The Role of Postoperative Irradiation in the Management of Sphenoid Wing Meningiomas

Peele, Kimberly A.; Kennerdell, John S.; Maroon, Joseph C.; Kalnicki, Shalom; Kazim, Michael; Gardner, Thomas W.; Malton, Mark L.; Goodglick, Todd; Rosen, Carl E.

doi:10.1016/s0161-6420(96)30430-2

Cited by 66 publications

(17 citation statements)

References 27 publications

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“…Actual tumor growth control rate after GMK of CS meningiomas ranged from 91% to 96.5% at 5 years and 82% to 94% at 10 years (10,12,13,16,23,24,35). In our series, 85.7% patients (12 out of 14 patients) after GMK treatment did not regrow for a mean follow up of 90.6 months and 2 patients had related acceptable complications, including 1 patient had visual deterioration and 1 face hypesthesia on the side of tumor after GMK.…”

Section: Radiosurgerymentioning

confidence: 57%

Large medial sphenoid wing meningiomas: long-term outcome and correlation with tumor size after microsurgical treatment in 127 consecutive cases

Liu

Yuan²,

Liu³

et al. 2012

Turkish Neurosurgery

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AIm:We present the long-term outcomes as well as their correlation with tumor size in 127 consecutive patients harboring large MSWM after microsurgical treatment. mATeRIAL and meTHods:The retrospective analysis of clinical data and follow-up data of 127 microsurgical treated patients with MSWM was performed. The mean maximum diameter of tumors was 5.2cm (ranged 1.5-10.0cm).ResuLTs: 104 cases (81.9%) achieved gross total resection. There was no operative mortality. Detailed follow-up data was available in 120 cases for a mean duration of 81.6 months (12-216 months). The permanent morbidity was 14.2%. The mean KPS score 1 year after surgery was 90.6 (ranged 60-100). Among 74 patients of preoperative visual acuity (VA) impairment, postoperative VA improved in 42 cases (56.8%), unchanged in 30 (40.5%), and deteriorated in 2 (2.7%). MR images revealed tumor recurrence after total resection in 10 cases (10.2%) and tumor progression after subtotal resection in 10 cases (45.5%).CoNCLusIoN: Tumor recurrence was the major risk in the long run, thus the initial surgery was extremely important and hence should be aggressive. The size of tumor affected the extent of tumor removal determining clinical outcomes including VA improvement and KPS score immediately after surgery; however, it was not correlated with long-term overall outcomes. BuLGuLAR: 104 olguda (%81,9) gros total rezeksiyon yapıldı. Operatif mortalite yoktu. Ayrıntılı takip verileri 120 olguda ortalama 81,6 ay (12-216 ay) için mevcuttu. Kalıcı morbidite %14,2 oranında görüldü. Cerrahiden 1 yıl sonra ortalama KPS skoru 90,6 (aralık 60-100) bulundu. Preoperatif görme keskinliği bozukluğu olan 74 hasta içinde postoperatif dönemde görme keskinliği 42 hastada (%56,8) arttı, 30'unda (%40,5) değişmedi ve 2'sinde (%2,7) kötüye gitti. MR görüntüleri total rezeksiyon sonrasında 10 olguda (%10,2) tümör reküransı ve subtotal rezeksiyon sonrasında 10 olguda (%45,5) tümör ilerlemesi gösterdi. soNuÇ: Uzun dönemde temel risk tümör reküransıydı ve bu nedenle ilk cerrahi çok önemlidir ve agresif olmalıdır. Tümör büyüklüğü, tümör çıkarma kapsamını etkileyerek ameliyattan hemen sonra görme keskinliği düzelmesi ve KPS skoru dahil klinik sonuçları etkiledi ancak uzun dönemli genel sonuçlarla korelasyon göstermedi.ANAHTAR sÖZCÜKLeR: Medial sfenoid kanat menenjiyomları, Tümör büyüklüğü, Tümör reküransı, İşlevsel sonuç

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Section: Radiosurgerymentioning

confidence: 57%

Large medial sphenoid wing meningiomas: long-term outcome and correlation with tumor size after microsurgical treatment in 127 consecutive cases

Liu

Yuan²,

Liu³

et al. 2012

Turkish Neurosurgery

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“…After first salvage treatment for a WHO grade I meningioma, considerably higher rates of subsequent progression have been reported, particularly after surgery alone. 29,30,36,45,46 For recurrent grade I meningiomas treated with re-resection, 3-year local progression risk of 55-60% is reported. 30,46 Stafford identified a 25% 10-year local progression risk after initial diagnosis, and essentially the same risk at 2 years (24%) after first recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…45 With specific reference to sphenoid wing meningiomas involving the optic apparatus often treated with subtotal resection, Peele found a mean interval to first recurrence/progression of 4.4 years, but a considerably shorter mean interval of 14 months after first recurrence. 36 Mehdorn published an experience with 463 patients noting that first recurrences are found at a mean 65 months, whereas second recurrences developed at a mean 34 months. 29 This approximates the rates of first recurrence following gross total resection of a WHO grade II meningioma.…”

Section: Discussionmentioning

confidence: 99%

Intermediate-risk meningioma: initial outcomes from NRG Oncology RTOG 0539

Rogers

Zhang

Vogelbaum

et al. 2018

Journal of Neurosurgery

195

102

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Objective(s) This is the first clinical outcomes report of NRG Oncology RTOG 0539, detailing the primary endpoint, 3-year progression-free survival (3yPFS), compared to a predefined historical control for intermediate-risk meningioma, and secondarily evaluating overall survival (OS), local failure, and prospectively scored adverse events (AEs). Methods NRG Oncology RTOG 0539 was a phase II clinical trial allocating meningioma patients to 1 of 3 prognostic groups and management strategies according to WHO grade, recurrence status, and resection extent. For the intermediate-risk group (Group 2), eligible patients had either newly diagnosed WHO grade II meningioma with gross total resection (GTR, Simpson I-III) or recurrent WHO grade I of any resection extent. Pathology and imaging were centrally reviewed. Patients were treated with radiation therapy (RT), either intensity modulated (IMRT) or 3D conformal (3DCRT), 54 Gy in 30 fractions. The RT target volume was defined as the tumor bed and any nodular enhancement (e.g. recurrent WHO grade I patients) with a minimum 8 mm and maximum 15 mm margin, depending upon tumor locale and set-up reproducibility of RT method. The primary endpoint was 3yPFS. Results were compared to historical controls (3yPFS 70% following GTR alone and 90% with GTR + RT). AEs were scored using NCI Common Toxicity Criteria. Results Fifty-six patients enrolled in the intermediate-risk group; 3 were ineligible. Additionally, 1 did not receive RT, and 4 withdrew without recurrence before 3 years. Thus 52 patients received protocol therapy, and 48 were evaluable for the primary endpoint, 3y PFS which was 93.8% (p=.0003). Within 3 years there were 3 PFS events: 1 WHO grade II patient died of disease, 1 WHO grade II patient progressed and remained alive, and 1 recurrent WHO grade I patient died from undetermined cause without progression. Three-year local failure was 4.1%, and 3-year OS 96%. After 3 years 2 additional patients progressed: 1 recurrent WHO grade I, and the other WHO grade II; both remain alive. Among 52 evaluable patients who received protocol treatment, 36 (69.2%) were WHO II with GTR, and 16 (30.8%) recurrent WHO I. There was no significant difference in PFS between these subgroups (p=.52, HR 0.56, 95% CI 0.09 to 3.35), validating their consolidation. Of the 52 evaluable patients, 44 (84.6%) received IMRT, and 50 (96.2%) were treated per protocol or with acceptable variation. AEs (definitely, probably or possibly related to protocol treatment) were limited to grade 1 or 2, with no reported grade 3 events. Conclusion This is the first clinical outcomes report from NRG Oncology RTOG 0539. Patients with intermediate-risk meningioma treated with RT experienced excellent 3yPFS with a low rate of local failure, and a low risk of adverse events. These results support the use of post-operative RT for newly diagnosed gross totally resected WHO grade II, or recurrent WHO grade I meningioma irrespective of resection extent. They also document minimal toxicity and high rates of tumor contr...

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“…Other presenting signs and symptoms include afferent dysfunction, lateral or superior rectus muscle restriction, ptosis, and neuropathy of cranial nerves II, III, and IV. 9 Growth of these tumors can lead to blindness and neurological sequelae of cavernous sinus or orbital apex involvement. Resection alone would leave these patients with significant deformity and a pulsating exophthalmos.…”

Section: Commentmentioning

confidence: 99%

Reconstruction After Resection of Sphenoid Wing Meningiomas

Leake

Gunnlaugsson

Urban

et al. 2005

Archives of Facial Plastic Surgery

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To review our experience of reconstructing the lateral and superior orbital walls after resection of sphenoid wing meningiomas. We will review the presentation and complications, examine the aesthetic results postoperatively, and compare preoperative and postoperative computed tomographic scans. To our knowledge, a comparative analysis of preoperative defect and postoperative reconstruction has not been performed. Methods:We conducted a retrospective analysis, with a minimum of 5 months and a maximum of 9 years of follow-up in an academic multidisciplinary skull base center. Twenty-two patients were treated for sphenoid wing meningiomas by resection and reconstruction with split calvarial bone graft and, for more than half of the patients, also with free abdominal fat graft. The main outcome measures were aesthetic evaluation of patients and analysis of tumor control using computed tomographic scans, survival, and complications.Results: A total of 24 resections were performed on 22 patients. The average follow-up was 14.6 months. All patients had meningiomas with similar preoperative presentations, and for 21 of the 22 patients aesthetic reconstruction resulted in the near symmetry of the 2 sides. All patients are currently alive, those who underwent complete resection are without recurrence, and 15 (68.2%) did not incur complications. One patient experienced a worsening of temporal wasting following radiation therapy. Conclusion:Reconstruction of the defect with split calvarial bone and free abdominal fat grafts affords the patient excellent aesthetic results as well as good symmetry, as demonstrated by a postoperative computed tomographic scan.

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The Role of Postoperative Irradiation in the Management of Sphenoid Wing Meningiomas

Cited by 66 publications

References 27 publications

Large medial sphenoid wing meningiomas: long-term outcome and correlation with tumor size after microsurgical treatment in 127 consecutive cases

Large medial sphenoid wing meningiomas: long-term outcome and correlation with tumor size after microsurgical treatment in 127 consecutive cases

Intermediate-risk meningioma: initial outcomes from NRG Oncology RTOG 0539

Reconstruction After Resection of Sphenoid Wing Meningiomas

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