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Kaisman-Elbaz T, Blumenfeld P, Wygoda M, Feldman J, Shoshan Y. Recovery of cranial nerve neuropathies after LINAC-based stereotactic radiosurgery for benign cavernous sinus meningioma. J Neurooncol 2024:10.1007/s11060-024-04783-3. [PMID: 39088156 DOI: 10.1007/s11060-024-04783-3] [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: 03/30/2024] [Accepted: 07/18/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE Cranial Nerve Neuropathies (CNNs) often accompany Cavernous Sinus Meningioma (CSM), for which Stereotactic Radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSR) are established treatments. This study assesses CNNs recovery in CSM patients treated with LINAC, offering insight into treatment effectiveness. METHODS This study was conducted on 128 patients with CSM treated with LINAC-based SRS/FSR between 2005 and 2020 at a single institution. 46 patients presented with CNNs. The study analyzed patients' demographics, clinical parameters, SRS/FSR treatment characteristics, post-treatment CNNs recovery duration, status, and radiological control on their last follow-up. RESULTS The median follow-up duration was 53.4 months. Patients were treated with SRS (n = 25) or FSR (n = 21). The mean pretreatment tumor volume was 9.5 cc decreasing to a mean end-of-follow-up tumor volume was 5.1 cc. Radiological tumor control was achieved in all cases. CNN recovery was observed in 80.4% of patients, with specific nerve recoveries documented as follows: extra-ocular nerves (43.2%), trigeminal nerve (32.4%), and optic nerve (10.8%). A higher CNNs recovery rate was associated with a smaller pre-treatment tumor volume (p < 0.001), and the median time-to-improvement was 3.7 months. Patients with tumor volumes exceeding 6.8 cc and those treated with FSR exhibited prolonged time-to-improvement (P < 0.03 and P < 0.04 respectively). CONCLUSIONS This study suggests that SRS/FSR for CSM provides good and sustainable CNNs recovery outcomes with excellent long-term radiological control. A higher CNNs recovery rate was associated with a smaller pre-treatment tumor volume. while shorter time-to-improvement was identified in patients treated with SRS compared to FSR, particularly in those with small pre-treatment tumor volume.
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Affiliation(s)
- Tehila Kaisman-Elbaz
- Department of Neurosurgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Philip Blumenfeld
- Radiotherapy Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Marc Wygoda
- Radiotherapy Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - John Feldman
- Radiotherapy Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Yigal Shoshan
- Department of Neurosurgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Ortiz García IM, Rodríguez Valero P, Jorques Infante AM, Cordero Tous N, Expósito Hernández J, Olivares Granados G. Long-term Experience of LINAC Single-Dose Radiosurgery for Skull Base Meningiomas: A Retrospective Single-Center Study of 241 Cases. Oper Neurosurg (Hagerstown) 2023; 25:529-537. [PMID: 37655877 DOI: 10.1227/ons.0000000000000887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/27/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Stereotactic radiosurgery (SRS) is increasingly applied to treat meningiomas, attributable to their increased incidence in older individuals at greater surgical risk. To evaluate the effectiveness of treatment with linear accelerator (LINAC)-based stereotactic radiosurgery in skull base meningiomas as either primary treatment or postresection adjuvant therapy. METHODS This study included 241 patients diagnosed with skull base meningiomas treated by single-dose SRS, with a median age of 59 years. SRS was primary treatment in 68.1% (n = 164) and adjuvant treatment in 31.9% (n = 77), using LINAC (Varian 600, 6 MeV). The median tumor volume was 3.2 cm 3 , and the median coverage dose was 14 Gy. Bivariate and multivariate analyses were performed to determine predictive factors for tumor progression, clinical deterioration, and complications. Kaplan-Meier analysis was used for survival analysis. RESULTS After the median follow-up of 102 months, the tumor control rate was 91.2% (n = 220). Progression-free survival rates were 97.07%, 90.1%, and 85.7% at 5, 10, and 14 years, respectively. Clinical improvement was observed in 56 patients (23.2%). In multivariate analysis, previous surgery (hazard ratio 3.8 [95%CI 1.136-12.71], P = .030) and selectivity (hazard ratio .21 [95%CI 0.066-0.677], P = .009) were associated with tumor progression and increased maximum dose (odds ratio [OR] 4.19 [95% CI 1.287-13.653], P = .017) with clinical deterioration. The permanent adverse radiation effect rate was 6.2% (n = 15) and associated with maximum brainstem dose >12.5 Gy (OR 3.36 [95% CI .866-13.03], P = .08) and cerebellopontine angle localization (OR 3.93 [95% CI 1.29-11.98], P = .016). CONCLUSION Treatment of skull base meningiomas with single-dose SRS using LINAC is effective over the long term. Superior tumor control is obtained in patients without previous surgery. Adverse effects are related to localization in the cerebellopontine angle, and maximum brainstem radiation dose was >12.5 Gy.
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Affiliation(s)
- Isabel M Ortiz García
- Department of Neurological Surgery, "Virgen de las Nieves" University Hospital, Granada , Spain
| | - Paula Rodríguez Valero
- Department of Neurological Surgery, "Virgen de las Nieves" University Hospital, Granada , Spain
| | - Ana M Jorques Infante
- Department of Neurological Surgery, "Virgen de las Nieves" University Hospital, Granada , Spain
| | - Nicolás Cordero Tous
- Department of Neurological Surgery, "Virgen de las Nieves" University Hospital, Granada , Spain
| | - José Expósito Hernández
- Department of Radiotherapy and Oncology, "Virgen de las Nieves" University Hospital, Granada , Spain
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Zabolotny RV, Kozlov AV, Galkin MV, Cherekaev VA, Kadasheva AB, Golanov AV, Strunina YV. [Comparison of methods of treatment of meningiomas invading the superior sagittal sinus]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:69-77. [PMID: 37830471 DOI: 10.17116/neiro20238705169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
There are various approaches to the treatment of patients with parasagittal meningiomas. OBJECTIVE To optimize treatment strategy for meningiomas invading the superior sagittal sinus. MATERIAL AND METHODS The study included 87 patients with benign parasagittal meningiomas between 2010 and 2012. Of these, 34 patients underwent surgery alone, 27 - radiotherapy, 26 - surgery and subsequent radiotherapy. Both groups were comparable in male-to-female ratio, age and localization of tumors in relation to superior sagittal sinus. The follow-up period was at least 5 years. We analyzed the effect of treatment on neurological status, Karnofsky score and tumor growth control. RESULTS Mean volume of tumors was 43.3 cm3 in patients undergoing surgery and 6.7 cm3 in the radiotherapy group. In the combined treatment group, mean volume was 65.8 cm3 before surgery and 8.8 cm3 before irradiation. General cerebral symptoms (84%), epileptic seizures (37%) and movement disorders (31%) prevailed. Surgery provided the best results in patients with small meningiomas (<14 cm3) causing focal neurological symptoms. Isolated radiotherapy was the most effective in asymptomatic patients. Large tumors required surgery with adjuvant irradiation. CONCLUSION Benign parasagittal meningiomas followed by focal neurological symptoms require surgical intervention regarding the best functional outcomes and tumor growth control. Radiotherapy without surgery is advisable for progressive asymptomatic tumors. Resection followed by irradiation is preferable if total resection without the risk of damage to veins and cortex is impossible.
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Affiliation(s)
- R V Zabolotny
- Moscow Multi-field Clinical Center «Kommunarka», Moscow, Russia
| | - A V Kozlov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - M V Galkin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | - A V Golanov
- Burdenko Neurosurgical Center, Moscow, Russia
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Belanger K, Ung TH, Damek D, Lillehei KO, Ormond DR. Concomitant Temozolomide plus radiotherapy for high-grade and recurrent meningioma: a retrospective chart review. BMC Cancer 2022; 22:367. [PMID: 35392834 PMCID: PMC8988385 DOI: 10.1186/s12885-022-09340-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background High-grade and recurrent meningiomas are often treatment resistant and pose a therapeutic challenge after surgical and radiation therapy (RT) failure. Temozolomide (TMZ) is a DNA alkylating agent that appears to have a radiosensitizing effect when used in combination with RT and may be worthwhile in meningioma treatment. Thus, we investigated the potential efficacy of concomitant RT plus TMZ compared to historical controls of just RT used in the treatment of high-grade and recurrent meningiomas. Methods We performed a retrospective analysis of patients with meningioma treated at the University of Colorado with TMZ chemoradiation. Progression free survival (PFS) and overall survival (OS) were calculated from the start of chemoradiation to local recurrence or death, respectively. Results Eleven patients (12 tumors) were treated with chemoradiation with a median follow-up of 41.5 months. There were two WHO grade 1, eight grade 2 and two grade 3 meningiomas. Three patients died during the follow-up period—one being disease related (11.1%). Two patients had meningioma recurrence—at 2.3 months (WHO grade 3), and 5.4 years (WHO grade 2). Three-year OS and PFS for grade 2 meningiomas were each 88%. Historical controls demonstrate a 3-year median OS and PFS of 83% and 75.8%, respectively. Conclusions Treatment options are limited for meningiomas after local failure. In this study, TMZ chemoradiation demonstrated no significant difference in PFS and OS in the treatment of grade 2 meningiomas compared to historic controls. Further study is warranted to find novel methods for the treatment of malignant and recurrent meningiomas.
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Affiliation(s)
- Katherine Belanger
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Timothy H Ung
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Denise Damek
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kevin O Lillehei
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - D Ryan Ormond
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA.
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Hypofractionated Stereotactic Radiotherapy for the Treatment of Benign Intracranial Meningiomas: Long-Term Safety and Efficacy. ACTA ACUST UNITED AC 2021; 28:3683-3691. [PMID: 34590613 PMCID: PMC8482200 DOI: 10.3390/curroncol28050314] [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: 08/28/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
Introduction: Hypofractionated stereotactic radiotherapy (hSRT) has emerged as an alternative to single-fraction stereotactic radiosurgery (SRS) and conventionally fractionated radiotherapy for the treatment of intracranial meningiomas (ICMs). However, there is a need for data showing long-term efficacy and complication rates, particularly for larger tumors in sensitive locations. Methods: A retrospective review was conducted on adult patients with ICMs seen at a tertiary care center. Eligible patients were treated with the CyberKnife platform and had a planned treatment course of 3–5 fractions from 2011–2020. The local control was assessed based on radiographic stability and the late toxicity/radionecrosis rates were recorded. Radiographic progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method. Results: In total, 62 patients (age 26–87) with 67 treated tumors were included in this study with a median follow-up of 64.7 months. RT was delivered as the primary treatment in 62.7% of cases and for recurrence in 37.3%. The most common tumor locations were the convexity of the brain and the base of the skull. The tumor sizes ranged from 0.1–51.8 cc and the median planning target volume was 4.9 cc. The most common treatment schedule was 18 Gy in 3 fractions. The five-year PFS and OS were 85.2% and 91.0%, respectively. The late grade III/IV toxicity rate was 3.2% and the radionecrosis rate was 4.8%. Conclusions: Based on our data, hSRT remains an effective modality to treat low-grade ICMs with acceptable long-term toxicity and radionecrosis rates. hSRT should be offered to patients who are not ideal candidates for SRS while preserving the benefits of hypofractionation.
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Vakharia K, Hasegawa H, Stafford SL, Link MJ. Salvage Radiosurgery for Optic Nerve Sheath Meningioma. Cureus 2021; 13:e16450. [PMID: 34422481 PMCID: PMC8369972 DOI: 10.7759/cureus.16450] [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] [Accepted: 07/18/2021] [Indexed: 11/17/2022] Open
Abstract
Optic nerve sheath meningiomas (ONSMs) are rare and benign tumors that affect the optic nerve. Although surgical decompression may be used for large tumors that cause mass effect on the surrounding structures, the mainstay of treatment is radiotherapy. We report the case of a 54-year-old female patient who presented with progressive vision loss due to a recurrent right ONSM despite fractionated radiotherapy eight years prior and the subsequent interval regression of the tumor. The optical coherence tomography at the time of recurrence revealed thinning of the right retinal nerve fiber layer. She underwent salvage stereotactic radiosurgery using a marginal dose of 15 Gy. At six months post-radiosurgery, the patient had a dramatic improvement in visual acuity and visual fields despite persistent thinning of the retinal nerve fiber layer. This case illustrates how salvage radiosurgery can be a useful treatment modality in these challenging situations. This tumor’s exophytic growth and the steep dose fall-off of Gamma Knife radiosurgery might favorably affect visual recovery. However, the outcomes of single-session radiosurgery for ONSMs should be further evaluated.
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Affiliation(s)
- Kunal Vakharia
- Department of Neurosurgery, University of South Florida, Tampa, USA.,Neurosurgery, Mayo Clinic, Rochester, USA
| | - Hirotaka Hasegawa
- Neurosurgery, Mayo Clinic, Rochester, USA.,Department of Neurosurgery, University of Tokyo, Tokyo, JPN
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Adhikari M, Adhikari B, Adhikari A, Yan D, Soni V, Sherman J, Keidar M. Cold Atmospheric Plasma as a Novel Therapeutic Tool for the Treatment of Brain Cancer. Curr Pharm Des 2020; 26:2195-2206. [PMID: 32116185 DOI: 10.2174/1381612826666200302105715] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Studies from the past few years revealed the importance of Cold Atmospheric Plasma (CAP) on various kinds of diseases, including brain cancers or glioblastoma (GBM), and hence coined a new term 'Plasma Medicine' in the modern world for promising therapeutic approaches. Here, we focus on the efficacy of CAP and its liquid derivatives on direct interactions or with specific nanoparticles to show pivotal roles in brain cancer treatment. METHOD In the present review study, the authors studied several articles over the past decades published on the types of CAP and its effects on different brain cancers and therapy. RESULTS A growing body of evidence indicates that CAP and its derivatives like Plasma Activated Media/ Water (PAM/PAW) are introduced in different kinds of GBM. Recent studies proposed that CAP plays a remarkable role in GBM treatment. To increase the efficacy of CAP, various nanoparticles of different origins got specific attention in recent times. In this review, different strategies to treat brain cancers, including nanoparticles, are discussed as enhancers of CAP induced targeted nanotherapeutic approach. CONCLUSION CAP treatment and its synergistic effects with different nanoparticles hold great promise for clinical applications in early diagnosis and treatment of GBM treatment. However, results obtained from previous studies were still in the preliminary phase, and there must be a concern over the use of optimal methods for a dosage of CAP and nanoparticles for complete cure of GBM.
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Affiliation(s)
- Manish Adhikari
- Department of Mechanical and Aerospace Engineering, The George Washington University, Science & Engineering Hall, 800 22nd Street, NW, Washington, DC, 20052, United States
| | - Bhawana Adhikari
- Plasma Bioscience Research Center, Applied Plasma Medicine Center, Department of Electrical and Biological Physics, Kwangwoon University, Seoul, 01897, Korea
| | - Anupriya Adhikari
- Department of Chemistry, Babasaheb Bhimrao Ambedkar University, Lucknow, 226025, India
| | - Dayun Yan
- Department of Mechanical and Aerospace Engineering, The George Washington University, Science & Engineering Hall, 800 22nd Street, NW, Washington, DC, 20052, United States
| | - Vikas Soni
- Department of Mechanical and Aerospace Engineering, The George Washington University, Science & Engineering Hall, 800 22nd Street, NW, Washington, DC, 20052, United States
| | - Jonathan Sherman
- Neurological Surgery, The George Washington University, Foggy Bottom South Pavilion, 22nd Street, NW, 7th Floor, Washington, DC, 20037, United States
| | - Michael Keidar
- Department of Mechanical and Aerospace Engineering, The George Washington University, Science & Engineering Hall, 800 22nd Street, NW, Washington, DC, 20052, United States
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Ha MH, Jang WY, Jung TY, Kim IY, Lim SH, Moon KS, Jung S. Treatment Outcome of Gamma Knife Radiosurgery for Petroclival Meningiomas: Retrospective Analysis of a Single Institution Experience. Brain Tumor Res Treat 2020; 8:83-92. [PMID: 33118341 PMCID: PMC7595854 DOI: 10.14791/btrt.2020.8.e16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 11/20/2022] Open
Abstract
Background Although Gamma Knife radiosurgery (GKRS) has been widely used for intracranial meningiomas as an alternative or adjuvant treatment, guidelines have not been established for the selection of patients with petroclival meningioma (PCM) for GKRS. In this study, we reported the factors related to tumor progression and postoperative complications in PCM patients treated by GKRS, with a review of the literatures. Methods Between 2004 and 2019, 64 patients (52 patients for alternative and 12 patients for adjuvant treatment) with PCM underwent GKRS in our institution. The clinical and radiological factors were retrospectively analyzed. The mean radiologic follow-up duration was 58.4 months (range, 6–164 months). The mean tumor volume and diameter before GKRS were 13.4 cm3 and 2.9 cm, respectively. The median marginal dose was 12 Gy (range, 10–14 Gy) with a 50% median isodose line. Fractionation was used in 19 cases (29%, two fractionations in 5 cases & three fractionations in 14 cases). Results Progression was noted in 7 cases (10.9%) and the progression-free survival rates were 91.1% at 5 years and 69.6% at 10 years. Although large in volume, moderate to severe peritumoral edema and male gender were somewhat related to progression, they did not reach statistical significance. Ten patients (15.6%) developed complications after GKRS. The most common complication was cranial nerve deficit (n=8), followed by hemiparesis, cognitive dysfunction, and hydrocephalus. Large size (maximal diameter ≥5 cm) [hazard ratio (HR) 0.091, 95% confidence interval (CI) 0.014–0.608; p=0.013] and multiplicity (HR 0.102, 95% CI 0.018–0.573; p=0.009) were independent factors for developing complications after GKRS. Conclusion GKRS can be considered an effective and safe treatment for large-volume PCM. However, for patients with large size or multiple masses, the treatment method should be determined with caution because the probability of complications after GKRS may increase.
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Affiliation(s)
- Myeong Hun Ha
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Woo Youl Jang
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Tae Young Jung
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - In Young Kim
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Sa Hoe Lim
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Kyung Sub Moon
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.
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Sarhan N, Abduljabbar L, Laperriere N, Shultz D, Asha M, Zadeh G, Millar BA, Tsang DS. Short Course Hypofractionated Radiotherapy for Frail or Elderly Patients With Meningioma. Cureus 2020; 12:e8604. [PMID: 32676243 PMCID: PMC7362603 DOI: 10.7759/cureus.8604] [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] [Indexed: 11/17/2022] Open
Abstract
Purpose/Objective(s) The incidence of intracranial meningiomas increases with age. The standard of care treatment is complete surgical excision, followed by radiation therapy (RT) if indicated. However, six weeks of RT can be challenging for elderly or frail patients. The purpose of this study was to determine if short course RT is safe and effective in elderly patients with meningioma. Materials/Methods We performed a retrospective analysis of patients with meningioma treated with short course beam RT (5-15 fractions) at a single institution. Seventeen patients (94%) received 4005 cGy over 15 fractions and one patient (6%) received 2500 cGy over five fractions. Study endpoints were treatment toxicity (edema), progression-free (PFS) and overall survival (OS). Results Eighteen patients with histologically proven (n = 12) or radiologically presumed meningioma (n = 6, presumed grade I) were identified. Median age at treatment was 85 years (66-95 years). There were eight, eight and two patients with grade I, II and III tumours, respectively. Eight patients (44%) had radiologic edema prior to RT. Six (33%) required dexamethasone treatment during RT and the dose was increased during RT for two patients. Fourteen patients had reduced or no edema post-RT and 13 patients had stable or improving symptoms post-RT. Six patients had disease progression (five in-field, one out-of-field). Median PFS was 3.3 and 0.9 years for grade I and II/III tumours, respectively (p = 0.014). Median OS was 3.3 and 2.5 years for grade I and II/III tumours, respectively (p = 0.12). Conclusion Short course RT for elderly patients with meningioma is well-tolerated and can offer disease control for some patients, particularly those with grade I tumours.
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Affiliation(s)
- Nasim Sarhan
- Radiation Oncology, Princess Margaret Cancer Center, Toronto, CAN
| | - Lulwah Abduljabbar
- Radiation Oncology, King Fahad Specialist Hospital, Dammam, SAU.,Radiation Oncology, Princess Margaret Cancer Center, Toronto, CAN
| | | | - David Shultz
- Radiation Oncology, Princess Margaret Cancer Center, Toronto, CAN
| | - Mohammed Asha
- Neurosurgery, Toronto Western Hospital, Toronto, CAN
| | - Gelareh Zadeh
- Neurosurgery, Toronto Western Hospital, Toronto, CAN
| | | | - Derek S Tsang
- Radiation Oncology, Princess Margaret Cancer Center, Toronto, CAN
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Zabolotny RA, Fedyanin AV, Yulchiev UA, Galkin MV, Kozlov AV. [Comprehensive treatment of patients with parasagittal meningiomas]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:121-125. [PMID: 31577278 DOI: 10.17116/neiro201983041121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
For many years, radical surgery was considered the only effective method for treating meningiomas, including parasagittal meningiomas (PSM). However, accumulated experience makes it evident that extensive resections in the parasagittal region lead to impaired venous outflow and involve high rates of disability and mortality. In recent decades, stereotactic radiotherapy has been developed and widely implemented in practical neurosurgery, its role in the treatment of PSM patients is discussed in this work. MATERIAL AND METHODS A sample of publications in the PubMed search system was taken using the following keywords: meningioma, parasagittal, superior sagittal sinus, stereotactic radiosurgery, stereotactic radiation therapy. No publications of evidence levels 1 and 2 have been found. Out of 123 works, 32 most relevant were selected. RESULTS AND DISCUSSION Currently, both neurosurgeons and radiologists are involved in the treatment of PSM. An analytical review of the literature on the treatment of PSM is presented. Both surgical treatment and radiation therapy have their pros and cons. No general approach to the treatment of these tumours has been developed to date. A comprehensive treatment is considered to be effective - the maximum possible removal of the tumor without damaging functionally significant structures, including venous outflow pathways, followed by radiotherapy for tumor residues. CONCLUSION In the existing literature, it was not possible to identify a single decision-making algorithm for the tactics of multimodality therapy for PSM patients, including the one for manipulations on the superior sagittal sinus and with regard to the role of ir irradiation radiation methods.
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Affiliation(s)
| | - A V Fedyanin
- Ryazan State Medical University named after academician I.P. Pavlov, Ryazan, Russia
| | | | - M V Galkin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A V Kozlov
- Burdenko Neurosurgical Center, Moscow, Russia
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Tumor Control and Cranial Nerve Outcomes After Adjuvant Radiosurgery for Low-Grade Skull Base Meningiomas. World Neurosurg 2019; 127:e221-e229. [DOI: 10.1016/j.wneu.2019.03.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 11/17/2022]
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Fatima N, Meola A, Pollom EL, Soltys SG, Chang SD. Stereotactic radiosurgery versus stereotactic radiotherapy in the management of intracranial meningiomas: a systematic review and meta-analysis. Neurosurg Focus 2019; 46:E2. [DOI: 10.3171/2019.3.focus1970] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/20/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEStereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) have been used as a primary treatment or adjuvant to resection in the management of intracranial meningiomas (ICMs). The aim of this analysis is to compare the safety and long-term efficacy of SRS and SRT in patients with primary or recurrent ICMs.METHODSA systematic review of the literature comparing SRT and SRS in the same study was conducted using PubMed, the Cochrane Library, Google Scholar, and EMBASE from January 1980 to December 2018. Randomized controlled trials, case-control studies, and cohort studies (prospective and retrospective) analyzing SRS versus SRT for the treatment of ICMs in adult patients (age > 16 years) were included. Pooled and subgroup analyses were based on the fixed-effect model.RESULTSA total of 1736 patients from 12 retrospective studies were included. The treatment modality used was: 1) SRS (n = 306), including Gamma Knife surgery (n = 36), linear accelerator (n = 261), and CyberKnife (n = 9); or 2) SRT (n = 1430), including hypofractionated SRT (hFSRT, n = 268) and full-fractionated SRT (FSRT, n = 1162). The median age of patients at the time of treatment was 59 years. The median follow-up duration after treatment was 35.5 months. The median tumor volumes at the time of treatment with SRS, hFSRT, and FSRT were 2.84 cm3, 5.45 cm3, and 12.75 cm3, respectively. The radiographic tumor control at last follow-up was significantly worse in patients who underwent SRS than SRT (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.27–0.82, p = 0.007) with 7% less volume of tumor shrinkage (OR 0.93, 95% CI 0.61–1.40, p = 0.72). Compared to SRS, the radiographic tumor control was better achieved by FSRT (OR 0.46, 95% CI 0.26–0.80, p = 0.006) than by hFSRT (OR 0.81, 95% CI 0.21–3.17, p = 0.76). Moreover, SRS leads to a significantly higher risk of clinical neurological worsening during follow-up (OR 2.07, 95% CI 1.06–4.06, p = 0.03) and of immediate symptomatic edema (OR 4.58, 95% CI 1.67–12.56, p = 0.003) with respect to SRT. SRT could produce a better progression-free survival at 4–10 years compared to SRS, but this was not statistically significant (p = 0.29).CONCLUSIONSSRS and SRT are both safe options in the management of ICMs. However, SRT carries a better radiographic tumor control rate and a lower incidence of posttreatment symptomatic worsening and symptomatic edema, with respect to SRS. However, further prospective studies are still needed to validate these results.
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Affiliation(s)
- Nida Fatima
- 1Department of Neurosurgery, Stanford University School of Medicine, Palo Alto; and
| | - Antonio Meola
- 1Department of Neurosurgery, Stanford University School of Medicine, Palo Alto; and
| | - Erqi L. Pollom
- 2Department of Radiation Oncology, Stanford University, Stanford, California
| | - Scott G. Soltys
- 2Department of Radiation Oncology, Stanford University, Stanford, California
| | - Steven D. Chang
- 1Department of Neurosurgery, Stanford University School of Medicine, Palo Alto; and
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Smee R, Williams J, Kotevski D, Schneider M. Radiotherapy as a means of treating meningiomas. J Clin Neurosci 2019; 61:210-218. [DOI: 10.1016/j.jocn.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/07/2018] [Accepted: 10/03/2018] [Indexed: 11/16/2022]
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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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Faramand A, Kano H, Niranjan A, Johnson SA, Hassib M, Park KJ, Arai Y, Flickinger JC, Lunsford LD. Cranial nerve outcomes after primary stereotactic radiosurgery for symptomatic skull base meningiomas. J Neurooncol 2018; 139:341-348. [PMID: 29691775 DOI: 10.1007/s11060-018-2866-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/08/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate cranial nerve (CN) outcomes after primary stereotactic radiosurgery (SRS) for petroclival, cavernous sinus, and cerebellopontine angle meningiomas. METHODS From our prospectively maintained database of 2022 meningioma patients who underwent Leksell stereotactic radiosurgery (SRS) during a 30-year interval, we found 98 patients with petroclival, 242 with cavernous sinus, and 55 patients with cerebellopontine angle meningiomas. Primary radiosurgery was performed in 245 patients. Patients included in this report had at least one CN deficit at the time of initial presentation and a minimum of 12 month follow up. Median age at the time of SRS was 58 years. Median follow up was 58 months (range 12-300 months), Median tumor volume treated with SRS was 5.9 cm3 (range 0.5-37.5 cm3), and median margin dose was 13 Gy (range 9-20Gy). RESULTS Tumor control was achieved in 229 patients (93.5%) at a median follow up of 58 months. Progression free survival rate (PFS) after SRS was 98.7% at 1 year, 96.4% at 3 years, 93.7% at 5 years, and 86.4% at 10 years Overall, 114 of the 245 patients (46.5%) reported improvement of CN function. Patients with CP angle meningiomas demonstrated lower rates of CN improvement compared to petroclival and cavernous sinus meningioma patients. Deterioration of CN function after SRS developed in 24 patients (10%). The rate of deterioration was 2.8% at 1 year, 5.2% at 3 years, and 8% at 10 years. CONCLUSION Primary SRS provides effective tumor control and favorable rate of improvement of preexisting CN deficit.
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Affiliation(s)
- Andrew Faramand
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hideyuki Kano
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. .,Department of Neurological Surgery, University of Pittsburgh, Suit B-400, UPMC Presbyterian, 200 Lothrop St, Pittsburgh, PA, 15213, USA.
| | - Ajay Niranjan
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stephen A Johnson
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mohab Hassib
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kyung-Jae Park
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, South Korea
| | - Yoshio Arai
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John C Flickinger
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - L Dade Lunsford
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Spontaneous Resolution of Optic Neuropathy in Sphenoid Wing Meningioma. Ophthalmic Plast Reconstr Surg 2017; 33:e163-e165. [DOI: 10.1097/iop.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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