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Wang JZ, Agnihotri S, Zadeh G. Radiation-Induced Meningiomas. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1416:159-173. [PMID: 37432626 DOI: 10.1007/978-3-031-29750-2_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
While the majority of meningiomas encountered clinically are sporadic, there is a rare subset that arises due to early life or childhood irradiation. Sources of this radiation exposure may be due to treatment of other cancers such as acute childhood leukemia, other central nervous system tumors such as medulloblastoma, the treatment of tinea capitis (rarely and historically), or environmental exposures, as seen in some of the Hiroshima and Nagasaki atomic bomb survivors. Regardless of their etiology, however, radiation-induced meningiomas (RIMs) tend to be highly biologically aggressive irrespective of WHO grade and are usually refractory to the conventional treatment modalities of surgery and/or radiotherapy. In this chapter, we will discuss these RIMs in their historical context, their clinical presentation, their genomic features and ongoing efforts to better understand these tumors from a biological standpoint in order to develop better, more efficacious therapies for these patients.
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Affiliation(s)
- Justin Z Wang
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada.
- Division of Neurosurgery, Department of Surgery, The University of Toronto, Toronto, ON, Canada.
| | - Sameer Agnihotri
- University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA, USA
| | - Gelareh Zadeh
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, The University of Toronto, Toronto, ON, Canada
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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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Abstract
Radiation-induced meningiomas (RIMs) became more common as the use of ionizing radiation was adopted in the treatment of medical conditions, both benign and malignant. Currently, RIMs represent the most common radiation-induced tumors. They are heterogeneous in terms of patient characteristics, radiographic appearance, genetics, pathology, symptoms, and management strategies. They tend to occur in a younger population and are generally more aggressive in nature than their spontaneous counterparts. Their characteristics also vary based on the dose of radiation received, which is most commonly separated into low dose (<10Gy) and high dose (>10Gy). The importance of the dosing classification is that it can provide insight into the nature and biologic behavior of the tumor. Given their heterogeneity, RIMs pose significant challenges in management. While surgical resection remains the preferred treatment when feasible, recent data supports stereotactic radiosurgery (SRS) as a comparable alternative. Although there is more knowledge about the molecular pathways leading to RIMs, targeted drug therapy is still limited and is the focus of current research.
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Huo M, Laperriere N, van Prooijen M, Shultz D, Coolens C, Hodaie M, Cusimano M, Gentili F, Zadeh G, Payne D, Schwartz M, Tsang DS. Efficacy of stereotactic radiosurgery for radiation-induced meningiomas. J Neurooncol 2020; 148:299-305. [PMID: 32342330 DOI: 10.1007/s11060-020-03515-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/22/2020] [Indexed: 01/24/2023]
Abstract
PURPOSE Stereotactic radiosurgery is an established treatment option for sporadic meningiomas, though limited data exists for radiation-induced lesions. METHODS Patients treated with cobalt-60 radiosurgery between October 2005 and December 2018 in an institutional registry were reviewed. Single fraction treatments were prescribed to the 50% isodose line. Lesions were deemed to be radiation-induced according to standard criteria previously established by Cahan et al. RESULTS: A total of 37 patients with 72 lesions were analysed. Median follow up per patient was 44 months (range, 1.4-150.7 months). Median age at initial radiotherapy was 5 years (4 months-48 years), and at radiosurgery was 38 years. Of the 72 lesions, 62 were grade 1 (n = 4) or radiologically-diagnosed (n = 58), six were grade 2 and four were grade 3. Median lesion volume was 2.13 cc (0.04-13.8 cc), while the median radiosurgery margin dose was 13 Gy. Local control, on a per lesion basis, was 88.6% at 5 years (95% confidence interval [CI] 72.3-95.6). For grade 1 or radiologically-diagnosed lesions, local control was 96.6% at 5 years (95% CI 77.9-99.5), whereas those with grade 2 or higher lesions had a local control of 40% at 5 years (95% CI 5.2-75.3, p = 0.005). Radiologic oedema developed in 17 lesions (23.6%) and was symptomatic in 12 patients (16.7%). Doses above 12 Gy were not associated with local control probability (p = 0.292). CONCLUSION Radiosurgery is an effective treatment option for grade 1 or radiologically-diagnosed radiation-induced meningiomas, with 12 Gy appearing to be a sufficient dose.
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Affiliation(s)
- Michael Huo
- Princess Margaret Cancer Centre, Toronto, Canada. .,The University of Toronto, Toronto, Canada. .,The University of Queensland, Brisbane, Australia.
| | - Normand Laperriere
- Princess Margaret Cancer Centre, Toronto, Canada.,The University of Toronto, Toronto, Canada
| | - Monique van Prooijen
- Princess Margaret Cancer Centre, Toronto, Canada.,The University of Toronto, Toronto, Canada
| | - David Shultz
- Princess Margaret Cancer Centre, Toronto, Canada.,The University of Toronto, Toronto, Canada
| | - Catherine Coolens
- Princess Margaret Cancer Centre, Toronto, Canada.,The University of Toronto, Toronto, Canada
| | - Mojgan Hodaie
- The University of Toronto, Toronto, Canada.,Toronto Western Hospital, Toronto, Canada
| | - Michael Cusimano
- The University of Toronto, Toronto, Canada.,St Michael's Hospital, Toronto, Canada
| | - Fred Gentili
- The University of Toronto, Toronto, Canada.,Toronto Western Hospital, Toronto, Canada
| | - Gelareh Zadeh
- The University of Toronto, Toronto, Canada.,Toronto Western Hospital, Toronto, Canada
| | - David Payne
- Princess Margaret Cancer Centre, Toronto, Canada.,The University of Toronto, Toronto, Canada
| | - Michael Schwartz
- The University of Toronto, Toronto, Canada.,Toronto Western Hospital, Toronto, Canada
| | - Derek S Tsang
- Princess Margaret Cancer Centre, Toronto, Canada.,The University of Toronto, Toronto, Canada
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Imber BS, Neal B, Casey DL, Darwish H, Lin AL, Cahlon O, Chon B, Tsai H, Hug E, Yamada Y, Yang TJ. Clinical Outcomes of Recurrent Intracranial Meningiomas Treated with Proton Beam Reirradiation. Int J Part Ther 2019; 5:11-22. [PMID: 31773037 DOI: 10.14338/ijpt-18-00045.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/28/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose Recurrent meningiomas remain therapeutically challenging, often progressive despite multimodality salvage. There are limited data guiding reirradiation (reRT), and proton beam radiation therapy (PBRT) offers a potential advantage owing to lower integral brain dose. Patients and Methods We retrospectively conducted a review of 16 patients who received PBRT reRT for recurrent meningiomas. Kaplan-Meier and proportional hazards were used to determine post-PBRT progression-free survival (PFS) and overall survival (OS) and to evaluate clinical predictors. Results At diagnosis, 7 (44%), 8 (50%), and 1 (6%) patient had World Health Organization (WHO) grade I, II and III tumors, respectively. All received prior radiation therapy (RT) to a median of 54 Gy (range 13-65.5). Median time to PBRT reRT after prior RT was 5.8 years (range 0.7-18.7). Median PBRT dose was 60 Gy(RBE) (range 30-66.6), and median planning tumor volume (PTV) was 76 cm3 (range 8-249). Median follow-up was 18.8 months. At last follow-up, 7 intracranial recurrences (44%) and 3 disease-related deaths (19%) were found. Median cohort PFS was 22.6 months, with 1- and 2-year PFS of 80% and 43%, respectively. Median OS was not achieved, with 1- and 2-year OS of 94% and 73%; all deaths were felt to be related to meningioma. Patients with initially grade I tumors had improved PFS versus higher grade (Hazard Ratio, HR = 0.23, P = .03) with 1- and 2-year PFS estimates of 100% versus 71% and 75% versus 29%, respectively. Longer interval between prior RT and PBRT also predicted improved PFS (P = .03) and OS (P = .049). Overall late grade 3+ toxicity rate was 31%. Two patients (13%) developed radionecrosis at 6 and 16 months after PBRT; only 1 was symptomatic. Conclusions This is the first series specifically analyzing PBRT alone as a reRT strategy for recurrent meningioma. We report fair intracranial control with low rates of radionecrosis at 1 year after reRT. However, strategies to achieve durable outcomes are needed, particularly for high-grade tumors.
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Affiliation(s)
- Brandon S Imber
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian Neal
- ProCure Proton Therapy Center, Somerset, NJ, USA
| | - Dana L Casey
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heba Darwish
- ProCure Proton Therapy Center, Somerset, NJ, USA
| | - Andrew L Lin
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oren Cahlon
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian Chon
- ProCure Proton Therapy Center, Somerset, NJ, USA
| | - Henry Tsai
- ProCure Proton Therapy Center, Somerset, NJ, USA
| | - Eugen Hug
- ProCure Proton Therapy Center, Somerset, NJ, USA
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T Jonathan Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Raheja A, Satyarthee GD. Sphenoid wing en plaque meningioma development following craniopharyngioma surgery and radiotherapy: Radiation-induced after three decades. Asian J Neurosurg 2017; 12:358-361. [PMID: 28761508 PMCID: PMC5532915 DOI: 10.4103/1793-5482.180946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Radiation therapy is widely used as adjuvant or primary treatment modality of neoplastic lesions. Radiation therapy may cause an acute adverse effect such as brain edema, radiation necrosis, or delayed, for example, panhypopituitarism, vasculitis, and rare de-novo neoplasm development. However, radiation-induced meningioma (RIM) occurrence is extremely rare. A detailed PubMed and Medline search yielded only three isolated Case-reports of RIM development in craniopharyngioma cases receiving radiotherapy after surgery. All cases occurred in patients < 13-year age, with male preponderance, detected after a mean interval of 23-year, the range being 2–44 years. Two had solitary while the third had multiple meningiomas. Authors report an 8-year-old female, who was operated for craniopharyngioma and received adjuvant therapy, was asymptomatic for next 30 years, met a road traffic accident and magnetic resonance imaging brain revealed incidental right sphenoid wing en plaque meningioma. She was planned for gamma-knife therapy as unwilling for surgical intervention. Management of RIM development after radiotherapy of craniopharyngioma along with pertinent literature is reviewed briefly.
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Affiliation(s)
- Amol Raheja
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Guru Dutta Satyarthee
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
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Liu A, Kuhn EN, Lucas JT, Laxton AW, Tatter SB, Chan MD. Gamma Knife radiosurgery for meningiomas in patients with neurofibromatosis Type 2. J Neurosurg 2015; 122:536-42. [PMID: 25555193 PMCID: PMC9168962 DOI: 10.3171/2014.10.jns132593] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Neurofibromatosis Type 2 (NF2) is a rare autosomal dominant disorder predisposing patients to meningiomatosis. The role of stereotactic radiosurgery (SRS) is poorly defined in NF2, and although the procedure has excellent control rates in the non-NF2 population, its utility has been questioned because radiation has been hypothesized to predispose patients to malignant transformation of benign tumors. To the authors' knowledge, this is the first study to examine the use of SRS specifically for meningiomas in patients with NF2. METHODS The authors searched a tumor registry for all patients with NF2 who had undergone Gamma Knife radiosurgery (GKRS) for meningioma in the period from January 1, 1999, to September 19, 2013, at a single tertiary care cancer center. Medical records were retrospectively reviewed for patient and tumor characteristics and outcomes. RESULTS Among the 12 patients who met the search criteria, 125 meningiomas were identified, 87 (70%) of which were symptomatic or progressive and thus treated with GKRS. The median age at the first GKRS was 31 years (interquartile range [IQR] 27-37 years). Five patients (42%) had multiple treatments with a median of 27 months (IQR 14-50 months) until the subsequent GKRS. The median follow-up in surviving patients was 43 months (IQR 34-110 months). The 5-year local tumor control and distant treatment failure rates were 92% and 77%, respectively. Toxicities occurred in 25% of the GKRS treatments, although the majority were Grade 1 or 2. At the last follow-up, 4 patients (33%) had died a neurological death at a median age of 39 years (IQR 37-46 years), and their cases accounted for 45% of all tumors, 55% of all treated tumors, and 58% of all GKRSs. Univariate analysis revealed several predictive variables for distant failure, including male sex (HR 0.28, 95% CI 0.086-0.92, p = 0.036), age at distant failure (HR 0.92, 95% CI 0.90-0.95, p < 0.0001), and prior number of GKRS treatments (HR 1.2, 95% CI 1.1-1.4, p = 0.0049). Local failure, maximum size of the treated tumor, delivered tumor margin dose, and WHO grade were not significant. On multivariate analysis, age at distant failure (HR 0.91, 95% CI 0.88-0.95, p < 0.0001) and prior number of GKRSs (HR 1.3, 95% CI 1.1-1.5, p = 0.004) remained significant. No malignant transformation events among treated tumors were observed. CONCLUSIONS Radiosurgery represents a feasible modality with minimal toxicity for NF2-associated meningiomas. Increasing patient age was associated with a decreased rate of distant failure, whereas an increasing number of prior GKRS treatments predicted distant failure. Further studies are necessary to determine the long-term patterns of treatment failure in these patients.
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Affiliation(s)
- Ann Liu
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Elizabeth N. Kuhn
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John T. Lucas
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Adrian W. Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen B. Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael D. Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Ogbonnaya ES, Peev N, Nagaraja S, Dardis R. Double trouble: a tale of two radio-treatments. BMJ Case Rep 2014; 2014:bcr-2014-205922. [PMID: 25239997 DOI: 10.1136/bcr-2014-205922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In recent years, an increasing number of patients are treated with radiation. In the early era of radiotherapy, which began soon after X-rays were discovered by Roentgen in 1895, tumours were irradiated with high doses of X-rays in a single fraction. The major initial setback was the damage caused to normal tissues; however, in recent times the use of stereotactic radiosurgery, which delivers high doses of radiation precisely to abnormal tissue targets while sparing the surrounding normal brain tissue, and particularly for surgically inaccessible tumours, has taken centre stage. Prophylactic whole brain radiation (in conjunction with aggressive chemotherapy) for childhood acute lymphoblastic leukaemia has been shown to improve patient survival, however, this is associated with complications in survivors. We report an interesting case of one of the longest survivors who has had double complications from radiotherapy-based interventions.
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Affiliation(s)
- Ebere Sunny Ogbonnaya
- Department of Neurosurgery, University Hospital Coventry and Warwickshire, Coventry, Coventry, UK
| | - Nikolay Peev
- Department of Neurosurgery, Salford Royal Hospital, Manchester, Manchester, UK
| | - Sanjoy Nagaraja
- Department of Radiology, University Hospital Coventry and Warwickshire, Coventry, Coventry, UK
| | - Ronan Dardis
- Department of Neurosurgery, University Hospital Coventry and Warwickshire, Coventry, Coventry, UK
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The evolving role of radiosurgery in the management of radiation-induced meningiomas: a review of current advances and future directions. BIOMED RESEARCH INTERNATIONAL 2014; 2014:107526. [PMID: 25136551 PMCID: PMC4124844 DOI: 10.1155/2014/107526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 06/30/2014] [Indexed: 11/25/2022]
Abstract
Meningiomas are among the most common primary adult brain tumors, which arise either spontaneously or secondary to environmental factors such as ionizing radiation. The latter are referred to as radiation-induced meningiomas (RIMs) which, while much less common than their spontaneous counterparts, are challenging from a management point of view. Similar to spontaneous meningiomas, the optimal management of RIMs is complete surgical resection. However, given their high grade, multiplicity, tendency to invade bone and venous sinuses, and high recurrence rate, this cannot always be accomplished safely. Therefore, other therapeutic modalities, such as stereotactic radiosurgery, have emerged. In the current review, we provide an overview of the historical outcomes achieved for RIMs through radiosurgery and microsurgical resection. Furthermore, we provide a discussion of clinical and radiological parameters that affect the decision-making process with regard to the management of RIMs. We also provide an outline of recent changes in our understanding of RIMs, based on molecular and genetic markers, and how these will change our management perspective. We conclude the review by summarizing some of the current obstacles in the management of RIMs with SRS and how current and future research can address these challenges.
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Prabhu VC, Perry EC, Melian E, Barton K, Guo R, Anderson DE. Intracranial meningiomas in individuals under the age of 30; Analysis of risk factors, histopathology, and recurrence rate. ACTA ACUST UNITED AC 2014. [DOI: 10.7243/2052-6946-2-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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11
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Kuhn EN, Taksler GB, Dayton O, Loganathan AG, Vern-Gross TZ, Bourland JD, Laxton AW, Chan MD, Tatter SB. Patterns of recurrence after stereotactic radiosurgery for treatment of meningiomas. Neurosurg Focus 2013; 35:E14. [DOI: 10.3171/2013.8.focus13283] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The purpose of this study was to evaluate patterns of failure after stereotactic radiosurgery (SRS) for meningiomas and factors that may influence these outcomes.
Methods
Based on a retrospective chart review, 279 patients were treated with SRS for meningiomas between January 1999 and March 2011 at Wake Forest Baptist Health. Disease progression was determined using serial imaging, with a minimum follow-up of 6 months (median 34.2 months).
Results
The median margin dose was 12.0 Gy (range 8.8–20 Gy). Local control rates for WHO Grade I tumors were 96.6%, 84.4%, and 75.7% at 1, 3, and 5 years, respectively. WHO Grade II and III tumors had local control rates of 72.3%, 57.7%, and 52.9% at 1, 3, and 5 years, respectively. Tumors without pathological grading had local control rates of 98.7%, 97.6%, and 94.2% at 1, 3, and 5 years, respectively. Of the local recurrences, 63.1% were classified as marginal (within 2 cm of treatment field). The 1-, 3-, and 5-year rates of distant failure were 6.5%, 10.3%, and 16.6%, respectively, for Grade I tumors and 11.4%, 17.2%, and 22.4%, respectively, for Grade II/III tumors. Tumors without pathological grading had distant failure rates of 0.7%, 3.2%, and 6.5% at 1, 3, and 5 years, respectively. Wilcoxon analysis revealed that multifocal disease (p < 0.001) and high-grade histology (WHO Grade II or III; p < 0.001) were significant predictors of local recurrence. Additionally, male sex was a significant predictor of distant recurrence (p = 0.04). Multivariate analysis also showed that doses greater than or equal to 12 Gy were associated with improved local control (p = 0.015).
Conclusions
In this patient series, 12 Gy was the minimum sufficient margin dose for the treatment of meningiomas. Male sex is a risk factor for distant failure, whereas high-grade histology and multifocal disease are risk factors for local failure.
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Affiliation(s)
| | - Glen B. Taksler
- 3Departments of Population Health and Medicine, New York University School of Medicine, New York, New York; and
| | - Orrin Dayton
- 4Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Amritraj G. Loganathan
- 2Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | | | - Adrian W. Laxton
- 2Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | - Stephen B. Tatter
- 2Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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12
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Patel TR, Chiang VLS. Secondary neoplasms after stereotactic radiosurgery. World Neurosurg 2013; 81:594-9. [PMID: 24148883 DOI: 10.1016/j.wneu.2013.10.043] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 10/17/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The use of medical radiation has increased 6-fold in the past 30 years. Within neurosurgery, the advent of stereotactic radiosurgery (SRS) has significantly altered the treatment paradigm for both benign and malignant central nervous system diseases. With this increased reliance on radiation has come a responsibility to identify the long-term risks, including the potential development of radiation-induced neoplasms. Although the data regarding traditional radiation exposure and its subsequent risks are well-defined, the data for SRS is less developed. METHODS We reviewed the published literature to more accurately define the risk of developing secondary neoplasms after stereotactic radiosurgery. RESULTS A total of 36 cases of SRS-induced neoplasms were identified. More than half of the cases had an initial diagnosis of vestibular schwannoma. Overall, the risk of developing an SRS-induced neoplasm is approximately 0.04% at 15 years. CONCLUSION The risk of developing an SRS-induced neoplasm is low but not zero. Thus, long-term surveillance imaging is advised for patients treated with SRS.
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Affiliation(s)
- Toral R Patel
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Veronica L S Chiang
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
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