-year radiological progression-free survival (PFS) was 100, 90, 78, and 47%, respectively. Moreover, 36 patients (27.7%) presented with clinical tumor progression. Clinical PFS at 1, 3, 5, and 10 years was 96, 91, 84, and 67%, respectively. After GKRS, 25 patients (19.2%) developed adverse effects, including radiation-induced edema (n = 22). In a multivariate analysis, a tumor volume of ≥10 ml and falx/parasagittal/convexity/intraventricular location were significantly associated with radiological PFS [hazard ratio (HR) = 1.841, 95% confidence interval (CI) = 1.018–3.331, p = 0.044; HR = 1.761, 95% CI = 1.008–3.077, p = 0.047]. In a multivariate analysis, a tumor volume of ≥10 ml was associated with radiation-induced edema (HR = 2.418, 95% CI = 1.014–5.771, p = 0.047). Of patients who presented with radiological tumor progression, nine were diagnosed with malignant transformation. The median time to malignant transformation was 111.7 months (ranging from 35.0 to 177.2 months). Clinical PFS after repeat GKRS was 49 and 20% at 3 and 5 years, respectively. Secondary WHO grade II meningiomas were significantly associated with a shorter PFS (p = 0.026).ConclusionsPost-operative GKRS is a safe and effective treatment for WHO grade I intracranial meningiomas. Large tumor volume and falx/parasagittal/convexity/intraventricular location were associated with radiological tumor progression. Malignant transformation was one of the main cause of tumor progression in WHO grade I meningiomas after GKRS.

Stereotactic radiosurgery for intraventricular meningioma: a systematic review and meta-analysis

“…Search retrieved 309 articles from Medline, Scopus, Embase, and Web of Science. After duplicate removal, 132 papers remained, of which 20 were included after the title/abstract screening stage [ 1 , 8 , 10 , 11 , 15 , 16 , 18 , 20 , 22 , 23 , 29 , 30 , 36 , 37 , 40 – 42 , 45 , 46 , 48 ] and 4 were retrieved from the bibliography review [ 2 , 6 , 33 , 43 ]. In the full-text review, 10 articles did not meet our inclusion criteria [ 8 , 11 , 20 , 29 , 37 , 41 , 42 , 45 , 48 ].…”

“…After duplicate removal, 132 papers remained, of which 20 were included after the title/abstract screening stage [ 1 , 8 , 10 , 11 , 15 , 16 , 18 , 20 , 22 , 23 , 29 , 30 , 36 , 37 , 40 – 42 , 45 , 46 , 48 ] and 4 were retrieved from the bibliography review [ 2 , 6 , 33 , 43 ]. In the full-text review, 10 articles did not meet our inclusion criteria [ 8 , 11 , 20 , 29 , 37 , 41 , 42 , 45 , 48 ]. Among excluded articles, 5 did not apply SRS for the treatment of current IVM [ 16 , 22 , 30 , 36 , 40 ], 2 did not have patients with IVM [ 11 , 18 ], one was conference abstract [ 45 ], one did not have enough data [ 2 ], and one had multiple spinal hemangioblastomas along with IVM and without application of SRS [ 1 ].…”

“…Among excluded articles, 5 did not apply SRS for the treatment of current IVM [ 16 , 22 , 30 , 36 , 40 ], 2 did not have patients with IVM [ 11 , 18 ], one was conference abstract [ 45 ], one did not have enough data [ 2 ], and one had multiple spinal hemangioblastomas along with IVM and without application of SRS [ 1 ]. Overall, 14 articles matched our inclusion criteria [ 6 , 8 , 10 , 15 , 20 , 23 , 29 , 33 , 37 , 41 – 43 , 46 , 48 ]. Figure 1 shows the PRISMA flow diagram for the screening process of the papers.…”

“…A total 14 studies and 101 tumors were included, which comprise, seven case-series [ 8 , 10 , 20 , 29 , 41 , 43 , 48 ] and seven case reports [ 6 , 15 , 23 , 33 , 37 , 42 , 46 ], and only seven [ 8 , 10 , 20 , 29 , 41 , 43 , 48 ] had enough data with at least 3 patients to be entered into the meta-analysis. If studies, case reports or case series, had sufficient data, they were also included in the individual patient tumor control analysis.…”

“…Using the JBI tool for the quality assessment of case series [ 8 , 10 , 20 , 29 , 41 , 43 , 48 ], 6 out of 7 had high-quality [ 8 , 20 , 29 , 41 , 43 , 48 ], and one had moderate quality [ 10 ]. Among case reports, 6 out of 7 had high-quality [ 6 , 15 , 23 , 37 , 42 , 46 ], and one had low-quality [ 33 ].…”