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Masalha W, Heiland DH, Steiert C, Krüger MT, Schnell D, Heiland P, Bissolo M, Grosu AL, Schnell O, Beck J, Grauvogel J. Management of Medial Sphenoid Wing Meningioma Involving the Cavernous Sinus: A Single-Center Series of 105 Cases. Cancers (Basel) 2022; 14:2201. [PMID: 35565330 PMCID: PMC9102569 DOI: 10.3390/cancers14092201] [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: 03/15/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Medial sphenoid wing meningiomas are among the three most common intracranial meningiomas. These tumors pose a challenge to neurosurgeons in terms of surgical treatment, as they may involve critical neurovascular structures and invade the cavernous sinus. In case of the latter, a complete resection may not be achievable. The purpose of this study was to investigate prognostic features affecting recurrence and progression-free survival (PFS) of medial sphenoid wing meningiomas involving the cavernous sinus, focusing on the contribution of surgery and postoperative radiotherapy. METHODS A retrospective analysis was conducted of the database of our institution, and 105 cases of medial sphenoid wing meningioma with invasion of the cavernous sinus, which were treated between 1998 and 2019, were included. Surgical treatment only was performed in 64 cases, and surgical treatment plus postoperative radiotherapy was performed in 41 cases. Kaplan-Meier analysis was conducted to estimate median survival and PFS rates, and Cox regression analysis was applied to determine significant factors that were associated with each therapeutic modality. RESULTS The risk of recurrence was significantly reduced after near-total resection (NTR) (p-value = 0.0011) compared to subtotal resection. Progression-free survival was also significantly prolonged after postoperative radiotherapy (p-value = 0.0002). CONCLUSIONS Maximal safe resection and postoperative stereotactic radiotherapy significantly reduced the recurrence rate of medial sphenoid wing meningiomas with infiltration of the cavernous sinus.
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Affiliation(s)
- Waseem Masalha
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
| | - Dieter Henrik Heiland
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
| | - Christine Steiert
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
| | - Marie T. Krüger
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
- Department of Neurosurgery, Cantonal Hospital St. Gallen, 9000 St. Gallen, Switzerland
| | - Daniel Schnell
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
- Department of Radiation Oncology, Medical Centre—University of Freiburg, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, 79106 Freiburg, Germany
| | - Pamela Heiland
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
| | - Marco Bissolo
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
| | - Anca-L. Grosu
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
- Department of Radiation Oncology, Medical Centre—University of Freiburg, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, 79106 Freiburg, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
| | - Jürgen Beck
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
| | - Jürgen Grauvogel
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
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Cheng Y, Lin Y, Long Y, Du L, Chen R, Hu T, Guo Q, Liao G, Huang J. Is the CyberKnife radiosurgery system effective and safe for patients? An umbrella review of the evidence. Future Oncol 2022; 18:1777-1791. [PMID: 35137603 DOI: 10.2217/fon-2021-0844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: The CyberKnife system combines real-time image guidance and a dynamic tracking system to implement frameless radiotherapy. This umbrella review is aimed to evaluate the effectiveness and safety of CyberKnife. Methods: A comprehensive search of health technology assessments and systematic reviews was performed among the Embase, PubMed and other grey databases until July 2020. Treatment outcomes were extracted, and the quality of included studies were assessed using AMSTAR-2. Results: Nineteen studies were eligible. CyberKnife not only had a wide range of applications, long overall survival and great local control, but also had a limited toxicity and good cost-effectiveness compared with other radiotherapy equipment. Conclusion: Despite the relatively low quality of the evidence, our findings can still provide a decision reference for policymakers.
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Affiliation(s)
- Yifan Cheng
- Medical Device Regulatory Research & Evaluation Centre, West China Hospital, Sichuan University, Chengdu, PR China.,Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yifei Lin
- Medical Device Regulatory Research & Evaluation Centre, West China Hospital, Sichuan University, Chengdu, PR China.,Precision Medicine Research Centre, West China Hospital, Sichuan University, Chengdu, PR China
| | - Youlin Long
- Medical Device Regulatory Research & Evaluation Centre, West China Hospital, Sichuan University, Chengdu, PR China
| | - Liang Du
- Medical Device Regulatory Research & Evaluation Centre, West China Hospital, Sichuan University, Chengdu, PR China
| | - Rui Chen
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Tengyue Hu
- West China School of Medicine, Sichuan University, Chengdu, PR China
| | - Qiong Guo
- Medical Device Regulatory Research & Evaluation Centre, West China Hospital, Sichuan University, Chengdu, PR China
| | - Ga Liao
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China.,Medical Big Data Centre, Sichuan University, Chengdu, PR China.,Department of Information Management, Department of Stomatology Informatics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Jin Huang
- Medical Device Regulatory Research & Evaluation Centre, West China Hospital, Sichuan University, Chengdu, PR China
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3
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Starnoni D, Tuleasca C, Levivier M, Daniel RT. Surgery for clinoidal meningiomas with cavernous sinus extension: Near-total excision and chiasmopexy. Acta Neurochir (Wien) 2022; 164:2511-2515. [PMID: 35761109 PMCID: PMC9427927 DOI: 10.1007/s00701-022-05281-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The main factors limiting the extent of resection for clinoidal meningiomas are cavernous sinus extension and vessel adventitia involvement. The proximity to the optic apparatus and the risk of radiation-induced optic neuropathy often prevents many surgeons from proposing adjuvant radiosurgery. METHOD We describe a simple technical solution that is to place a fat graft between the optic apparatus and the residual tumor to maintain the distance gained at surgery and facilitates the identification of anatomic structures. CONCLUSION This technique allows to deliver optimal therapeutic doses to the residue reduces the dose received by the optic nerve below 8 Gy.
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Affiliation(s)
- Daniele Starnoni
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland.
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL) , Lausanne, Switzerland
| | - Marc Levivier
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Roy T Daniel
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
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Goldbrunner R, Stavrinou P, Jenkinson MD, Sahm F, Mawrin C, Weber DC, Preusser M, Minniti G, Lund-Johansen M, Lefranc F, Houdart E, Sallabanda K, Le Rhun E, Nieuwenhuizen D, Tabatabai G, Soffietti R, Weller M. EANO guideline on the diagnosis and management of meningiomas. Neuro Oncol 2021; 23:1821-1834. [PMID: 34181733 PMCID: PMC8563316 DOI: 10.1093/neuonc/noab150] [Citation(s) in RCA: 262] [Impact Index Per Article: 87.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Meningiomas are the most common intracranial tumors. Yet, only few controlled clinical trials have been conducted to guide clinical decision making, resulting in variations of management approaches across countries and centers. However, recent advances in molecular genetics and clinical trial results help to refine the diagnostic and therapeutic approach to meningioma. Accordingly, the European Association of Neuro-Oncology (EANO) updated its recommendations for the diagnosis and treatment of meningiomas. A provisional diagnosis of meningioma is typically made by neuroimaging, mostly magnetic resonance imaging. Such provisional diagnoses may be made incidentally. Accordingly, a significant proportion of meningiomas, notably in patients that are asymptomatic or elderly or both, may be managed by a watch-and-scan strategy. A surgical intervention with tissue, commonly with the goal of gross total resection, is required for the definitive diagnosis according to the WHO classification. A role for molecular profiling including gene panel sequencing and genomic methylation profiling is emerging. A gross total surgical resection including the involved dura is often curative. Inoperable or recurrent tumors requiring treatment can be treated with radiosurgery, if the size or the vicinity of critical structures allows that, or with fractionated radiotherapy (RT). Treatment concepts combining surgery and radiosurgery or fractionated RT are increasingly used, although there remain controversies regard timing, type, and dosing of the various RT approaches. Radionuclide therapy targeting somatostatin receptors is an experimental approach, as are all approaches of systemic pharmacotherapy. The best albeit modest results with pharmacotherapy have been obtained with bevacizumab or multikinase inhibitors targeting vascular endothelial growth factor receptor, but no standard of care systemic treatment has been yet defined.
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Affiliation(s)
- Roland Goldbrunner
- Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - Pantelis Stavrinou
- Neurosurgical Department, Metropolitan Hospital, Athens, Greece and Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Mawrin
- Department of Neuropathology, University of Magdeburg, Magdeburg, Germany
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Matthias Preusser
- Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Minniti
- Radiation Oncology Unit, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Morten Lund-Johansen
- Department of Neurosurgery, Bergen University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Florence Lefranc
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Emanuel Houdart
- Service de Neuroradiologie, Hopital Lariboisiere, Paris, France
| | - Kita Sallabanda
- Department of Neurosurgery, University Hospital San Carlos, Universidad Complutense de Madrid, Madrid, Spain
- Hospital Clinico Universitario San Carlos, Madrid, Spain
- CyberKnife Centre, Genesiscare Madrid, Madrid, Spain
| | - Emilie Le Rhun
- Department of Neurology and Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Ghazaleh Tabatabai
- Center for Neurooncology, Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Riccardo Soffietti
- Department of Neuro-Oncology, City of Health and Science University Hospital, Turin, Italy
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
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5
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Zach L, Agami A, Furman O, Attia M, Cohen Z, Mizrachi IBB, Tam G, Zibly Z, Nissim O, Spiegelmann R, Huna-Baron R. Neuro-ophthalmologic outcomes of standard versus hypo-fractionated stereotactic radiotherapy of AVPM. Radiat Oncol 2021; 16:166. [PMID: 34454551 PMCID: PMC8403384 DOI: 10.1186/s13014-021-01879-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most anterior visual pathway meningiomas (AVPM) are benign and slow-growing, but these tumors may affect visual functions, including visual acuity (VA) and visual field (VF). Due to location, most are treated non-surgically by fractionated stereotactic radiotherapy (FSRT), aiming to prevent tumor progression and visual functions deterioration. Unfortunately, FSRT in itself may affect visual functions. The current preferred treatment regimen (in terms of safety and effectiveness) is undetermined. While most cases are treated with conventional fractionation (cFSRT)-50.4-54 Gy in 28-30 fractions of 1.8-2 Gy, advances in technology have allowed shortening of total treatment length to hypofractionation (hSRT)-25-27 Gy in 3-5 fractions of 5-9 Gy. Our aim was to evaluate the association of radiotherapy regimen for treating AVPM (cFSRT vs. hSRT) with visual function outcomes (VA, VF) at the last neuro-ophthalmologic evaluation. METHODS We conducted a retrospective cohort study of AVPM cases treated at Sheba Medical Center during 2004-2015. We compared cFSRT and hSRT regimens regarding visual function (VA, VF) outcomes at the last neuro-ophthalmologic evaluation. VA was determined by the logarithm of the minimum angle of resolution (LogMAR). VF was determined by the mean deviation (MD). A clinically relevant change in VA was defined as 0.2 LogMAR. RESULTS 48 patients (13 receiving hSRT, 35 receiving cFSRT) were included, with a median follow-up of 55 months. No significant difference was evident regarding LogMAR or MD of involved eyes at the last evaluation. Six (17%) patients in the cFSRT group experienced clinically relevant VA deterioration in the involved eye, compared with six (46%) in hSRT (p = 0.06). CONCLUSION Our findings, using comprehensive and meticulous investigation of visual outcomes, suggest that hSRT may be associated with higher risk for VA and VF deterioration in AVPM especially in ONSM. We recommend the use of cFSRT for ONSM.
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Affiliation(s)
- Leor Zach
- Neuro-Oncology Unit, Sheba Medical Center, Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Amir Agami
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Galilee Medical Center, Nahariyya, Israel
| | - Orit Furman
- Neuro-Oncology Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Moshe Attia
- Neurosurgery Department, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Cohen
- Neurosurgery Department, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Guy Tam
- Neuro-Ophthalmology Service, Sheba Medical Center, Ramat Gan, Israel
| | - Zion Zibly
- Neurosurgery Department, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ouzi Nissim
- Neurosurgery Department, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roberto Spiegelmann
- Neurosurgery Department, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruth Huna-Baron
- Neuro-Ophthalmology Service, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hoffmann E, Clasen K, Frey B, Ehlers J, Behling F, Skardelly M, Bender B, Schittenhelm J, Reimold M, Tabatabai G, Zips D, Eckert F, Paulsen F. Retrospective analysis of recurrence patterns and clinical outcome of grade II meningiomas following postoperative radiotherapy. Radiat Oncol 2021; 16:116. [PMID: 34172069 PMCID: PMC8235826 DOI: 10.1186/s13014-021-01825-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atypical meningiomas exhibit a high tendency for tumor recurrence even after multimodal therapy. Information regarding recurrence patterns after additive radiotherapy is scarce but could improve radiotherapy planning and therapy decision. We conducted an analysis of recurrence patterns with regard to target volumes and dose coverage assessing target volume definition and postulated areas of tumor re-growth origin. Prognostic factors contributing to relapse were evaluated. METHODS The clinical outcome of patients who had completed additive, somatostatin receptor (SSTR)-PET/CT-based fractionated intensity-modulated radiotherapy for atypical meningioma between 2007 and 2017 was analyzed. In case of tumor recurrence/progression, treatment planning was evaluated for coverage of the initial target volumes and the recurrent tumor tissue. We proposed a model evaluating the dose distribution in postulated areas of tumor re-growth origin. The median of proliferation marker MIB-1 was assessed as a prognostic factor for local progression and new distant tumor lesions. RESULTS Data from 31 patients who had received adjuvant (n = 11) or salvage radiotherapy (n = 20) were evaluated. Prescribed dose ranged from 54.0 to 60.0 Gy. Local control at five years was 67.9%. Analysis of treatment plans of the eight patients experiencing local failure proved sufficient extent of target volumes and coverage of the prescribed dose of at least 50.0 Gy as determined by mean dose, D98, D2, and equivalent uniform dose (EUD) of all initial target volumes, postulated growth-areas, and areas of recurrent tumor tissue. In all cases, local failure occurred in high-dose volumes. Tumors with a MIB-1 expression above the median (8%) showed a higher tendency for re-growth. CONCLUSIONS The model showed adequate target volume and relative dose distribution but absolute dose appears lower in recurrent tumors without reaching statistical significance. This might provide a rationale for dose escalation studies. Biological factors such as MIB-1 might aid patients' stratification for dose escalation.
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Affiliation(s)
- Elgin Hoffmann
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. .,Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. .,Department of Radiation Oncology, Eberhard-Karls-University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Kerstin Clasen
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Bettina Frey
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Jakob Ehlers
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Felix Behling
- Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Marco Skardelly
- Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Clinic for Neurosurgery, Hospital Reutlingen, Reutlingen, Germany
| | - Benjamin Bender
- Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Jens Schittenhelm
- Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital Tuebingen, Calwerstr. 3, 72076, Tuebingen, Germany
| | - Matthias Reimold
- Department of Nuclear Medicine, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Ghazaleh Tabatabai
- Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tuebingen, Hertie Institute for Clinical Brain Research, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.,Department of Neurooncology, Department of Neurology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK) Partnersite Tuebingen, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Franziska Eckert
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK) Partnersite Tuebingen, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK) Partnersite Tuebingen, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Lovo EE, Moreira A, Navarro PA, Barahona KC, Campos F, Caceros V, Blanco A, Arguello-Méndez J, Arce L, Contreras WO. Multiplatform Radiosurgery for Intracranial Meningiomas and Dose to the Dural Tail. Cureus 2021; 13:e12683. [PMID: 33604217 PMCID: PMC7880855 DOI: 10.7759/cureus.12683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Introduction Meningiomas are extra-axial central nervous system tumors. Complete resection is often curative with macroscopically complete removal of the tumor, excision of its dural attachment, and any abnormal bone. Radiosurgery is also an option for high-risk patients or in patients with surgically residual disease. Dural tail is a typical radiological sign on contrast-enhanced MRI; it can contain tumor cells or be a reaction due to vascular congestion and edema. Radiosurgical planning treatment varies regarding the identification and coverage of the dural tail. This study aimed to retrospectively analyze a series of 143 patients with WHO Grade I meningiomas treated with different radiosurgical platforms, and dosing parameters focused on planning and dose delivery to the dural tail. Methods From February 2011 to July 2020, 143 patients with histologically confirmed or radiologically assumed WHO Grade I meningiomas were treated using rotating gamma-ray Infini™ (Gamma [MASEP Medical Science Technology Development Co., Shenzhen, China]), TomoTherapy® (Tomo [Accuray Inc., Sunnyvale, CA]), and CyberKnife® (CK [Accuray Inc.]). All plans were retrospectively reviewed to establish the maximum distance (MaxDis) from the prescription dose to the end of the dural tail and the minimum dose at the dural tail (MinDoseT) at this point. We also established the midpoint distance (MPDis) from the prescription dose to MaxDis and the dose at this point (MPDose). Plans were further distinguished when the physician intended to cover the dural tail versus when not. Patients and tumor response were assessed by imaging and clinical and phone call evaluations. Results Of the 143 patients, 81 were treated using Gamma, 34 using Tomo, and 28 using CK. Eighty patients were eligible for follow-up, of whom 58 (72.5%) had an unmistakable dural tail sign. Median follow-up was 1,118 days (range 189-3,496), mean age was 54.5 (range 19-90), and 61 were women, and 19 were men. Overall tumor volume was 6.5 cc (range 0.2-59); mean tumor volumes by different platforms were 2.4, 9.45, and 8 cc; dose prescribed and mean tumor coverage were 14 Gy and 92%, 14.5 Gy and 95%, and 14 Gy and 95.75% with Gamma, Tomo, and CK, respectively. The dural tail was drawn and planned with an attempt to treat in 18 patients (31%); the mean MaxDis, MinDoseT, MPDis, and MPDose were 9.0 mm, 2 Gy, 4.5 mm, and 10.6 Gy, respectively. At last follow-up, tumor control was achieved in 96% of patients for the whole series, and there were no statistical variations regarding tumor volume, dose, conformality, or control when stereotactic radiosurgery was used to cover the dural tail versus when it was not (p=0.105). One patient experienced a Grade 4 Radiation Therapy Oncology Group toxicity as an adverse radiation effect that required surgery, and 11 (7.6%) experienced a Grade 1 toxicity. Conclusions This is our preliminary report regarding the efficacy of radiosurgery for meningiomas using diverse platforms at three years of follow-up; the results regarding tumor control are in accordance with the published literature as of this writing. A conscious pursuit of the dural tail with the prescription dose has not proven to provide better tumor control than not doing so - even small areas of the tumor uncovered by the prescription dose did not alter tumor control at current follow-up. The doses delivered to these uncovered areas are quite significant; further follow-up is necessary to validate these findings.
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Affiliation(s)
- Eduardo E Lovo
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Alejandra Moreira
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Paula A Navarro
- Functional Neurosurgery, Clínica Foscal Internacional, Bucaramanga, COL
| | - Kaory C Barahona
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Fidel Campos
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Victor Caceros
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Alejandro Blanco
- Radiosurgery, Robotic Radiosurgery Center, International Cancer Center Group, San José, CRI
| | - Julio Arguello-Méndez
- Radiosurgery, Robotic Radiosurgery Center, International Cancer Center Group, San José, CRI.,Radioterapia Robótica, Centro Oncológico Costarricense, San José, CRI
| | - Leonor Arce
- Radiosurgery, Robotic Radiosurgery Center, International Cancer Center Group, San José, CRI
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8
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Vanmarcke D, Menten J, Defraene G, Van Calenbergh F, De Vleeschouwer S, Lambrecht M. Stroke rate after external fractionated radiotherapy for benign meningioma. J Neurooncol 2021; 152:99-106. [PMID: 33394261 DOI: 10.1007/s11060-020-03678-3] [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: 11/03/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Patients with a benign meningioma often have a long survival following the treatment of their meningioma. Since radiotherapy is frequently part of the treatment, long-term side effects are of considerable concern. A controversial long-term side effect of radiotherapy is stroke. Due to its severity, it is important to know the frequency of this side effect. The aim of this study was to assess the stroke incidence and risk factors among patients receiving radiotherapy for their benign meningioma. METHODS We performed a retrospective database study of patients who underwent primary or adjuvant radiotherapy for their benign meningioma at University Hospitals Leuven from January 2003 to December 2017. RESULTS We included 169 patients with a median age of 51 years (range 22-84). Every patient received fractionated radiotherapy using photons with a median dose of 56 Gy (range 54-56) in fractions of 2 Gy (range 1.8-2). The median follow-up was 5.3 years (range 0.1-14). The cumulative stroke incidence function showed an incidence of 11.6% after 9 years of follow-up, translating to a stroke incidence per year of 1.29%. We found two significant risk factors for stroke: medically treated arterial hypertension (p = 0.005) and history of previous stroke or transient ischemic attack (p < 0.001). 5-year local control and overall survival rates were respectively 97.4% and 91.2%. Other late grade III/IV toxicities occurred in 16.0% (27/169) of patients. CONCLUSION Our study shows a higher incidence of stroke in patients who received radiotherapy for their benign meningioma compared to the general population.
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Affiliation(s)
| | - Johan Menten
- Radiotherapy-Oncology, University Hospitals, Leuven, Belgium
| | - Gilles Defraene
- Department of Oncology-Laboratory Experimental Radiotherapy, KU Leuven-University of Leuven, Leuven, Belgium
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9
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Hadi I, Biczok A, Terpolilli N, Thorsteinsdottir J, Forbrig R, Albert NL, Yanchovski P, Zollner B, Bodensohn R, Corradini S, Bartenstein P, Belka C, Tonn JC, Schichor C, Niyazi M. Multimodal therapy of cavernous sinus meningioma: Impact of surgery and 68Ga-DOTATATE PET-guided radiation therapy on tumor control and functional outcome. Neurooncol Adv 2021; 3:vdab114. [PMID: 34704034 PMCID: PMC8541706 DOI: 10.1093/noajnl/vdab114] [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: 11/14/2022] Open
Abstract
BACKGROUND Functional preservation in patients with WHO grade I meningioma involving the cavernous sinus (CSM) is crucial for long-term tumor control. Concise data on the functional outcome of an interdisciplinary, multimodal treatment are scarce. We analyzed functional outcome and tumor control in CSM patients following maximal safe resection (MSR), fractionated stereotactic radiotherapy (FSRT), or combination of them, retrospectively. METHODS Patients with WHO grade I CSM treated between 2003 and 2017 were included. Prior to FSRT, a 68Ga-DOTATATE PET/CT was performed for radiation planning. Progression-free survival (PFS) was analyzed using Kaplan-Meier method and log-rank test was performed to test differences between groups. Visual function was analyzed at baseline and follow-up. RESULTS Eighty-five patients were included. MSR alone was performed in 48 patients (group A), MSR followed by FSRT in 25 patients (group B), and FSRT alone in 12 patients (group C). Intracranial tumor volumes were higher in A and B compared to C (median 9.2/10.8/4.3 ccm for A/B/C, P = .023). Median follow-up was 47/46/45 months and PFS at 5 years 55.7%, 100%, and 100% in A/B/C, respectively (P < .001). Optic nerve compression was more common in A (91.7%) and B (84.0%) than C (16.7%), P < .001. Post-therapeutic new onset or deterioration of double vision was observed in 29% (A), 17% (B), and 0% (C). CONCLUSION Personalized treatment strategies for CSM are essential to control space-occupying or functionally compromising lesions. The additional potential side effect of radiotherapy seems to be justified under the aspect of longer tumor control with low functional risk. Without space-occupying effect of CSM, FSRT alone is reasonably possible.
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Affiliation(s)
- Indrawati Hadi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Annamaria Biczok
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Nicole Terpolilli
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Robert Forbrig
- Department of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Petar Yanchovski
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Barbara Zollner
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Raphael Bodensohn
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - Christian Schichor
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
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10
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Conti A, Senger C, Acker G, Kluge A, Pontoriero A, Cacciola A, Pergolizzi S, Germanò A, Badakhshi H, Kufeld M, Meinert F, Nguyen P, Loebel F, Vajkoczy P, Budach V, Kaul D. Correction to: Normofractionated stereotactic radiotherapy versus CyberKnife-based hypofractionation in skull base meningioma: a German and Italian pooled cohort analysis. Radiat Oncol 2020; 15:279. [PMID: 33317569 PMCID: PMC7734707 DOI: 10.1186/s13014-020-01707-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Alfredo Conti
- Department of Neurosurgery, University of Bologna, Bologna, Italy.,Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Carolin Senger
- CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Güliz Acker
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), 10178, Berlin, Germany
| | - Anne Kluge
- CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Alberto Cacciola
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | | | - Antonino Germanò
- Department of Neurosurgery, University of Bologna, Bologna, Italy
| | - Harun Badakhshi
- Ernst Von Bergmann Medical Center, Department of Radiation Oncology, Potsdam, Germany
| | - Markus Kufeld
- CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Meinert
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Phuong Nguyen
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Loebel
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Budach
- CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany.
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11
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Abstract
Aim: The coronavirus disease (COVID-19) pandemic is bound to put tremendous pressure on the existing healthcare system. This aim of this technical note is to help in triaging patients with brain tumours who are sent for radiotherapy during this pandemic and to provide safe and evidence-based care. Materials and Methods: Published data for this review were identified by systematically searching PubMed database from November 2007 onwards with the following Medical Subject Heading (Mesh) terms ‘Brain tumours’, ‘COVID-19’, ‘coronavirus’, ‘SARS-nCoV-2’, ‘Radiotherapy’, ‘Guidelines’ ‘hypofractionation’ using Boolean search algorithm. Articles in English language were reviewed. Results: We tried to apply the as low as reasonable achievable (ALARA) principle in triaging and management of patients for radiotherapy. We identified protocols which have hypofractionated regimens (reducing patient visits to hospital, time spent in treatment console) with similar outcomes when compared to conventional fractionated regimens and not overburdening the healthcare facility. We also identified the tumours for which we could safely avoid or delay the initiation of radiotherapy. Conclusion: Treatment decisions made during the COVID-19 pandemic rely on the safety first/do no harm principle and evidence-based prioritisation of cases for triage. This article is a tool to aid in triaging and prioritising brain tumour patient management. This is for consideration during the pandemic only and certainly not as a strategy for permanent practice change.
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12
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Combs SE, Belka C, Niyazi M, Corradini S, Pigorsch S, Wilkens J, Grosu AL, Guckenberger M, Ganswindt U, Bernhardt D. First statement on preparation for the COVID-19 pandemic in large German Speaking University-based radiation oncology departments. Radiat Oncol 2020; 15:74. [PMID: 32264908 PMCID: PMC7136995 DOI: 10.1186/s13014-020-01527-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022] Open
Abstract
The COVID-19 pandemic is challenging modern radiation oncology. At University Hospitals, we have a mandate to offer high-end treatments to all cancer patients. However, in times of crisis we must learn to prioritize resources, especially personnel. Compromising oncological outcome will blur all statistics, therefore all measures must be taken with great caution. Communication with our neighboring countries, within societies and between departments can help meet the challenge. Here, we report on our learning system and preparation measures to effectively tackle the COVID-19 challenge in University-Based Radiation Oncology Departments.
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Affiliation(s)
- Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, Ismaninger Straße 22, D-81675 München, Munich, Germany. .,Department of Radiation Sciences (DRS), Institute of Radiation Medicine (IRM), Ingolstädter Landstraße 1, Neuherberg, Germany. .,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.
| | - Claus Belka
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.,Department of Radiation Oncology, University Hospital, LMU, Munich, Germany
| | - Maximilian Niyazi
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.,Department of Radiation Oncology, University Hospital, LMU, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU, Munich, Germany
| | - Steffi Pigorsch
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, Ismaninger Straße 22, D-81675 München, Munich, Germany.,Department of Radiation Sciences (DRS), Institute of Radiation Medicine (IRM), Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Jan Wilkens
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, Ismaninger Straße 22, D-81675 München, Munich, Germany
| | - Anca L Grosu
- Department of Radiation Oncology, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Freiburg, Freiburg im Breisgau, Germany
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ute Ganswindt
- Department of Radiation Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Denise Bernhardt
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, Ismaninger Straße 22, D-81675 München, Munich, Germany.,Department of Radiation Sciences (DRS), Institute of Radiation Medicine (IRM), Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
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