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Corvino S, Altieri R, La Rocca G, Piazza A, Corazzelli G, Palmiero C, Mariniello G, Maiuri F, Elefante A, de Divitiis O. Topographic Patterns of Intracranial Meningioma Recurrences-Systematic Review with Clinical Implication. Cancers (Basel) 2024; 16:2267. [PMID: 38927972 PMCID: PMC11201517 DOI: 10.3390/cancers16122267] [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: 06/02/2024] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND While several risk factors for recurrences have been defined, the topographic pattern of meningioma recurrences after surgical resection has been scarcely investigated. The possibility of theoretically predicting the site of recurrence not only allows us to better understand the pathogenetic bases of the disease and consequently to drive the development of new targeted therapies, but also guides the decision-making process for treatment strategies and tailored follow-ups to decrease/prevent recurrence. METHODS The authors performed a comprehensive and detailed systematic literature review of the EMBASE and MEDLINE electronic online databases regarding the topographic pattern of recurrence after surgical treatment for intracranial meningiomas. Demographics and histopathological, neuroradiological and treatment data, pertinent to the topography of recurrences, as well as time to recurrences, were extracted and analyzed. RESULTS Four studies, including 164 cases of recurrences according to the inclusion criteria, were identified. All studies consider the possibility of recurrence at the previous dural site; three out of four, which are the most recent, consider 1 cm outside the previous dural margin to be the main limit to distinguish recurrences closer to the previous site from those more distant. Recurrences mainly occur within or close to the surgical bed; higher values of proliferation index are associated with recurrences close to the original site rather than within it. CONCLUSIONS Further studies, including genomic characterization of different patterns of recurrence, will better clarify the main features affecting the topography of recurrences. A comparison between topographic classifications of intracranial meningioma recurrences after surgery and after radiation treatment could provide further interesting information.
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Affiliation(s)
- Sergio Corvino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Division, Università di Napoli Federico II, 80131 Naples, Italy; (G.C.); (C.P.); (G.M.); (F.M.); (O.d.D.)
| | - Roberto Altieri
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Giuseppe La Rocca
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, 20123 Rome, Italy;
| | - Amedeo Piazza
- Department of Neurosurgery, “Sapienza” University, 00185 Rome, Italy;
| | - Giuseppe Corazzelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Division, Università di Napoli Federico II, 80131 Naples, Italy; (G.C.); (C.P.); (G.M.); (F.M.); (O.d.D.)
| | - Carmela Palmiero
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Division, Università di Napoli Federico II, 80131 Naples, Italy; (G.C.); (C.P.); (G.M.); (F.M.); (O.d.D.)
| | - Giuseppe Mariniello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Division, Università di Napoli Federico II, 80131 Naples, Italy; (G.C.); (C.P.); (G.M.); (F.M.); (O.d.D.)
| | - Francesco Maiuri
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Division, Università di Napoli Federico II, 80131 Naples, Italy; (G.C.); (C.P.); (G.M.); (F.M.); (O.d.D.)
| | - Andrea Elefante
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Oreste de Divitiis
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Division, Università di Napoli Federico II, 80131 Naples, Italy; (G.C.); (C.P.); (G.M.); (F.M.); (O.d.D.)
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Lee EJ, Chung HT, Park H, Kim JW, Kim DG, Paek SH. Factors associated with radiation toxicity and long-term tumor control more than 10 years after Gamma Knife surgery for non-skull base, nonperioptic benign supratentorial meningiomas. J Neurosurg 2023; 138:1580-1590. [PMID: 36208439 DOI: 10.3171/2022.8.jns22422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gamma Knife surgery (GKS) is a well-established treatment for benign intracranial meningiomas; however, the dosimetric factors associated with long-term GKS efficacy and safety remain to be elucidated. Using data obtained with at least 10 years of follow-up, the authors aimed 1) to analyze GKS efficacy and safety for the treatment of benign meningiomas confined to non-skull base, nonperioptic supratentorial locations and 2) to determine the radiation dose window that allows for long-term efficacy and safety, namely the minimum dose to achieve long-term local control (LC) and the maximum safe dose to avoid adverse radiation effects (AREs). METHODS A retrospective analysis was performed on patients who underwent GKS for benign meningiomas in the abovementioned location at the authors' institution between 1998 and 2010 and who received follow-up for more than 10 years. The authors meticulously extracted the values of various dosimetric factors by using a dose-volume histogram. Cox proportional hazard regression analyses were performed to investigate the dosimetric factors associated with LC and ARE. RESULTS Fifty-five patients (male/female ratio 1:4.2) with 68 tumors were enrolled. The median (range) gross target volume and marginal dose were 4.2 (0.2-31.7) cm3 and 14.3 (9-20) Gy, respectively. In total, 23.5% of tumors progressed at an average of 72 months, with 10- and 15-year progression-free survival rates of 80.9% and 73.5%, respectively. In univariate analysis, higher marginal dose, coverage (%), Dmin, D98%, Dmean, D2%, Dmax, and Paddick conformity index were significantly associated with LC. In multivariate analysis, D98% was the significant factor, with a cutoff value of 11 Gy (HR 0.754, p < 0.001). Symptomatic AREs occurred in 7 patients at an average of 7 months after GKS. AREs were significantly associated with the volume of normal tissue irradiated with more than 14 Gy (nV14Gy), with a cutoff value of 0.66 cm3 (HR 2.459, p = 0.002). CONCLUSIONS D98% was a barometer of the minimum required dose associated with long-term LC, and nV14Gy was related to symptomatic AREs. The authors recommend a marginal dose ranging from 11 to 14 Gy to achieve long-term efficacy and safety in patients with non-skull base, nonperioptic benign supratentorial meningiomas, with the assumption of thorough tumor coverage.
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Affiliation(s)
- Eun Jung Lee
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Hyun-Tai Chung
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Hangeul Park
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Jin-Wook Kim
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Dong Gyu Kim
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Sun Ha Paek
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
- 3Advanced Institutes of Convergence Technology, Seoul National University, Suwon-si, Gyeonggi-do, Republic of Korea
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Abstract
Meningiomas comprise a histologically and clinically diverse set of tumors arising from the meningothelial lining of the central nervous system. In the past decade, remarkable progress has been made in deciphering the biology of these common neoplasms. Nevertheless, effective systemic or molecular therapies for meningiomas remain elusive and are active areas of preclinical and clinical investigation. Thus, standard treatment modalities for meningiomas are limited to maximal safe resection, radiotherapy, or radiosurgery. This review examines the history, clinical rationale, and future directions of radiotherapy and radiosurgery as integral and effective treatments for meningiomas.
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Affiliation(s)
- William C Chen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Calixto-Hope G Lucas
- Department of Pathology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago, IL 60611, USA
| | - C Leland Rogers
- Radiation Oncology, GammaWest Cancer Services, Salt Lake City, UT, USA
| | - David R Raleigh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
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Razavian NB, Helis CA, Laxton A, Tatter S, Bourland JD, Mott R, Lesser GJ, Strowd R, White JJ, Chan MD, Cramer CK. Outcomes of radiation-induced meningiomas treated with stereotactic radiosurgery. J Neurooncol 2023; 161:259-266. [PMID: 36222952 DOI: 10.1007/s11060-022-04156-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Data on the efficacy and safety of stereotactic radiosurgery (SRS) for treatment of radiation-induced meningiomas (RIMs) are limited. METHODS A single institution database of Cobalt-60 SRS cases from 08/1999 to 10/2020 was reviewed. Radiation-induced meningiomas were identified using Cahan's criteria. Endpoints included overall survival (OS), progression free survival (PFS), local control (LC), treatment failure, and treatment toxicity. Univariate and multivariate analyses were performed using cox proportional hazard models. RESULTS A total of 29 patients with 86 RIM lesions were identified. Median follow-up after SRS was 59 months. The median dose prescribed to the 50% isodose line was 14 Gy (range 12-20 Gy). The actuarial 5-yr OS and PFS were 96% and 68%, respectively. Patients treated for recurrent RIMs had a significantly lower PFS (45% vs 94% at 3 yr, p < 0.005) than patients treated in the upfront setting. Patients with presumed or WHO grade I RIMs had a significantly greater PFS (3-year PFS 96% vs 20%) than patients with WHO grade II RIMs (p < 0.005). On a per-lesion basis, local control (LC) at 1-, 3-, and 5-yrs was 82%, 76%, 74%, respectively. On multivariate analysis, female gender was associated with improved LC (p < 0.001), while marginal doses > 14 Gy were associated with worse local control (p < 0.001). Grade I-III toxicity following treatment was 9.0%. CONCLUSIONS Stereotactic radiosurgery is a safe and effective treatment option for radiographic RIMs, WHO grade I RIMs, or lesions treated in the upfront setting. WHO grade II lesions and recurrent lesions are at increased risk for disease progression.
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Affiliation(s)
- Niema B Razavian
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
| | - Corbin A Helis
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Adrian Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - J Daniel Bourland
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Ryan Mott
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Glenn J Lesser
- Department of Medical Oncology and Hematology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Roy Strowd
- Department of Medical Oncology and Hematology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jaclyn J White
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
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Ganz JC. Meningiomas. PROGRESS IN BRAIN RESEARCH 2022; 268:163-190. [PMID: 35074079 DOI: 10.1016/bs.pbr.2021.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Meningiomas arise in various locations. Convexity tumors are relatively simple to remove. Skull base tumors and tumors adjacent to the major cerebral veins and venous sinuses can be very difficult to extirpate. Attempts at radical resection can lead to serious morbidity. The combination of bulk reduction using microsurgery followed by GKNS gives greatly improved survival and very low morbidity. With smaller tumors, GKNS may be used as the primary treatment. Increasing numbers of asymptomatic meningiomas are demonstrated either as an unexpected finding or as a residual or recurrent tumor after surgery. In all of these situations, GKNS gives a better result than observation or reoperation.
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Affiliation(s)
- Jeremy C Ganz
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
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Corniola MV, Roche PH, Bruneau M, Cavallo LM, Daniel RT, Messerer M, Froelich S, Gardner PA, Gentili F, Kawase T, Paraskevopoulos D, Régis J, Schroeder HW, Schwartz TH, Sindou M, Cornelius JF, Tatagiba M, Meling TR. Management of cavernous sinus meningiomas: Consensus statement on behalf of the EANS skull base section. BRAIN AND SPINE 2022; 2:100864. [PMID: 36248124 PMCID: PMC9560706 DOI: 10.1016/j.bas.2022.100864] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/08/2022] [Accepted: 01/16/2022] [Indexed: 01/04/2023]
Abstract
Introduction The evolution of cavernous sinus meningiomas (CSMs) might be unpredictable and the efficacy of their treatments is challenging due to their indolent evolution, variations and fluctuations of symptoms, heterogeneity of classifications and lack of randomized controlled trials. Here, a dedicated task force provides a consensus statement on the overall management of CSMs. Research question To determine the best overall management of CSMs, depending on their clinical presentation, size, and evolution as well as patient characteristics. Material and methods Using the PRISMA 2020 guidelines, we included literature from January 2000 to December 2020. A total of 400 abstracts and 77 titles were kept for full-paper screening. Results The task force formulated 8 recommendations (Level C evidence). CSMs should be managed by a highly specialized multidisciplinary team. The initial evaluation of patients includes clinical, ophthalmological, endocrinological and radiological assessment. Treatment of CSM should involve experienced skull-base neurosurgeons or neuro-radiosurgeons, radiation oncologists, radiologists, ophthalmologists, and endocrinologists. Discussion and conclusion Radiosurgery is preferred as first-line treatment in small, enclosed, pauci-symptomatic lesions/in elderly patients, while large CSMs not amenable to resection or WHO grade II-III are candidates for radiotherapy. Microsurgery is an option in aggressive/rapidly progressing lesions in young patients presenting with oculomotor/visual/endocrinological impairment. Whenever surgery is offered, open cranial approaches are the current standard. There is limited experience reported about endoscopic endonasal approach for CSMs and the main indication is decompression of the cavernous sinus to improve symptoms. Whenever surgery is indicated, the current trend is to offer decompression followed by radiosurgery. A thorough evaluation of cavernous sinus meningiomas by a multidisciplinary team is mandatory. Microsurgery should be considered for aggressive lesions in young patients. Extended endoscopic approaches can be effective when combined with radiotherapy. Stereotaxic radiotherapy and stereotaxic radiosurgery offer excellent tumour control in small/asymptomatic lesions .
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Damen PJJ, Bulthuis VJ, Hanssens PEJ, Lie ST, Fleischeuer R, Melotte V, Wouters KA, Ruland A, Beckervordersandforth J, Speel EJM. WHO grade I meningiomas that show regrowth after gamma knife radiosurgery often show 1p36 loss. Sci Rep 2021; 11:16432. [PMID: 34385566 PMCID: PMC8361078 DOI: 10.1038/s41598-021-95956-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/21/2021] [Indexed: 12/12/2022] Open
Abstract
WHO grade I meningiomas occasionally show regrowth after radiosurgical treatment, which cannot be predicted by clinical features. There is increasing evidence that certain biomarkers are associated with regrowth of meningiomas. The aim of this retrospective study was to asses if these biomarkers could be of value to predict regrowth of WHO grade I meningiomas after additive radiosurgery. Forty-four patients with WHO grade I meningiomas who underwent additive radiosurgical treatment between 2002 and 2015 after Simpson IV resection were included in this study, of which 8 showed regrowth. Median follow-up time was 64 months (range 24–137 months). Tumors were analyzed for the proliferation marker Ki-67 by immunohistochemistry and for deletion of 1p36 by fluorescence in situ hybridization (FISH). Furthermore, genomic DNA was analyzed for promoter hypermethylation of the genes NDRG1–4, SFRP1, HOXA9 and MGMT. Comparison of meningiomas with and without regrowth after radiosurgery revealed that loss of 1p36 (p = 0.001) and hypermethylation of NDRG1 (p = 0.046) were correlated with regrowth free survival. Loss of 1p36 was the only parameter that was significantly associated with meningioma regrowth after multivariate analysis (p = 0.01). Assessment of 1p36 loss in tumor tissue prior to radiosurgery might be considered an indicator of prognosis/regrowth. However, this finding has to be validated in an independent larger set of tumors.
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Affiliation(s)
- Pim J J Damen
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, Postbox 5800, 6202 AZ, Maastricht, The Netherlands
| | - Vincent J Bulthuis
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Suan Te Lie
- Gamma Knife Center Tilburg, ETZ-Elisabeth Hospital, Tilburg, The Netherlands
| | - Ruth Fleischeuer
- Department of Pathology, ETZ-Elisabeth Hospital, Tilburg, The Netherlands
| | - Veerle Melotte
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, Postbox 5800, 6202 AZ, Maastricht, The Netherlands
| | - Kim A Wouters
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, Postbox 5800, 6202 AZ, Maastricht, The Netherlands
| | - Andrea Ruland
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, Postbox 5800, 6202 AZ, Maastricht, The Netherlands
| | - Jan Beckervordersandforth
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, Postbox 5800, 6202 AZ, Maastricht, The Netherlands
| | - Ernst Jan M Speel
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, Postbox 5800, 6202 AZ, Maastricht, The Netherlands.
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Bowden G, Faramand A, Mallella A, Wei Z, Patel K, Niranjan A, Lunsford LD. Does the Timing of Radiosurgery after Grade 1 Meningioma Resection Affect Long-Term Outcomes? Stereotact Funct Neurosurg 2021; 99:506-511. [PMID: 34289489 DOI: 10.1159/000517427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/23/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Meningiomas are the most common benign intracranial tumors. Gamma Knife® stereotactic radiosurgery (GKSRS) has become a preferred management for recurrent or residual meningiomas. This study focuses on the relationship between tumor control and the time interval between resection of a World Health Organization (WHO) grade 1 meningioma and GKSRS. METHODS This single institution retrospective analysis reviewed our experience in 238 patients who underwent GKSRS after a pathologically confirmed WHO grade 1 meningioma resection. The median follow-up was 7.4 years. The median aggregate tumor volume at GKSRS was 6 cm3 and a median margin dose of 13 Gy was utilized. Neurological symptoms were evident in 60% of patients at the time of procedure. RESULTS Overall actuarial tumor control rates achieved were 91.3% at 5 years, 83.4% at 10 years, and 76% at 15 years. There were 35 patients (15%) who developed tumor progression within or directly adjacent to the GKSRS treatment field. The median time until progression was 6.3 years. The duration between surgical intervention and GKSRS did not show statistical significance at 3 months (p = 0.9), 6 months (p = 0.8), 12 months (p = 0.5), or 24 months (p = 0.9). Fifteen patients (6%) had tumor progression at an anatomically distinct location outside the GKSRS target volume. Neurological symptomatic improvement was more likely with early radiosurgery intervention (p = 0.007). CONCLUSION Postoperative GKSRS was associated with excellent long-term tumor control for WHO grade 1 meningiomas, regardless of the interval after initial surgery. In addition, earlier radiosurgery was associated with superior symptom improvement.
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Affiliation(s)
- Gregory Bowden
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew Faramand
- Departments of Neurological Surgery and the Center for Image-Guided Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Arka Mallella
- Departments of Neurological Surgery and the Center for Image-Guided Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zhishuo Wei
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kevin Patel
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ajay Niranjan
- Departments of Neurological Surgery and the Center for Image-Guided Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - L Dade Lunsford
- Departments of Neurological Surgery and the Center for Image-Guided Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Dietz N, Sharma M, Ugiliweneza B, Wang D, Boakye M, Williams B, Andaluz N. Health Care Utilization in Patients Undergoing Repeat Stereotactic Radiosurgery for Vestibular Schwannoma with 5-Year Follow-up: A National Database Analysis. J Neurol Surg B Skull Base 2020; 83:19-27. [DOI: 10.1055/s-0040-1716672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 08/03/2020] [Indexed: 10/23/2022] Open
Abstract
Abstract
Background Stereotactic radiosurgery (SRS) has been used as an alternative to microsurgery in patients with small vestibular schwannoma (VS). We compare health care utilization metrics in patients undergoing repeat-SRS (re-SRS) and no repeat SRS (nr-SRS) at long-term follow-up.
Materials and Methods We queried the MarketScan database using International Classification of Diseases, Ninth Revision and Current Procedural Terminology 4, from 2000 to 2016. We included adult patients who had diagnosis of VS and treatment with SRS with at least 5 years of continuous enrollment after the procedure. Outcomes were hospital admissions, outpatient services, and medication refills.
Results Of 1,047 patients, 5.1% (n = 53) had repeat SRS. Majority of re-SRS (74%, n = 39) were done within 2 years of index procedure and 51% were within 1-year of initial procedure. Patients who required re-SRS incurred higher hospital readmission rate, outpatient services, and had higher payments compared with those who did not require re-SRS at 6 months, 1 year, and 2 years following the initial procedures. Re-SRS received 3.0- and 3.1-times higher payments at 1 and 2 years compared with nr-SRS cohort. At 5 years following SRS, median combined payments for re-SRS cohort was $105286 (interquartile range [IQR] $70999, $156569) compared with $44172 (IQR $22956, $84840) for nr-SRS cohort.
Conclusion More than half of the re-SRS procedures were noted within first year of initial SRS for VS. Overall payments at 5 years for repeat SRS was more than double that for nr-SRS. Repeat SRS was also associated with more re-admissions and outpatient services at annual follow-up time points.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Brian Williams
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Norberto Andaluz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
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Tsurubuchi T, Matsuda M, Muroi A, Sakamoto N, Ishikawa E, Matsumura A. An Aggressive Extension of Dumbbell-Type Pediatric Skull Base Meningioma: A Case Report with Review of the Literature. World Neurosurg 2020; 139:535-547. [PMID: 32371076 DOI: 10.1016/j.wneu.2020.04.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pediatric meningiomas account for less than 2% of pediatric brain tumors. Pediatric clear cell meningiomas (CCMs) occurring in the posterior fossa are particularly rare. Therapeutic strategies differ among the previous pediatric CCM case reports. Therefore, to clarify the clinical features of pediatric CCMs, we report a rare case of dumbbell-type pediatric CCM and a corresponding literature review. CASE DESCRIPTION A 7-year-old boy with complaints of headache, left facial palsy, dysarthria, and left-sided ataxic gait was emergently admitted to our hospital. His consciousness level was slight stupor, with Glasgow Coma Scale score 3-5-6, and he showed left ptosis, dysarthria, and ataxias of the left trunk and extremities. Magnetic resonance imaging (MRI) scan showed acute obstructive hydrocephalus because of the tumor's compression of the brainstem. The dumbbell-shaped tumor extended from the lateral wall of the cavernous sinus, through the left Meckel's cave, to the cerebellopontine angle. Physical examination and perioperative MRI scan showed no evidence regarding neurofibromatosis type I or II. The tumor was removed in a 2-staged operation. Postoperative proton therapy was done to treat some residual tumors. One year after postoperative proton therapy, there is no recurrence, and apart from left corneal and facial hypesthesia, he is healthy. CONCLUSIONS We reported a rare case of pediatric skull base-type CCM with huge extension originating from the anteromedial wall of Meckel's cave firmly adhered to the cavernous sinus wall to the posterior fossa that was successfully treated with surgery and postoperative proton therapy. CCM has a high recurrence rate; therefore, careful prolonged follow-up is needed.
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Affiliation(s)
- Takao Tsurubuchi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ai Muroi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Noriaki Sakamoto
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Park CK, Jung NY, Chang WS, Jung HH, Chang JW. Gamma Knife Radiosurgery for Postoperative Remnant Meningioma: Analysis of Recurrence Factors According to World Health Organization Grade. World Neurosurg 2019; 132:e399-e402. [DOI: 10.1016/j.wneu.2019.08.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/19/2019] [Accepted: 08/22/2019] [Indexed: 10/26/2022]
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Image-Guided Robotic Radiosurgery for Treatment of Recurrent Grade II and III Meningiomas. A Single-Center Study. World Neurosurg 2019; 131:e96-e107. [PMID: 31306844 DOI: 10.1016/j.wneu.2019.07.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/05/2019] [Accepted: 07/06/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) has been increasingly applied for malignant meningiomas as an alternative to conventionally fractioned radiation therapy. We performed a retrospective analysis of an institutional patient cohort with malignant meningiomas treated by image-guided SRS. METHODS All patients with atypical or anaplastic meningiomas who were treated by SRS using CyberKnife (CK) were identified. Local failure and regional and/or distant recurrences were evaluated together with toxicity and overall survival. RESULTS We identified 127 treated lesions (105 atypical and 22 anaplastic) in 35 patients. The mean time interval between the last surgery and subsequent CK-SRS was 30.8 ± 24.5 months. Most lesions (83.5%) were treated using single-fraction CK-SRS. The median planning target volume of all 127 lesions was 1.71 cm3 (range, 0.06-22.5 cm3). The median follow-up period was 23 months (range, 2.1-60.3 months). The estimated local control rates were 97%, 77%, and 67% at 12, 36, and 60 months, respectively, in atypical meningiomas and 66% each at 12 and 24 months in anaplastic meningiomas. The regional progression-free survival was 93%, 73%, and 59% at 12, 36, and 60 months, respectively, in atypical lesions and 93% and 46% at 12 and 24 months in anaplastic lesions. The estimated distant tumor progression-free interval in atypical lesions was 80%, 44%, and 44% at 12, 36, and 60 months, respectively, and 49% and 24% at 12 and 24 months, respectively, in anaplastic lesions. Age was identified as a risk factor for local failure. CONCLUSIONS Although the real boundaries of efficacy of SRS have to be further evaluated in a prospective trial, it seems that aggressive treatment by high-dose single or multisession SRS of recurring malignant meningiomas provides satisfactory local control rates.
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13
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Nagy G, Yianni J, Bhattacharyya D, Rowe JG, Kemeny AA, Radatz MWR. Repeat Radiosurgery Treatment After Cavernous Malformation Radiosurgery. World Neurosurg 2018; 118:e296-e303. [PMID: 29969736 DOI: 10.1016/j.wneu.2018.06.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Of cavernous malformations (CMs) treated with radiosurgery (RS), 5% bleed after 2-year initial latency period. This rate is similar to failure rate of RS for other pathologies, which often require repeat RS for favorable outcome. The aim of this pilot study was to define failure of CM RS and to assess safety of second RS. METHODS Retrospective analysis was performed of 7 of 345 CMs retreated with RS; 6 CMs were deep-seated, and 1 was superficial. Median time between the 2 treatments was 8 years (range, 3-16 years), and median follow-up time after second RS was 3 years (range, 1-9 years). RESULTS Following the 2-year latency period after RS, 6% of deep-seated and 5% of hemispheric CMs, and 6% of deep-seated and 2% of hemispheric lesions caused transient neurologic deficits without hemorrhage. A second treatment was indicated for rebleed in 5 cases and for recurrent transient neurologic deficits in 2 cases. Prescribed dose was 15 Gy (range, 12-20 Gy) at first treatment and 12 Gy (range, 12-18 Gy) at second treatment. Target volumes were 692 mm3 (range, 54-2400 mm3) and 935 mm3 (range, 150-1550 mm3) at first and second treatments, respectively, and treatment volumes were 811 mm3 (range, 79-2500 mm3) and 962 mm3 (range, 194-1750 mm3), respectively. Differences in treatment parameters were not significant. Reason for failure was inaccurate target definition in only 2 cases. There were no bleeds, morbidity, or mortality after second RS. CONCLUSIONS Second RS applied to previously treated CMs is safe and may be effective. Further investigations are needed to verify these findings and assess long-term benefit of second RS.
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Affiliation(s)
- Gábor Nagy
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - John Yianni
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom; National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom; Thornbury Radiosurgery Centre, Sheffield, United Kingdom
| | - Debapriya Bhattacharyya
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom; National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom; Thornbury Radiosurgery Centre, Sheffield, United Kingdom
| | - Jeremy G Rowe
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom; National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom; Thornbury Radiosurgery Centre, Sheffield, United Kingdom
| | | | - Matthias W R Radatz
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom; National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom; Thornbury Radiosurgery Centre, Sheffield, United Kingdom.
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14
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Lee CC, Trifiletti DM, Sahgal A, DeSalles A, Fariselli L, Hayashi M, Levivier M, Ma L, Álvarez RM, Paddick I, Regis J, Ryu S, Slotman B, Sheehan J. Stereotactic Radiosurgery for Benign (World Health Organization Grade I) Cavernous Sinus Meningiomas—International Stereotactic Radiosurgery Society (ISRS) Practice Guideline: A Systematic Review. Neurosurgery 2018; 83:1128-1142. [DOI: 10.1093/neuros/nyy009] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/05/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Daniel M Trifiletti
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Antonio DeSalles
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California
| | - Laura Fariselli
- Radiotherapy unit, Radiosurgery dep Istituto neurologico Carlo Besta Foundation, Milan, Italy
| | - Motohiro Hayashi
- Department of Neurosurgery, Tokyo Women's Medical University, Toyko, Japan
| | - Marc Levivier
- Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Lijun Ma
- Division Physics, Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Roberto Martínez Álvarez
- Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - Ian Paddick
- Division Physics, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jean Regis
- Department of Functional Neurosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Samuel Ryu
- Department of Radiation Oncology, Stony Brook University, Stony Brook, New York
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
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15
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CyberKnife Stereotactic Radiosurgery for Atypical and Malignant Meningiomas. World Neurosurg 2016; 91:574-581.e1. [DOI: 10.1016/j.wneu.2016.04.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 11/19/2022]
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16
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Cohen-Inbar O, Lee CC, Schlesinger D, Xu Z, Sheehan JP. Long-Term Results of Stereotactic Radiosurgery for Skull Base Meningiomas. Neurosurgery 2015; 79:58-68. [DOI: 10.1227/neu.0000000000001045] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Abstract
BACKGROUND:
Gamma knife radiosurgery (GKRS) is well established in the management of inaccessible, recurrent, or residual benign skull base meningiomas. Most series report clinical outcome parameters and complications in the short intermediate period after radiosurgery. Reports of long-term tumor control and neurological status are still lacking.
OBJECTIVE:
To report the presentation, treatment, and long-term outcome of skull base meningiomas after GKRS.
METHODS:
From a prospectively collected institutional review board-approved database, we selected patients with a World Health Organization grade I skull base meningioma treated with a single-session GKRS and a minimum of 60 months follow-up. One hundred thirty-five patients, 54.1% males (n = 73), form the cohort. Median age was 54 years (19–80). Median tumor volume was 4.7 cm3 (0.5–23). Median margin dose was 15 Gy (7.5–36). Median follow-up was 102.5 months (60.1–235.4). Patient and tumor characteristics were assessed to determine the predictors of neurological function and tumor progression.
RESULTS:
At last follow-up, tumor volume control was achieved in 88.1% (n = 119). Post-GKRS clinical improvement or stability was reported in 61.5%. The 5-, 10-, and 15-year actuarial progression-free survival rates were 100%, 95.4%, and 68.8%, respectively. Favorable outcome (both tumor control and clinical preservation/improvement) was attained in 60.8% (n = 79). Pre-GKRS performance status (Karnofsky Performance Scale) was shown to influence tumor progression (P = .001) and post-GKRS clinical improvement/preservation (P = .003).
CONCLUSION:
GKRS offers a highly durable rate of tumor control for World Health Organization grade I skull base meningiomas, with an acceptably low incidence of neurological deficits. The Karnofsky Performance Scale at the time of radiosurgery serves as a reliable long-term predictor of overall outcome.
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Affiliation(s)
- Or Cohen-Inbar
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Cheng-chia Lee
- Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei, Taiwan
| | - David Schlesinger
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Jason P. Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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17
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Mansouri A, Guha D, Klironomos G, Larjani S, Zadeh G, Kondziolka D. Stereotactic radiosurgery for intracranial meningiomas: current concepts and future perspectives. Neurosurgery 2015; 76:362-71. [PMID: 25599213 DOI: 10.1227/neu.0000000000000633] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Meningiomas are among the most common adult brain tumors. Although the optimal management of meningiomas would provide complete elimination of the lesion, this cannot always be accomplished safely through resection. Therefore, other therapeutic modalities, such as stereotactic radiosurgery (as primary or adjunctive therapy), have emerged. In the current review, we have provided an overview of the historical outcomes of various radiosurgical modalities applied in the management of meningiomas. Furthermore, we provide a discussion on key factors (eg World Health Organization grade, lesion size, and lesion location) that affect tumor control and adverse event rates. We discuss recent changes in our understanding of meningiomas, based on molecular and genetic markers, and how these will change our perspective on the management of meningiomas. We conclude by outlining the areas in which knowledge gaps persist and provide suggestions as to how these can be addressed.
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Affiliation(s)
- Alireza Mansouri
- *Division of Neurosurgery, University of Toronto, Toronto, Canada; ‡Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto Canada; §Departments of Neurosurgery and Radiation Oncology, NYU Langone Medical Center, New York University
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18
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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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Bulthuis VJ, Hanssens PEJ, Lie ST, van Overbeeke JJ. Gamma Knife radiosurgery for intracranial meningiomas: Do we need to treat the dural tail? A single-center retrospective analysis and an overview of the literature. Surg Neurol Int 2014; 5:S391-5. [PMID: 25289168 PMCID: PMC4173303 DOI: 10.4103/2152-7806.140192] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 05/04/2014] [Indexed: 11/05/2022] Open
Abstract
Background: The dural tail (DT) has been described as a common feature in meningiomas. There is a great variation of tumor invasion and extent of tumor cells in the DT. Therefore, the necessity to include the whole DT in Gamma Knife radiosurgery is not clear, since inclusion increases the target volume and therefore increases the risk of complications. In this analysis, we evaluated whether the complete tail should be included as part of the target in Gamma Knife radiosurgery for meningiomas. Methods: Between June 2002 and December 2010, Gamma Knife radiosurgery was performed in 160 patients with 203 meningiomas with a DT. In 105 tumors, the diagnosis was based on magnetic resonance imaging (MRI) characteristics, and in 98 tumors, the diagnosis was confirmed by histopathologic examination after surgery. The median volume of the tumors was 3.55 cc. All tumors were treated with Gamma Knife radiosurgery with a median prescribed dose of 13 Gy (range 11-15), resulting in a median marginal dose of 11 Gy (range 10-15). Only the part of the DT closely related to the tumor mass was included in the target. The median follow-up period was 41 months (range 12-123). Results: In image-based meningiomas, the overall local control rate was 96.2% with 2- and 5-year control rates of 98.0% and 95.1%, respectively. In WHO grade I tumors, the overall local control rate was 85.9% with 2- and 5-year control rates of 94.5% and 88.0%, respectively. The overall local control rate in World Health Organization (WHO) grade II tumors was 70.6% with control rates of 83.4% and 64.4% after 2 and 5 years, respectively. The growth of all new tumors was found in the radiation target area. No tumor growth was observed in the part of the DT that had been excluded from the target volume. Conclusion: We found in this study that routinely excluding the DT from the target does not lead to out-of-field tumor progression. Given the possibility that the DT is infiltrated with tumor cells, regular follow-up is needed.
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Affiliation(s)
- Vincent J Bulthuis
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Suan Te Lie
- Gamma Knife Center, St. Elisabeth Hospital, Tilburg, The Netherlands ; Department of Neurosurgery, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Jacobus J van Overbeeke
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
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20
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Kuhn EN, Taksler GB, Dayton O, Loganathan A, Bourland D, Tatter SB, Laxton AW, Chan MD. Is There a Tumor Volume Threshold for Postradiosurgical Symptoms? A Single-Institution Analysis. Neurosurgery 2014; 75:536-45; discussion 544-5; quiz 545. [DOI: 10.1227/neu.0000000000000519] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Single-fraction radiosurgery may carry a higher risk of symptomatic peritumoral edema than conventionally fractionated radiotherapy, with a reported incidence of 2.5% to 37%. Previous research has shown that larger tumor volume and margin dose >14 Gy are associated with increased risk of toxicity. Parasagittal location has been associated with toxicity in some studies, but not in others.
OBJECTIVE:
To determine risk factors for and patterns of postradiosurgical symptoms (PRS).
METHODS:
This single-institution retrospective chart review included 282 stereotactic radiosurgery procedures for an intracranial meningioma from January 1999 to March 2011. PRS were assessed by using the Common Terminology Criteria for Adverse Events (Version 4.0). Statistical analyses were conducted by using the 194 procedures for which treatment plans were available.
RESULTS:
PRS were observed after 65 procedures (23%); 35 (12%) were grade 2 or higher. Posttreatment edema occurred in 21% of grade I PRS, 68% of grade II PRS, and 71% of grade III PRS. Tumor volume ≥7.1 cc (adjusted hazards ratio = 4.9, P = .02), prior external beam radiotherapy (adjusted hazards ratio = 2.6, P = .03), and histological grade (P = .005) predicted PRS. On multivariate analysis, parasagittal location was not predictive of PRS, although skull base location predicted a lower risk of symptomatic posttreatment edema (adjusted hazards ratio = 0.133, P = .02).
CONCLUSION:
In our series, prior external beam radiotherapy, tumor volume, and tumor grade are risk factors for PRS, while pretreatment edema approached statistical significance. Peritumoral edema is the predominant mechanism of significant PRS, and skull base tumors have a lower risk of posttreatment edema.
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Affiliation(s)
- Elizabeth N. Kuhn
- Department of Neurosurgery, University of Alabama at Birmingham Medical Center, Birmingham, Alabama
- Department of Neurosurgery, Wake Forest School of Medicine, Winston–Salem, North Carolina
| | | | - Orrin Dayton
- Department of Neurosurgery, University of Florida Health, Gainesville, Florida; and Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Amritraj Loganathan
- Department of Neurosurgery, Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Daniel Bourland
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Stephen B. Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Adrian W. Laxton
- 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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