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Bunevicius A, Suleiman M, Patel S, Martínez Álvarez R, Martinez Moreno NE, Liscak R, Hanuska J, Langlois AM, Mathieu D, Mau C, Caldwell C, Tuanquin LC, Zacharia BE, McInerney J, Lee CC, Yang HC, Peterson JL, Trifiletti DM, Ogino A, Kano H, Warnick RE, Saylany A, Buch LY, Lee JYK, Strickland BA, Zada G, Chang EL, Lunsford LD, Sheehan J. Stereotactic radiosurgery for treatment of radiation-induced meningiomas: a multiinstitutional study. J Neurosurg 2021; 135:862-870. [PMID: 33385995 DOI: 10.3171/2020.7.jns202064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Radiation-induced meningiomas (RIMs) are associated with aggressive clinical behavior. Stereotactic radiosurgery (SRS) is sometimes considered for selected RIMs. The authors investigated the effectiveness and safety of SRS for the management of RIMs. METHODS From 12 institutions participating in the International Radiosurgery Research Foundation, the authors pooled patients who had prior cranial irradiation and were subsequently clinically diagnosed with WHO grade I meningiomas that were managed with SRS. RESULTS Fifty-two patients underwent 60 SRS procedures for histologically confirmed or radiologically suspected WHO grade I RIMs. The median ages at initial cranial radiation therapy and SRS for RIM were 5.5 years and 39 years, respectively. The most common reasons for cranial radiation therapy were leukemia (21%) and medulloblastoma (17%). There were 39 multiple RIMs (35%), the mean target volume was 8.61 ± 7.80 cm3, and the median prescription dose was 14 Gy. The median imaging follow-up duration was 48 months (range 4-195 months). RIM progressed in 9 patients (17%) at a median duration of 30 months (range 3-45 months) after SRS. Progression-free survival at 5 years post-SRS was 83%. Treatment volume ≥ 5 cm3 predicted progression (HR 8.226, 95% CI 1.028-65.857, p = 0.047). Seven patients (14%) developed new neurological symptoms or experienced SRS-related complications or T2 signal change from 1 to 72 months after SRS. CONCLUSIONS SRS is associated with durable local control of RIMs in the majority of patients and has an acceptable safety profile. SRS can be considered for patients and tumors that are deemed suboptimal, poor surgical candidates, and those whose tumor again progresses after removal.
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Affiliation(s)
- Adomas Bunevicius
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Mohand Suleiman
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Samir Patel
- 2Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Roman Liscak
- 4Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir Hanuska
- 4Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Anne-Marie Langlois
- 5Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada
| | - David Mathieu
- 5Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada
| | - Christine Mau
- 6Penn State Health, Hershey Medical Center, Hershey, Pennsylvania
| | | | | | - Brad E Zacharia
- 6Penn State Health, Hershey Medical Center, Hershey, Pennsylvania
| | - James McInerney
- 6Penn State Health, Hershey Medical Center, Hershey, Pennsylvania
| | - Cheng-Chia Lee
- 7Neurological Institute, Taipei Veterans General Hospital, and National Yang-Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- 7Neurological Institute, Taipei Veterans General Hospital, and National Yang-Ming University, Taipei, Taiwan
| | | | | | - Akiyoshi Ogino
- 9Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- 9Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Anissa Saylany
- 11Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Love Y Buch
- 11Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - John Y K Lee
- 11Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | | | - Gabriel Zada
- 12University of Southern California, Los Angeles, California
| | - Eric L Chang
- 12University of Southern California, Los Angeles, California
| | - L Dade Lunsford
- 9Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jason Sheehan
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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Radiation-Induced Meningiomas: An Exhaustive Review of the Literature. World Neurosurg 2016; 97:635-644.e8. [PMID: 27713063 DOI: 10.1016/j.wneu.2016.09.094] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 09/18/2016] [Accepted: 09/23/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Radiation-induced meningioma (RIM) is an uncommon late risk of cranial irradiation. We conducted an exhaustive review of individual patient data to characterize RIM. METHODS Using a systematic search of the PubMed database, we performed a comprehensive literature review to characterize and investigate RIM. Student t tests were used to evaluate differences between variables. A Kaplan-Meier analysis was used to assess survival. Statistical significance was assessed using a log-rank test. RESULTS Our analysis included 251 cases of RIM. The average age at onset for the primary lesion was 13.0 ± 13.5 years, and the average radiation dose delivered to this lesion was 38.8 ± 16.8 Gy. Secondary meningiomas could be divided into grades I (140), II (55), and III (10) tumors. Thirty patients (11.9%) had multiple lesions, and 46 (18.3%) had recurrent meningiomas. The latency period between radiotherapy for primary lesions and the onset of meningiomas was 22.9 ± 11.4 years. The latency period was shorter for patients with grade III meningioma and for those in the high-dose and intermediate-dose radiation groups who received systemic chemotherapy. Aggressive meningiomas and multiple meningiomas were more common in the high-dose and intermediate-dose groups than in the low-dose group. The 5-year and 10-year survival rates for all patients with meningioma were 77.7% and 66.1%, respectively. CONCLUSIONS For patients treated with cranial radiotherapy, the risk of secondary meningioma warrants a longer follow-up period beyond the standard time frame typically designated for determining the risk of primary tumor relapse.
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