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Shuto T, Matsunaga S, Sasame J. Stereotactic intensity-modulated radiotherapy for skull base meningioma using the HybridArc with Novalis STx system. Surg Neurol Int 2023; 14:420. [PMID: 38213458 PMCID: PMC10783683 DOI: 10.25259/sni_815_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/15/2023] [Indexed: 01/13/2024] Open
Abstract
Background Skull base meningiomas are often difficult to remove completely with preserved nerve function and may require radiation therapy. However, the Gamma Knife is unsuitable for large tumor volume or the optic nerve, which is difficult to identify on imaging. We report the results of stereotactic radiotherapy with HybridArc using Novalis STx for skull base meningiomas. Methods We retrospectively examined 28 patients with skull base meningioma who underwent stereotactic radiotherapy (54 Gy/30 fractions) with HybridArc. Results The 28 patients, nine males and 19 females, were aged 31-83 years (mean 58.4 years), and the tumor volume was 2.6-97.1 mL (mean 29.7 mL). HybridArc irradiation was performed with D95 54 Gy/30 fractions for all patients with a median follow-up period of 36.0 months (range: 12-78 months). Tumor control rates at 1, 2, and 5 years after radiotherapy were 92.6%, 89.1%, and 82.8%, respectively. Only one non-atypical meningioma remained uncontrolled; thus, the tumor control rate for non-atypical meningioma at 1, 2, and 5 years was 94.1%. Tumor control rates for atypical meningioma at 1, 2, and 5 years were 85.7%, 71.4%, and 53.6%, respectively, significantly worse than for non-atypical meningiomas (P = 0.0395). Radiation injury was observed in two cases (7.1%). Visual field defects were observed in 16 patients, and diplopia in 6. Visual field and diplopia improvements were achieved in 5 and 2 patients, respectively (with overlap). Conclusion Stereotactic radiotherapy (54 Gy/30 fractions) with HybridArc using Novalis STx is a safe and effective approach for relatively large skull base meningiomas.
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Affiliation(s)
- Takashi Shuto
- Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Japan
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Holdaway M, Starner J, Patel RR, Salama J, Langer DJ, Ellis JA, Boockvar JA, D'Amico RS, Wernicke AG. Improvement in visual outcomes of patients with base of skull meningioma as a result of evolution in the treatment techniques in the last three decades: a systematic review. J Neurooncol 2023; 163:485-503. [PMID: 37354356 DOI: 10.1007/s11060-023-04366-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/07/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE We systematically reviewed visual outcomes over the last three decades in patients undergoing treatment for base of skull (BOS) meningiomas and provide recommendations to preserve vision. METHODS In accordance with the PRISMA guidelines for systematic reviews, a search was conducted from 6/1/2022-9/1/2022 using PubMed and Web of Science. Inclusion criteria included (1) patients treated for BOS meningiomas (2) treatment modality specified (3) specifics of surgical techniques and/or dose/fractions of radiotherapy (4) individual patient outcomes of treatment. Each study was assessed for bias based on study design and heterogeneity of results. RESULTS A total of 50 studies were included (N = 2911). When comparing improved vision versus unchanged or worsened vision, studies investigating surgery alone published from 2006 and onward had significantly better visual outcomes compared to pre-2006 studies (p = 0.02). When comparing improved vision versus unchanged or worsened vision, studies investigating combined therapy with surgery and radiation published from 2008 and onward had significantly better visual outcomes compared to pre-2008 studies (p < 0.01). Combined modality therapy was less likely to worsen vision compared to either surgery or radiation monotherapy (p < 0.01). However, surgery and radiation monotherapy were more likely to actually improve outcomes compared to combination therapy (p < 0.01). CONCLUSION For over a decade we have observed improvement in visual outcomes in patients managed for meningioma of BOS, likely attributing the innovation in microsurgical and more targeted and conformal radiation techniques. Combination therapy may be the safest option for preventing worsening of vision, but the highest rates of improving visual function are achieved through monotherapy when indicated.
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Affiliation(s)
| | - John Starner
- Department of Radiation Medicine, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 130 East 77th Street, New York, NY, 10065, USA
| | - Roshal R Patel
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Joshua Salama
- SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - David J Langer
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - Jason A Ellis
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - John A Boockvar
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - Randy S D'Amico
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - A Gabriella Wernicke
- Department of Radiation Medicine, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 130 East 77th Street, New York, NY, 10065, USA.
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA.
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Graillon T, Tabouret E, Salgues B, Horowitz T, Padovani L, Appay R, Farah K, Dufour H, Régis J, Guedj E, Barlier A, Chinot O. Innovative treatments for meningiomas. Rev Neurol (Paris) 2023; 179:449-463. [PMID: 36959063 DOI: 10.1016/j.neurol.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/25/2023]
Abstract
Multi-recurrent high-grade meningiomas remain an unmet medical need in neuro-oncology when iterative surgeries and radiation therapy sessions fail to control tumor growth. Nevertheless, the last 10years have been marked by multiple advances in the comprehension of meningioma tumorigenesis via the discovery of new driver mutations, the identification of activated intracellular signaling pathways, and DNA methylation analyses, providing multiple potential therapeutic targets. Today, Anti-VEGF and mTOR inhibitors are the most used and probably the most active drugs in aggressive meningiomas. Peptide radioactive radiation therapy aims to target SSTR2A receptors, which are strongly expressed in meningiomas, but have an insufficient effect in most aggressive meningiomas, requiring the development of new techniques to increase the dose applied to the tumor. Based on the multiple potential intracellular targets, multiple targeted therapy clinical trials targeting Pi3K-Akt-mTOR and MAP kinase pathways as well as cell cycle and particularly, cyclin D4-6 are ongoing. Recently discovered driver mutations, SMO, Akt, and PI3KCA, offer new targets but are mostly observed in benign meningiomas, limiting their clinical relevance mainly to rare aggressive skull base meningiomas. Therefore, NF2 mutation remains the most frequent mutation and main challenging target in high-grade meningioma. Recently, inhibitors of focal adhesion kinase (FAK), which is involved in tumor cell adhesion, were tested in a phase 2 clinical trial with interesting but insufficient activity. The Hippo pathway was demonstrated to interact with NF2/Merlin and could be a promising target in NF2-mutated meningiomas with ongoing multiple preclinical studies and a phase 1 clinical trial. Recent advances in immune landscape comprehension led to the proposal of the use of immunotherapy in meningiomas. Except in rare cases of MSH2/6 mutation or high tumor mass burden, the activity of PD-1 inhibitors remains limited; however, its combination with various radiation therapy modalities is particularly promising. On the whole, therapeutic management of high-grade meningiomas is still challenging even with multiple promising therapeutic targets and innovations.
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Affiliation(s)
- T Graillon
- Aix-Marseille University, AP-HM, Inserm, MMG, Neurosurgery department, La Timone Hospital, Marseille, France.
| | - E Tabouret
- Aix-Marseille University, AP-HM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service de Neurooncologie, Marseille, France
| | - B Salgues
- Nuclear Medicine Department, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Assistance publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - T Horowitz
- AP-HM, CNRS, centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix-Marseille University, Marseille, France
| | - L Padovani
- AP-HM, Timone Hospital, Radiotherapy Department, Marseille, France
| | - R Appay
- AP-HM, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France; Aix-Marseille University, CNRS, INP, Inst Neurophysiopathol, Marseille, France
| | - K Farah
- Aix-Marseille University, Institut de Neurosciences des Systèmes, UMR Inserm 1106, Functional Neurosurgery and Radiosurgery, Timone University Hospital, Marseille, France
| | - H Dufour
- Aix-Marseille University, AP-HM, Inserm, MMG, Neurosurgery department, La Timone Hospital, Marseille, France
| | - J Régis
- Aix-Marseille University, Institut de Neurosciences des Systèmes, UMR Inserm 1106, Functional Neurosurgery and Radiosurgery, Timone University Hospital, Marseille, France
| | - E Guedj
- AP-HM, CNRS, centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix-Marseille University, Marseille, France
| | - A Barlier
- Aix-Marseille University, AP-HM, Inserm, MMG, Laboratory of Molecular Biology Hospital La Conception, Marseille, France
| | - O Chinot
- Aix-Marseille University, AP-HM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service de Neurooncologie, Marseille, France
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Yu J, Zeng J, Hu G, Wang J, Chen G, Huang M, Liang S, He Y, Deng Y, Gong Y, Fu J. Post-operative gamma knife radiosurgery for WHO grade I intracranial meningiomas: A single-center, retrospective study. Front Neurol 2023; 14:1094032. [PMID: 36860575 PMCID: PMC9968875 DOI: 10.3389/fneur.2023.1094032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/13/2023] [Indexed: 02/15/2023] Open
Abstract
Objective To explore the results of the Gamma Knife radiosurgery (GKRS) for World Health Organization (WHO) grade I intracranial meningiomas after surgical resection. Methods A 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. Results Of 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). Conclusions Post-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.
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Affiliation(s)
- Jinxiu Yu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiamin Zeng
- Department of Pathology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guanye Hu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jing Wang
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guohao Chen
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Minyi Huang
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shunyao Liang
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yong He
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yinhui Deng
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ye Gong
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Junyi Fu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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A Review of the Role of Stereotactic Radiosurgery and Immunotherapy in the Management of Primary Central Nervous System Tumors. Biomedicines 2022; 10:biomedicines10112977. [PMID: 36428546 PMCID: PMC9687865 DOI: 10.3390/biomedicines10112977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Stereotactic radiosurgery (SRS) and immune checkpoint inhibitors (ICIs) are widely used in the management of brain metastases. These therapies are commonly administered concurrently; as SRS may enhance anti-tumor immunity and responsiveness to ICIs. However, the use of ICIs with and without SRS in the management of primary brain tumors remains a controversial topic. Meningiomas are the most common nonmalignant and extra-parenchymal brain tumor, which often respond well to surgery and radiotherapy. However, higher grade meningiomas tend to be resistant to these treatments, and the use of chemotherapy and targeted agents in this setting have yielded disappointing results. Thus, there is heightened interest in the utilization of ICIs. Glioblastoma is the most common malignant primary intraparenchymal brain tumor. It is associated with a grim prognosis with a median overall survival of approximately 20 months, despite optimal therapy. While SRS in the adjuvant setting, and ICI in the recurrent setting, have failed to demonstrate a survival benefit, SRS in the preoperative setting has the potential to enhance anti-tumor immunity and responsiveness to ICIs. Thus, these treatments represent an attractive option to add to the armamentarium of meningioma and glioblastoma management. In this review, we provide a detailed overview of the evidence supporting the use of ICIs and SRS in each of these settings.
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Fu J, Zeng J, Huang M, Liang S, He Y, Xie L, Deng Y, Yu J. Primary versus postoperative gamma knife radiosurgery for intracranial benign meningiomas: a matched cohort retrospective study. BMC Cancer 2022; 22:206. [PMID: 35209858 PMCID: PMC8876815 DOI: 10.1186/s12885-022-09321-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
Objective The aims of this study were to investigate the long-term outcomes of primary versus postoperative Gamma Knife radiosurgery (GKRS) for benign meningiomas. Methods Three hundred and forty meningioma patients underwent GKRS were retrospectively reviewed. Patients in the postoperative GKRS group were matched to those in the primary GKRS group, in a 1:1 ratio. Results The study consisted of 122 patients, including primary (n = 61) and postoperative (n = 61) GKRS group. Thirty-four patients (27.9%) occurred radiological progression after a median follow-up of 72.5 (range, 24.2–254.5) months. The median time to radiological progression was 85.1 (range, 20.7–205.1) months. The radiological progression-free survival (PFS) was 100%, 93%, 87%, and 49%, at 1, 3, 5, and 10 years respectively. Thirty-one patients (25.4%) occurred clinical progression. The clinical PFS was 92%, 89%, 84%, and 60%, at 1, 3, 5, and 10 years. In combined group, only max diameter ≥ 50 mm was associated with radiological (p = 0.020) and clinical PFS (hazard ratio [HR] = 2.896, 95% confidence interval [CI] = 1.280–6.553, p = 0.011). Twenty-five patients (20.5%) developed GKRS related adverse effects, including radiation-induced edema (n = 21). Non-skull base tumors (HR = 3.611, 95% CI = 1.489–8.760, p = 0.005) and preexisting peritumoral edema (HR = 3.571, 95% CI = 1.167–10.929, p = 0.026) were significantly related to radiation-induced edema in combined group. There was no significant difference in radiological PFS (p = 0.403), clinical PFS (p = 0.336), and GKRS related adverse effects (p = 0.138) between primary and postoperative GKRS groups. Conclusions Primary GKRS could provide similar radiological and clinical outcomes, as well as similar complication rate compared with postoperative GKRS. For selective benign meningioma patients (asymptomatic or mildly symptomatic tumors; unfavorable locations for surgical resection; comorbidities or an advanced age), GKRS could be an alternative primary treatment.
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Affiliation(s)
- Junyi Fu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China
| | - Jiamin Zeng
- Department of Pathology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China
| | - Minyi Huang
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China
| | - Shunyao Liang
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China
| | - Yong He
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China
| | - Longchang Xie
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China
| | - Yinhui Deng
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China
| | - Jinxiu Yu
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China.
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Ius T, Tel A, Minniti G, Somma T, Solari D, Longhi M, De Bonis P, Scerrati A, Caccese M, Barresi V, Fiorentino A, Gorgoglione L, Lombardi G, Robiony M. Advances in Multidisciplinary Management of Skull Base Meningiomas. Cancers (Basel) 2021; 13:2664. [PMID: 34071391 PMCID: PMC8198762 DOI: 10.3390/cancers13112664] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 12/18/2022] Open
Abstract
The surgical management of Skull Base Meningiomas (SBMs) has radically changed over the last two decades. Extensive surgery for patients with SBMs represents the mainstream treatment; however, it is often challenging due to narrow surgical corridors and proximity to critical neurovascular structures. Novel surgical technologies, including three-dimensional (3D) preoperative imaging, neuromonitoring, and surgical instruments, have gradually facilitated the surgical resectability of SBMs, reducing postoperative morbidity. Total removal is not always feasible considering a risky tumor location and invasion of surrounding structures and brain parenchyma. In recent years, the use of primary or adjuvant stereotactic radiosurgery (SRS) has progressively increased due to its safety and efficacy in the control of grade I and II meningiomas, especially for small to moderate size lesions. Patients with WHO grade SBMs receiving subtotal surgery can be monitored over time with surveillance imaging. Postoperative management remains highly controversial for grade II meningiomas, and depends on the presence of residual disease, with optional upfront adjuvant radiation therapy or close surveillance imaging in cases with total resection. Adjuvant radiation is strongly recommended in patients with grade III tumors. Although the currently available chemotherapy or targeted therapies available have a low efficacy, the molecular profiling of SBMs has shown genetic alterations that could be potentially targeted with novel tailored treatments. This multidisciplinary review provides an update on the advances in surgical technology, postoperative management and molecular profile of SBMs.
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Affiliation(s)
- Tamara Ius
- Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Alessandro Tel
- Maxillofacial Surgery Department, Department of Medicine, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (A.T.); (M.R.)
| | - Giuseppe Minniti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy;
- IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, 80125 Naples, Italy; (T.S.); (D.S.)
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, 80125 Naples, Italy; (T.S.); (D.S.)
| | - Michele Longhi
- Unit of Radiosurgery and Stereotactic Neurosurgery, Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata (AOUI), 37128 Verona, Italy;
| | - Pasquale De Bonis
- Department of Neurosurgery, Sant’ Anna University Hospital, 44124 Ferrara, Italy; (P.D.B.); (A.S.)
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Alba Scerrati
- Department of Neurosurgery, Sant’ Anna University Hospital, 44124 Ferrara, Italy; (P.D.B.); (A.S.)
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; (M.C.); (G.L.)
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy;
| | - Alba Fiorentino
- Radiation Oncology Department, Advance Radiation Therapy, General Regional Hospital F. Miulli, 70021 Acquaviva delle Fonti, Italy;
| | - Leonardo Gorgoglione
- Department of Neurosurgery, Hospital “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy;
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; (M.C.); (G.L.)
| | - Massimo Robiony
- Maxillofacial Surgery Department, Department of Medicine, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (A.T.); (M.R.)
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Takehana K, Nakamura D, Abdelghaffar A, Uto M, Katagiri T, Arakawa Y, Mineharu Y, Miyamoto S, Mizowaki T. Short diameter may be a useful simple indicator of the tumor response in skull base meningiomas after conventionally fractionated stereotactic radiotherapy. Eur Radiol 2021; 31:6367-6373. [PMID: 33569622 PMCID: PMC8270820 DOI: 10.1007/s00330-021-07707-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/08/2020] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the radiological change patterns in skull base meningiomas after conventionally fractionated stereotactic radiotherapy (CFSRT) to determine a simple and valid method to assess the tumor response. MATERIALS AND METHODS Forty-one patients with a benign skull base meningioma treated by CFSRT from March 2007 to August 2015 were retrospectively evaluated. We measured tumor volume (TV), long-axis diameter (LD), and short-axis diameter (SD) on both pre-treatment images and follow-up images of 1, 3, and 5 years after CFSRT, respectively. The paired t test was used to detect differences in the LD and SD change rates. Spearman's correlation coefficients were calculated to evaluate relationships between the TV and the diameters changes. RESULTS The number of available follow-up MRIs that was performed at 1, 3, and 5 years after the CFSRT was 41 (100%), 34 (83%), and 23 (56%), respectively. The change rates of SD were significantly higher than those of LD at every time point and more strongly correlated with the change rates of tumor volume at 3 and 5 years after CFSRT. CONCLUSIONS SD may be useful as a simple indicator of the tumor response for skull base meningioma after CFSRT. KEY POINTS • The change rate in short-axis diameter is a useful and simple indicator of the response of skull base meningioma to conventionally fractionated stereotactic radiotherapy. • Conventionally fractionated stereotactic radiotherapy for skull base meningioma achieved excellent 5-year local control.
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Affiliation(s)
- Keiichi Takehana
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Daisuke Nakamura
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.,Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Alshaymaa Abdelghaffar
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.,Department of Clinical Oncology, Sohag University Hospital, Sohag University, Sohag, Egypt
| | - Megumi Uto
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tomohiro Katagiri
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yohei Mineharu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
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Ottenhausen M, Rumalla K, Alalade AF, Nair P, La Corte E, Younus I, Forbes JA, Ben Nsir A, Banu MA, Tsiouris AJ, Schwartz TH. Decision-making algorithm for minimally invasive approaches to anterior skull base meningiomas. Neurosurg Focus 2019; 44:E7. [PMID: 29606040 DOI: 10.3171/2018.1.focus17734] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior skull base meningiomas are benign lesions that cause neurological symptoms through mass effect on adjacent neurovascular structures. While traditional transcranial approaches have proven to be effective at removing these tumors, minimally invasive approaches that involve using an endoscope offer the possibility of reducing brain and nerve retraction, minimizing incision size, and speeding patient recovery; however, appropriate case selection and results in large series are lacking. METHODS The authors developed an algorithm for selecting a supraorbital keyhole minicraniotomy (SKM) for olfactory groove meningiomas or an expanded endoscopic endonasal approach (EEA) for tuberculum sella (TS) or planum sphenoidale (PS) meningiomas based on the presence or absence of olfaction and the anatomical extent of the tumor. Where neither approach is appropriate, a standard transcranial approach is utilized. The authors describe rates of gross-total resection (GTR), olfactory outcomes, and visual outcomes, as well as complications, for 7 subgroups of patients. Exceptions to the algorithm are also discussed. RESULTS The series of 57 patients harbored 57 anterior skull base meningiomas; the mean tumor volume was 14.7 ± 15.4 cm3 (range 2.2-66.1 cm3), and the mean follow-up duration was 42.2 ± 37.1 months (range 2-144 months). Of 19 patients with olfactory groove meningiomas, 10 had preserved olfaction and underwent SKM, and preservation of olfaction in was seen in 60%. Of 9 patients who presented without olfaction, 8 had cribriform plate invasion and underwent combined SKM and EEA (n = 3), bifrontal craniotomy (n = 3), or EEA (n = 2), and one patient without both olfaction and cribriform plate invasion underwent SKM. GTR was achieved in 94.7%. Of 38 TS/PS meningiomas, 36 of the lesions were treated according to the algorithm. Of these 36 meningiomas, 30 were treated by EEA and 6 by craniotomy. GTR was achieved in 97.2%, with no visual deterioration and one CSF leak that resolved by placement of a lumbar drain. Two patients with tumors that, based on the algorithm, were not amenable to an EEA underwent EEA nonetheless: one had GTR and the other had a residual tumor that was followed and removed via craniotomy 9 years later. CONCLUSIONS Utilizing a simple algorithm aimed at preserving olfaction and vision and based on maximizing use of minimally invasive approaches and selective use of transcranial approaches, the authors found that excellent outcomes can be achieved for anterior skull base meningiomas.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Matei A Banu
- 2Department of Neurosurgery, Columbia-Presbyterian Medical Center, New York, New York
| | | | - Theodore H Schwartz
- Departments of1Neurological Surgery.,3Otorhinolaryngology.,5Neuroscience, Weill Cornell Medical College; and
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10
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Hung YC, Lee CC, Guo WY, Shiau CY, Chang YC, Pan DHC, Sheehan JP, Chung WY. Gamma knife radiosurgery for the treatment of cavernous sinus meningiomas: post-treatment long-term clinical outcomes, complications, and volume changes. J Neurooncol 2019; 143:261-270. [PMID: 31020456 DOI: 10.1007/s11060-019-03090-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/03/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the outcomes of patients who underwent Gamma Knife radiosurgery (GKRS) for the treatment of cavernous sinus (CS) meningiomas. METHODS We retrospectively reviewed the clinical and radiological outcomes of 95 patients with CS meningiomas at Taipei Veterans General Hospital between 1993 and 2011. The study cohort comprised 27 men and 68 women with a median age of 50 years (range 29-79 years). The median pre-GKRS tumor volume was 6.6 ml (range 0.9-35.7 ml). The median margin dose was 12 Gy (range 11-21 Gy). The clinical factors related to favorable outcomes were assessed. RESULTS The median follow-up period was 59 (range 12-209) months. At the final follow-up, the tumor volume regressed in 70 patients (74%) and progressed in eight (8%). Kaplan-Meier analysis revealed that the progression-free survival rates at 5 and 10 years were 92.7% and 81.2%, respectively. Three patients (3.2%) experienced exacerbated cranial nerve dysfunction following radiosurgery. Confined tumors were found to be an independent prognostic factor for tumor control and shorter times to regression in the multivariable analyses. No risk factor for tumor progression was identified in either the univariate or multivariate analyses. CONCLUSIONS GKRS provides good long-term tumor control and is associated with low cranial nerve-related morbidity development rates in patients with small- to medium-sized CS meningiomas. Confined tumor could be an independent prognostic factor for tumor control and shorter times to regression in multivariate analysis. Life-long follow-up is mandatory in such settings, even for outpatients with shrunken or stabilized tumors.
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Affiliation(s)
- Yi-Chieh Hung
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan, Republic of China.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan, Republic of China.,Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.,School of Medicine, National Yang-Ming University, 17 F., No. 210, Sec. 2, Shi-Pai Rd., Beitou, Taipei, 11217, Taiwan, Republic of China
| | - Wan-Yuo Guo
- School of Medicine, National Yang-Ming University, 17 F., No. 210, Sec. 2, Shi-Pai Rd., Beitou, Taipei, 11217, Taiwan, Republic of China.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Cheng-Ying Shiau
- School of Medicine, National Yang-Ming University, 17 F., No. 210, Sec. 2, Shi-Pai Rd., Beitou, Taipei, 11217, Taiwan, Republic of China.,Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, Taipei, Taiwan, Republic of China
| | - David Hung-Chi Pan
- School of Medicine, National Yang-Ming University, 17 F., No. 210, Sec. 2, Shi-Pai Rd., Beitou, Taipei, 11217, Taiwan, Republic of China.,Department of Neurosurgery, Taipei Medical University- Shuang Ho Hospital, New Taipei City, Taiwan, Republic of China
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Wen-Yuh Chung
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China. .,School of Medicine, National Yang-Ming University, 17 F., No. 210, Sec. 2, Shi-Pai Rd., Beitou, Taipei, 11217, Taiwan, Republic of China.
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11
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Nguyen EK, Nguyen TK, Boldt G, Louie AV, Bauman GS. Hypofractionated stereotactic radiotherapy for intracranial meningioma: a systematic review. Neurooncol Pract 2018; 6:346-353. [PMID: 31555449 DOI: 10.1093/nop/npy053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background The availability of image guidance and intensity modulation has led to the increasing use of hypofractionated stereotactic radiotherapy (hSRT) as an alternative to conventionally fractionated radiotherapy or radiosurgery for intracranial meningiomas (ICMs). As the safety and efficacy of this approach is not well characterized, we conducted a systematic review of the literature to assess the clinical outcomes of hSRT in the setting of ICMs. Methods A systematic review of Medline and EMBASE databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies were retrospective or prospective series that examined an ICM population of ≥10 patients, delivered >1 fraction of photon hSRT (≥2.5 Gy per fraction), and had a median follow-up of ≥2 years. Descriptive statistics were generated for included studies. Results Of 1480 initial studies, 14 met eligibility criteria for inclusion, reporting on 630 patients (age range, 18-90) treated for 638 tumors. Primary radiotherapy was delivered in 37% of patients, 36% had radiation following surgery, and surgical details were unavailable for 27%. In 474 tumors assessed for radiologic response, 78% remained stable, 18% decreased in size, and 4% increased in size. Crude local control was 90%-100% as reported in 10 studies. The median late toxicity rate was 10%. The most common significant late toxicities were decreased visual acuity and new cranial neuropathy. Conclusions With limited follow-up, the available literature suggests hSRT for ICMs has local control and toxicity profiles comparable to other radiotherapy approaches. Confirmation in larger patient cohorts with a longer duration of follow-up is required.
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Affiliation(s)
- Eric K Nguyen
- Department of Oncology, Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Timothy K Nguyen
- Department of Radiation Oncology, London Regional Cancer Program, Ontario, Canada
| | - Gabe Boldt
- Department of Radiation Oncology, London Regional Cancer Program, Ontario, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, London Regional Cancer Program, Ontario, Canada
| | - Glenn S Bauman
- Department of Radiation Oncology, London Regional Cancer Program, Ontario, Canada
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12
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Proton therapy for treatment of intracranial benign tumors in adults: A systematic review. Cancer Treat Rev 2018; 72:56-64. [PMID: 30530009 DOI: 10.1016/j.ctrv.2018.11.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The depth-dose distribution of a proton beam, materialized by the Bragg peak makes it an attractive radiation modality as it reduces exposure of healthy tissues to radiations, compared with photon therapy Prominent indications, based on a long-standing experience are: intraocular melanomas, low-grade skull-base and spinal canal malignancies. However, many others potential indications are under investigations such as the benign morbid conditions that are compatible with an extended life-expectancy: low grade meningiomas, paragangliomas, pituitary adenomas, neurinomas craniopharyngioma or recurrent pleomorphic adenomas. MATERIALS Given the radiation-induced risk of secondary cancer and the potential neurocognitive and functional alteration with photonic radiotherapy, we systematically analyzed the existing clinical literature about the use of proton therapy as an irradiation modality for cervical or intracranial benign tumors. The aim of this review was to report clinical outcomes of adult patients with benign intracranial or cervical tumors treated with proton therapy and to discuss about potential advantages of proton therapy over intensity modulated radiotherapy or radiosurgery. RESULTS Twenty-four studies were included. There was no randomized studies. Most studies dealt with low grade meningiomas (n = 9). Studies concerning neurinoma (n = 4), pituitary adenoma (n = 5), paraganglioma (n = 5), or craniopharyngioma (n = 1) were fewer. Whatever the indication, long term local control was systematically higher than 90% and equivalent to series with conventional radiotherapy. CONCLUSION Proton-therapy for treatment of adult benign intracranial and cervical tumors is safe. Randomized or prospective cohorts with long term cognitive evaluations are needed to assess the real place of proton-therapy in the treatment of adults benign head and neck tumors.
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13
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Leroy HA, Tuleasca C, Reyns N, Levivier M. Radiosurgery and fractionated radiotherapy for cavernous sinus meningioma: a systematic review and meta-analysis. Acta Neurochir (Wien) 2018; 160:2367-2378. [PMID: 30393820 DOI: 10.1007/s00701-018-3711-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/16/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Radiosurgery (RS) and fractionated radiotherapy (FRT) are part of the therapeutic armamentarium for the management of cavernous sinus meningiomas. We propose a systematic review of the local tumor control and clinical outcomes after monofractionated radiosurgical treatment, including gamma knife radiosurgery (GKRS) and linear accelerator (Linac RS), or fractionated radiotherapy. MATERIALS AND METHODS The current review and meta-analysis adhered to the PRISMA guidelines. We performed a search in PubMed, Embase, and Medline based on the following mesh terms, used alone or in diverse combinations, in both title and abstract: "cavernous sinus," "meningioma," "radiosurgery," "gamma knife," "linac," "cyberknife," and "radiotherapy". We screened 425 studies. We selected 36 studies, matching all selection criteria: 24 for GK, 5 for Linac, and 7 for FRT. RESULTS Were included 2817 patients (GKRS, n = 2047, LinacRS, n = 350, FRT, n = 420). Half of patients benefited from upfront RS or FRT; the other half benefited from adjuvant RS or FRT (combined approach or tumor recurrence). The mean gross target volume (GTV) was smaller for RS as compared to FRT (p = 0.07). The median marginal doses were 13.9 Gy (range, 11 to 28) for GKRS and 14 Gy (range, 12.8 to 17.7) for LinacRS. For FRT, patients received a mean dose of 51.2 Gy (25.5 fractions, 1.85 Gy each). The mean overall follow-up values were 48 months (range, 15 to 89) for GKRS, 69 months (range, 46 to 87) for Linac, and 59.5 months (range, 33 to 83) for FRT. PFS at 5 years for GKRS, LinacRS, and FRT were respectively 93.6%, 95.6%, and 97.4% (p = 0.32, the Kruskal-Wallis). Monofractionated treatments (GKRS and LinacRS) induced more tumor volume regression than FRT (p = 0.001). Tumor recurrence or progression ranged between 3 and 5.8%, without statistically significant differences between modalities (p > 0.05). Trigeminal symptoms improved in approximately 54%, and III-IV-VI cranial nerves (CN) palsies improved in approximately 45%. After GKRS, visual acuity improved in 21% (not enough data available for other modalities). De novo deficits occurred in 5 to 7.5%. Adverse radiation effects appeared in 4.6 to 9.3% (all techniques pooled). CONCLUSION RS achieved a twice-higher rate of tumor volume regression than FRT. GKRS series reported an improvement in visual acuity in 21% of the cases. GKRS, Linac, and FRT provided similar clinical post therapeutic outcomes for the trigeminal and oculomotor CN.
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Affiliation(s)
- Henri-Arthur Leroy
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
- Department of Neurosurgery and Neuro-oncology, CHU Lille, F-59000, Lille, France.
- Department of Neurosurgery, Lille University Hospital, Rue Emile Laine, 59037, Lille Cedex, France.
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Signal Processing Laboratory (LTS-5), Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Nicolas Reyns
- Department of Neurosurgery and Neuro-oncology, CHU Lille, F-59000, Lille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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14
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Bernat AL, Priola SM, Elsawy A, Farrash F, Pasarikovski CR, Almeida JP, Lenck S, De Almeida J, Vescan A, Monteiro E, Zadeh GM, Gentili F. Recurrence of Anterior Skull Base Meningiomas After Endoscopic Endonasal Resection: 10 Years' Experience in a Series of 52 Endoscopic and Transcranial Cases. World Neurosurg 2018; 120:e107-e113. [PMID: 30077030 DOI: 10.1016/j.wneu.2018.07.210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Although the indication of endoscopic approaches for anterior skull base meningiomas (ASBM) has been progressively refined, there remains a paucity of data on recurrence rates after resection. To analyze and compare recurrence rates of ASBM resected through endoscopic endonasal (EEE) versus transcranial (TCA) approaches. MATERIAL AND METHODS We performed a retrospective analysis of patients submitted to the EEE or TCA approach for ASBM resection from May 2006 to January 2016 in our center. Clinical, radiological, and pathology data were retrieved for analysis. Tumor size, location, surgical technique, extent of resection, and tumor grade were assessed. The 2 groups were compared to identify predictors and differences regarding tumor recurrence. RESULTS Fifty-two patients (17 olfactory groove meningioma [OGM] and 35 tuberculum sellae meningioma [TSM]) were included; 26 (6 OGM and 20 TSM) underwent EEE and 26 (13 OGM and 13 TSM) TCA, with a mean follow-up of 41 months. Gross total resection was achieved in 38 (73%) patients (18 [69%] in EEE and 20 [77%] in TCA). Eight (15%) patients presented with recurrence: 5 (19%) in the EEE group and 3 (11.5%) in the TCA group without a statistical difference (P = 0.69). Among the recurrences, gross total resection had been achieved in 1 case of each group. In the EEE group, 1 patient underwent TCA for a recurrent tumor and another patient was referred for radiosurgery. CONCLUSIONS This study has shown an overall similar recurrence rate of ASBM regardless of the technique used. However, the analysis of larger series with longer follow-up is necessary to clearly define the indications and to fully validate the efficacy of EEE.
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Affiliation(s)
- Anne-Laure Bernat
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada; Department of Neurosurgery, University Paris-Diderot, Lariboisière Hospital, Paris, France.
| | - Stefano Maria Priola
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada; Department of Neurosurgery, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad Elsawy
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada; Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Faisal Farrash
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada; Department of Neurosurgery, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Christopher R Pasarikovski
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Joao Paulo Almeida
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Stéphanie Lenck
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada; Department of Interventional Neuroradiology, University Pierre et Marie Curie, La Pitié-Salpêtrière Hospital, Paris, France
| | - John De Almeida
- Department of Otolaryngology, UHN, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Allan Vescan
- Department of Otolaryngology, UHN, Toronto, Ontario, Canada; Department of Otolaryngology, Mount Sinai Hospital, UHN, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology, UHN, Toronto, Ontario, Canada; Department of Otolaryngology, Mount Sinai Hospital, UHN, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gelareh Mohammed Zadeh
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Fred Gentili
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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15
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Lin AJ, Hui C, Dahiya S, Lu HC, Kim AH, Campian JL, Tsien C, Zipfel GJ, Rich KM, Chicoine M, Huang J. Radiologic Response and Disease Control of Recurrent Intracranial Meningiomas Treated With Reirradiation. Int J Radiat Oncol Biol Phys 2018; 102:194-203. [PMID: 29970312 DOI: 10.1016/j.ijrobp.2018.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/14/2018] [Accepted: 05/02/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of reirradiation of recurrent meningiomas and factors related to patient selection and treatment modality. METHODS AND MATERIALS Recurrent meningioma patients who failed prior stereotactic radiosurgery (SRS) or fractionated external beam radiation therapy (EBRT) received reirradiation using either SRS or EBRT. Complete response (CR), partial response (PR), and progression after reirradiation were evaluated using the MacDonald criteria. Local control (LC), progression-free survival (PFS), and overall survival (OS) after reirradiation were analyzed using the Kaplan-Meier method. Logistic and Cox regression analyses were performed to identify factors associated with reirradiation modality and PFS, respectively. RESULTS Forty-three patients (14 grade 1/unknown, 29 grade 2/3) were reirradiated with SRS (67%) or EBRT (33%). Median time from initial SRS/EBRT to reirradiation was 60 months (range, 7.5-202); median tumor volume at the time of reirradiation was 4.8 cm3 (range, 0.14-64). After a median radiologic follow-up of 19.4 months, the response rate (CR + PR) was 8% for grade 1 and 20% for grade 2/3 meningiomas. After 2 years, LC was 78%, PFS was 63%, and OS was 80%. Larger tumor volume and prior SRS were associated with reirradiation using EBRT. Reirradiated grade 2/3 meningiomas had significantly worse PFS than grade 1 (2-year PFS: 50% vs 92%, respectively; P = .02) but not LC (P = .11) or OS (P = .39). On multivariable analysis, worse PFS was significantly associated with grade 2/3 histology (hazard ratio, 3.92; 95% confidence interval, 1.33-11.6) as well as worse Karnofsky Performance Scale score but not reirradiation dose, volume, and modality. Grades 3 to 4 radiation necrosis developed in 4 patients (10%). CONCLUSIONS Reirradiation of recurrent meningiomas appears to be feasible with promising clinical outcomes and an acceptable toxicity profile.
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Affiliation(s)
- Alexander J Lin
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Caressa Hui
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Sonika Dahiya
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
| | - Hsiang-Chih Lu
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
| | - Albert H Kim
- Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri
| | - Jian L Campian
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Christina Tsien
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Gregory J Zipfel
- Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri
| | - Keith M Rich
- Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri
| | - Michael Chicoine
- Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri
| | - Jiayi Huang
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri.
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Brahimi Y, Antoni D, Srour R, Proust F, Cebula H, Labani A, Noël G. [Base of the skull meningioma: Efficacy, clinical tolerance and radiological evaluation after radiotherapy]. Cancer Radiother 2018; 22:264-286. [PMID: 29773473 DOI: 10.1016/j.canrad.2017.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/15/2017] [Accepted: 09/20/2017] [Indexed: 11/29/2022]
Abstract
Skull base meningioma leads to functional disturbances, which can significantly alter the quality of life. The optimal management of these lesions, whose goals are neurological preservation and tumour local control, is not yet clearly established. It is widely recognized that the goal of a radical excision should be abandoned despite the advances in the field of microsurgery of skull base lesions. Although less morbid, partial tumour excision would be associated with increased risk of local tumour recurrence. Although discussed both exclusive and adjuvant have proven to be highly successful in terms of clinical improvement and local control. Various radiation techniques have demonstrated their efficacy in the management of this pathology. However, high rates of clinical improvement are in contrast with low rates of radiological improvement. The notion of clinical and radiological dissociation appeared. However, in most of these studies, the analysis of the radiological response could be subject of legitimate criticism. This work proposes to review the local control, the efficacy and the clinical tolerance and the radiological response of the various radiation techniques for the meningioma of the base of the skull and to demonstrate the interest of quantitative volumetric analyses in the follow-up of meningioma after radiotherapy.
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Affiliation(s)
- Y Brahimi
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - D Antoni
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; Laboratoire de radiobiologie, UMR 7178 institut pluridisciplinaire Hubert-Curien (IPHC), université de Strasbourg, 67000 Strasbourg, France; CNRS, IPHC UMR 7178, 67000 Strasbourg, France
| | - R Srour
- Service de neurochirurgie, hôpital Pasteur, 39, avenue de la Liberté, 68024 Colmar cedex, France
| | - F Proust
- Service de neurochirurgie, hôpital universitaire de Strasbourg, 1, rue Molière, 67000 Strasbourg, France
| | - H Cebula
- Service de neurochirurgie, hôpital universitaire de Strasbourg, 1, rue Molière, 67000 Strasbourg, France
| | - A Labani
- Service de radiologie, hôpital universitaire de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - G Noël
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; Laboratoire de radiobiologie, UMR 7178 institut pluridisciplinaire Hubert-Curien (IPHC), université de Strasbourg, 67000 Strasbourg, France; CNRS, IPHC UMR 7178, 67000 Strasbourg, France.
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Kirkpatrick JP, Soltys SG, Lo SS, Beal K, Shrieve DC, Brown PD. The radiosurgery fractionation quandary: single fraction or hypofractionation? Neuro Oncol 2017; 19:ii38-ii49. [PMID: 28380634 DOI: 10.1093/neuonc/now301] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Stereotactic radiosurgery (SRS), typically administered in a single session, is widely employed to safely, efficiently, and effectively treat small intracranial lesions. However, for large lesions or those in close proximity to critical structures, it can be difficult to obtain an acceptable balance of tumor control while avoiding damage to normal tissue when single-fraction SRS is utilized. Treating a lesion in 2 to 5 fractions of SRS (termed "hypofractionated SRS" [HF-SRS]) potentially provides the ability to treat a lesion with a total dose of radiation that provides both adequate tumor control and acceptable toxicity. Indeed, studies of HF-SRS in large brain metastases, vestibular schwannomas, meningiomas, and gliomas suggest that a superior balance of tumor control and toxicity is observed compared with single-fraction SRS. Nonetheless, a great deal of effort remains to understand radiobiologic mechanisms for HF-SRS driving the dose-volume response relationship for tumors and normal tissues and to utilize this fundamental knowledge and the results of clinic studies to optimize HF-SRS. In particular, the application of HF-SRS in the setting of immunomodulatory cancer therapies offers special challenges and opportunities.
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Affiliation(s)
| | | | - Simon S Lo
- University of Washington, Seattle, Washington, USA
| | - Kathryn Beal
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - Dennis C Shrieve
- University of Utah School of Medicine, Salt Lake City, Utah, UT, USA
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Li Z, Li H, Wang S, Zhao J, Cao Y. Pediatric Skull Base Meningiomas: Clinical Features and Surgical Outcomes. J Child Neurol 2016; 31:1523-1527. [PMID: 27543558 DOI: 10.1177/0883073816664669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/26/2016] [Accepted: 07/04/2016] [Indexed: 11/16/2022]
Abstract
The purpose of this study is to investigate the clinical, pathological, and prognostic characteristics of pediatric skull base meningiomas. A retrospective analysis of 44 pediatric skull base patients younger than 18 years who underwent surgery at Beijing Tiantan Hospital was performed. The study group included 20 males and 24 females. Multiple lesions were seen in 8 patients. WHO grade I was found in 28 patients and higher grade was seen in 16 patients. Recurrence or progression occurred in 10 patients after the initial operation. The overall survival rate in the follow-up period for the entire cohort was 89.7%. The authors found no sex predominance in pediatric skull base meningiomas. In addition, this lesion was more often seen in their second decades. In contrast to skull base meningiomas in adult patients, pediatric skull base meningiomas had a higher incidence of nonbenign histopathological variants and a higher rate of recurrence.
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Affiliation(s)
- Zhicen Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases, Beijing, China
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Demiral S, Dincoglan F, Sager O, Gamsiz H, Uysal B, Gundem E, Elcim Y, Dirican B, Beyzadeoglu M. Hypofractionated stereotactic radiotherapy (HFSRT) for who grade I anterior clinoid meningiomas (ACM). Jpn J Radiol 2016; 34:730-737. [PMID: 27659448 DOI: 10.1007/s11604-016-0581-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/05/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE While microsurgical resection plays a central role in the management of ACMs, extensive surgery may be associated with substantial morbidity particularly for tumors in intimate association with critical structures. In this study, we evaluated the use of HFSRT in the management of ACM. MATERIALS AND METHODS A total of 22 patients with ACM were treated using HFSRT. Frameless image guided volumetric modulated arc therapy (VMAT) was performed with a 6 MV linear accelerator (LINAC). The total dose was 25 Gy delivered in five fractions over five consecutive treatment days. Local control (LC) and progression free survival (PFS) rates were calculated using the Kaplan-Meier method. Common Terminology Criteria for Adverse Events, version 4.0 was used in toxicity grading. RESULTS Out of the total 22 patients, outcomes of 19 patients with at least 36 months of periodic follow-up were assessed. Median patient age was 40 years old (range 24-77 years old). Median follow-up time was 53 months (range 36-63 months). LC and PFS rates were 100 and 89.4 % at 1 and 3 years, respectively. Only two patients (10.5 %) experienced clinical deterioration during the follow-up period. CONCLUSION LINAC-based HFSRT offers high rates of LC and PFS for patients with ACMs.
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Affiliation(s)
- Selcuk Demiral
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey.
| | - Ferrat Dincoglan
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey
| | - Omer Sager
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey
| | - Hakan Gamsiz
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey
| | - Bora Uysal
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey
| | - Esin Gundem
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey
| | - Yelda Elcim
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey
| | - Bahar Dirican
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey
| | - Murat Beyzadeoglu
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey
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Long-term evaluation of the effect of hypofractionated high-energy proton treatment of benign meningiomas by means of (11)C-L-methionine positron emission tomography. Eur J Nucl Med Mol Imaging 2016; 43:1432-43. [PMID: 26819102 DOI: 10.1007/s00259-016-3310-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine if (11)C-L-methionine PET is a useful tool in the evaluation of the long-term effect of proton beam treatment in patients with meningioma remnant. METHODS Included in the study were 19 patients (4 men, 15 women) with intracranial meningioma remnants who received hypofractionated high-energy proton beam treatment. Patients were examined with (11)C-L-methionine PET and MRI prior to treatment and after 6 months, and 1, 2, 3, 5, 7 and 10 years. Temporal changes in methionine uptake ratio, meningioma volume, meningioma regrowth and clinical symptoms throughout the follow-up period were evaluated. RESULTS In 17 patients the tumour volume was unchanged throughout the follow-up. The methionine uptake ratio on PET decreased over the years in most patients. In two patients the tumour remnant showed progression on MRI. In these patients, prior to the volume increase on MRI, the methionine uptake ratio increased. One patient experienced transient clinical symptoms and showed radiological evidence of a radiation-induced reaction close to the irradiated field. CONCLUSION Proton beam treatment is a safe and effective treatment for achieving long-term growth arrest in meningioma remnants. Follow-up with (11)C-L-methionine PET may be a valuable adjunct to, but not a replacement for, standard radiological follow-up.
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