Radiotherapy alone or after subtotal resection for benign skull base meningiomas

Mendenhall, William M.; Morris, Christopher G.; Amdur, Robert J.; Foote, Kelly D.; Friedman, William A.

doi:10.1002/cncr.11645

Cited by 104 publications

(64 citation statements)

References 37 publications

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“…Progression-free survival rates at 5 and 10 years after conventional radiotherapy range from 73% to 92% and 61% to 83%, respectively. 23,25,26,35,40,57 More contemporary techniques such as intensity-modulated radiation therapy and proton therapy offer increased conformality and more sparing of critical structures compared with conventional techniques. 44,58 The lower integral dose and higher conformality that are touted as the advantages of intensity-modulated radiation therapy and proton beam over conventional radiotherapy techniques for meningiomas have been longstanding features of radiosurgery.…”

Section: Radiation Therapymentioning

confidence: 99%

Gamma Knife radiosurgery for posterior fossa meningiomas: a multicenter study

Sheehan

Starke

Kano

et al. 2015

JNS

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abbreviatioNs CI = confidence interval; CN = cranial nerve; CPA = cerebellopontine angle; GKRS = Gamma Knife radiosurgery; HR = hazard ratio; OR = odds ratio; SRS = stereotactic radiosurgery. obJect Posterior fossa meningiomas represent a common yet challenging clinical entity. They are often associated with neurovascular structures and adjacent to the brainstem. Resection can be undertaken for posterior fossa meningiomas, but residual or recurrent tumor is frequent. Stereotactic radiosurgery (SRS) has been used to treat meningiomas, and this study evaluates the outcome of this approach for those located in the posterior fossa.methods At 7 medical centers participating in the North American Gamma Knife Consortium, 675 patients undergoing SRS for a posterior fossa meningioma were identified, and clinical and radiological data were obtained for these cases. Females outnumbered males at a ratio of 3.8 to 1, and the median patient age was 57.6 years (range 12-89 years). Prior resection was performed in 43.3% of the patient sample. The mean tumor volume was 6.5 cm 3 , and a median margin dose of 13.6 Gy (range 8-40 Gy) was delivered to the tumor.results At a mean follow-up of 60.1 months, tumor control was achieved in 91.2% of cases. Actuarial tumor control was 95%, 92%, and 81% at 3, 5, and 10 years after radiosurgery. Factors predictive of tumor progression included age greater than 65 years (hazard ratio [HR] 2.36, 95% CI 1.30-4.29, p = 0.005), prior history of radiotherapy (HR 5.19, 95% CI 1.69-15.94, p = 0.004), and increasing tumor volume (HR 1.05, 95% CI 1.01-1.08, p = 0.005). Clinical stability or improvement was achieved in 92.3% of patients. Increasing tumor volume (odds ratio [OR] 1.06, 95% CI 1.01-1.10, p = 0.009) and clival, petrous, or cerebellopontine angle location as compared with petroclival, tentorial, and foramen magnum location (OR 1.95, 95% CI 1.05-3.65, p = 0.036) were predictive of neurological decline after radiosurgery. After radiosurgery, ventriculoperitoneal shunt placement, resection, and radiation therapy were performed in 1.6%, 3.6%, and 1.5%, respectively.coNclusioNs Stereotactic radiosurgery affords a high rate of tumor control and neurological preservation for patients with posterior fossa meningiomas. Those with a smaller tumor volume and no prior radiation therapy were more likely to have a favorable response after radiosurgery. Rarely, additional procedures may be required for hydrocephalus or tumor progression.

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Section: Radiation Therapymentioning

confidence: 99%

Gamma Knife radiosurgery for posterior fossa meningiomas: a multicenter study

Sheehan

Starke

Kano

et al. 2015

JNS

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“…External-beam radiation therapy 2,11,32,35,36,38,53,55 as well as stereotactic radiosurgery [3][4][5][6]12,14,[16][17][18][19][20]22,26,27,30,31,33,34,37,40,41,[43][44][45][46]48,54,58,60,61,63,64 have become viable adjuvant treatment as well as primary treatment modalities for many meningiomas. Their use is supported by high rates of tumor control and a low incidence of complications.…”

mentioning

confidence: 99%

Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival

Williams¹,

Yen²,

Starke³

et al. 2011

JNS

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Object. Stereotactic radiosurgery serves as an important primary and adjuvant treatment option for patients with many types of intracranial meningiomas. This is particularly true for patients with parasellar meningiomas. In this study, the authors evaluated the outcomes of Gamma Knife surgery (GKS) used to treat parasellar meningiomas.Methods. The study is a retrospective review of the outcomes in 138 patients with meningiomas treated at the University of Virginia from 1989 to 2006; all patients had a minimum follow-up of 24 months. There were 31 men and 107 women whose mean age was 54 years (range 19-85 years). Eighty-four patients had previously undergone resection. The mean pre-GKS tumor volume was 7.5 ml (range 0.2-54.8 ml). Clinical and radiographic evaluations were performed, and factors related to favorable outcomes in each case were assessed.Results. The mean follow-up duration was 84 months (median 75.5 months, range 24-216 months). In 118 patients (86%), the tumor volume was unchanged or had decreased at last follow-up. Kaplan-Meier analysis demonstrated radiographic progression-free survival at 5 and 10 years to be 95.4% and 69%, respectively. Fourteen patients (10%) developed new cranial nerve palsies following GKS. Factors associated with tumor control included younger age, a higher isodose, and smaller tumor volume. A longer follow-up duration was associated with either a decrease or increase in tumor volume. Fourteen patients (10%) experienced new or worsening cranial nerve deficits after treatment. Factors associated with this occurrence were larger pretreatment tumor volume, lower peripheral radiation dose, lower maximum dose, tumor progression, and longer follow-up.Conclusions. Gamma Knife surgery offers an acceptable rate of tumor control for parasellar meningiomas and accomplishes this with a low incidence of neurological deficits. Radiological control after radiosurgery is more likely in those patients with a smaller tumor volume and a higher prescription dose. (DOI: 10.3171/2011.1.JNS091939) keY WorDs • stereotactic radiosurgery • parasellar meningioma • skull base • cavernous sinus 1571Abbreviations used in this paper: GKS = Gamma Knife surgery; PFS = progression-free survival.

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“…[28][29][30] As more conformal therapies were developed, higher radiation doses could be administered while sparing dose to surrounding neural structures, resulting in an additional improvement in the 10-year progression-free survival rate. In a more recent study, Mendenhall et al 31 have shown five-, 10-, and 15-year local control rates of 95, 92, and 92%, respectively, for meningiomas treated with radiation therapy subsequent to subtotal resection.…”

Section: Radiosurgical Treatmentmentioning

confidence: 96%

“…25,[33][34][35] The efficacy of this method is clearly demonstrated by radiosurgical control rates, which have been reported to be extremely high: approaching or exceeding 90% in many contemporary studies involving either linear accelerator-based systems or gamma knife surgery (GKS). 2,3,25,31,[36][37][38][39][40][41] The efficacy of stereotatic radiosurgery as an alternative to aggressive resection was confirmed in a recent study published by Davidson et al 42 They found that for those patients treated with GKS with an initial subtotal resection or with recurrent disease, the five-and 10-year actuarial progression-free survival rate was 100 and 94%, respectively.…”

Section: Radiosurgical Treatmentmentioning

confidence: 99%

Surgical and Radiation Treatment of Skull Base Meningiomas

Cole¹,

Couldwell²

2008

US Neurology

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Meningiomas comprise approximately 20% of adult primary intracranial neoplasms.1 Of these, benign meningiomas are known to have an indolent growth pattern, usually without infiltration into adjacent nervous tissue. [2][3][4][5] Because meningiomas have a well-circumscribed character, surgery has historically been the preferred treatment when total resection can be achieved with reasonable morbidity. Surgical resection has resulted in five-, 10-, and 15-year progression-free rates of 93, 80, and 68%, respectively. 6 Despite the development of multiple techniques designed to minimize morbidity while obtaining a surgical cure, however, complete resection remains difficult and is not achievable in approximately 20-30% of presenting patients because of multiple regional involvement, severe adherence to or invasion of the brainstem, involvement of cranial nerves, or encasement of the vertebrobasilar circulation. 6-11 Currently, controversy exists as to whether skull base meningiomas, especially those involving the petroclivus and/or cavernous sinus, are best treated with radical resection, subtotal resection followed by radiosurgical treatment of the residual lesion, or radiosurgical treatment alone. Petroclival Tumors and Cavernous ExtensionMeningiomas of the petroclival region usually involve the petrous apex and the upper two-thirds of the clivus. Appropriately, cautious subtotal resection has become the preferred treatment to reduce post-operative morbidity, along with the addition of radiation treatment of tumor remnants. 18-21Meningiomas along the medial sphenoid wing that invade the cavernous sinus are also a treatment challenge because of the possibility of tumor infiltration of the traversing cranial nerves and internal carotid artery and, to a lesser degree, the involvement of the adjacent pituitary gland. 22 The goal of surgical cure must therefore take into account local invasion of neurovascular structures within the cavernous sinus. As a consequence, several authors have emphasized the use of subtotal resection to limit the risk for permanent post-operative cranial nerve or the potential for vascular injury over complete resection. 7,9,12,23 The long-term outcome after subtotal resection of meningiomas within the cavernous sinus alone is, however, associated with an unacceptably high symptomatic recurrence rate. 24 Radiosurgical TreatmentDespite the high symptomatic recurrence rate and microsurgical improvements over the past few years, subtotal resection of meningiomas along the skull base, particularly those within the petroclival and cavernous sinus locations, remains a desired surgical outcome because such limited resection lends an acceptable level of morbidity. 7,11,[25][26][27] Because of the unacceptable morbidity of radical resection, along with the high incidence of recurrence, adjuvant techniques for treating these tumors have been developed.Early studies from the 1980s demonstrated that external-beam field radiation therapy could provide durable local tumor control for those benign meningio...

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Radiotherapy alone or after subtotal resection for benign skull base meningiomas

Cited by 104 publications

References 37 publications

Gamma Knife radiosurgery for posterior fossa meningiomas: a multicenter study

Gamma Knife radiosurgery for posterior fossa meningiomas: a multicenter study

Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival

Surgical and Radiation Treatment of Skull Base Meningiomas

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