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Vassantachart AK, Ehret F, Chen E, Kumar R, Gogineni E, Andraos TY, Sahgal A, Redmond KJ, Lo SS, Chang EL, Sheehan J, Chao ST, Kim GGY, Kresl JJ, Schulder M, Palmer JD, Gibbs IC, Santacroce A, Shih HA. A Case-based Guide for World Health Organization (WHO) Grade 2 Meningioma Radiosurgery and Radiation Therapy from The Radiosurgery Society. Pract Radiat Oncol 2024:S1879-8500(24)00090-0. [PMID: 38970567 DOI: 10.1016/j.prro.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE Meningiomas represent the most common primary tumor of the central nervous system. Current treatment options include surgical resection with or without adjuvant radiation therapy (RT), definitive RT, and observation. However, the radiation dose, fractionation, and margins used to treat patients with WHO grade 2 meningiomas, which account for approximately 20% of all meningiomas, are not clearly defined, and deciding on the optimal treatment modality can be challenging owing to the lack of randomized data. METHODS AND MATERIALS In this manuscript, 3 cases of patients with WHO grade 2 meningiomas are presented with descriptions of treatment options after gross total resection, subtotal resection, and previous irradiation. Treatment recommendations were compiled from 9 central nervous system radiation oncology and neurosurgery experts from The Radiosurgery Society, and the consensus of treatment recommendations is reported. RESULTS Both conventional and stereotactic RT are treatment options for WHO grade 2 meningiomas. The majority of prospective data in the setting of WHO grade 2 meningiomas involve larger margins. Stereotactic radiosurgery/hypofractionated stereotactic RT are less appropriate in this setting. Conventionally fractionated RT to at least 59.4 Gy is considered standard of care with utilization of preoperative and postoperative imaging to evaluate the extent of disease and possible osseous involvement. After careful discussion, stereotactic radiosurgery/hypofractionated stereotactic RT may play a role for the subset of patients who are unable to tolerate the standard lengthy conventionally fractionated treatment course, for those with prior RT, or for small residual tumors. However, more studies are needed to determine the optimal approach. CONCLUSIONS This case-based evaluation of the current literature seeks to provide examples for the management of grade 2 meningiomas and give examples of both conventional and stereotactic RT.
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Affiliation(s)
| | - Felix Ehret
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany; European Radiosurgery Center Munich, Munich, Germany
| | - Eric Chen
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Ritesh Kumar
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Emile Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Therese Y Andraos
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Eric L Chang
- Department of Radiation Oncology, Keck School of Medicine of University of Southern California and Norris Cancer Center, Los Angeles, California
| | - Jason Sheehan
- Department of Neurologic Surgery, University of Virginia, Charlottesville, Virginia
| | - Samuel T Chao
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Grace Gwe-Ya Kim
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - John J Kresl
- Phoenix CyberKnife and Radiation Oncology Center, Phoenix, Arizona
| | - Michael Schulder
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Joshua D Palmer
- Department of Radiation Oncology, Arthur G. James Cancer Hospital/The Ohio State University, Columbus, Ohio
| | - Iris C Gibbs
- Department of Radiation Oncology, Stanford Medicine, Stanford, California
| | - Antonio Santacroce
- European Radiosurgery Center Munich, Munich, Germany; Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany; Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Hamm, Germany
| | - Helen A Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Bin Sumaida A, Shanbhag NM, Balaraj K. Evaluating the Efficacy and Safety of CyberKnife for Meningiomas: A Systematic Review. Cureus 2024; 16:e56848. [PMID: 38528994 PMCID: PMC10961244 DOI: 10.7759/cureus.56848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/24/2024] [Indexed: 03/27/2024] Open
Abstract
This systematic review aims to evaluate CyberKnife (Accuray, Madison, WI, USA) radiosurgery's efficacy, safety, and outcomes in treating meningiomas, focusing on tumour control rates, symptom relief, survival rates, quality of life, and adverse events. A comprehensive literature search was conducted across PubMed, EMBASE, Web of Science, Google Scholar, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), covering studies published in the last 20 years and available in English. The inclusion criteria targeted studies involving patients with meningioma treated with CyberKnife radiosurgery, reporting on specific outcomes of interest. Quality assessment was performed using the Newcastle-Ottawa Scale for observational studies, and a narrative synthesis approach was adopted for data analysis. Twenty-one studies met the inclusion criteria, encompassing various design types and patient demographics. The review highlights CyberKnife's effectiveness in managing benign and atypical meningiomas and specific challenging cases like perioptic lesions and large cranial base tumours. Key findings include high tumour control rates, preservation or improvement of visual functions in perioptic lesions, and promising results in benign spinal tumours and supratentorial meningiomas. Comparative analyses suggest better radiographic tumour control and a lower incidence of post-treatment complications with stereotactic radiotherapy over stereotactic radiosurgery. Long-term outcomes and safety profiles underline the viability of CyberKnife as a treatment option, with minimal permanent side effects reported. CyberKnife radiosurgery is a highly effective and safe treatment modality for meningiomas. It offers significant benefits in tumour control, symptom relief, and maintaining the quality of life with minimal adverse effects. The precision and adaptability of CyberKnife technology make it a valuable addition to the treatment arsenal for meningiomas. It necessitates further research and adoption in clinical practice, especially in regions like the United Arab Emirates, where its use is emerging.
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Affiliation(s)
| | - Nandan M Shanbhag
- Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE
- Oncology/Radiation Oncology/Palliative Care, Tawam Hospital, Al Ain, ARE
| | - Khalid Balaraj
- Oncology/Radiation Oncology, Tawam Hospital, Al Ain, ARE
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Ortiz García IM, Rodríguez Valero P, Jorques Infante AM, Cordero Tous N, Expósito Hernández J, Olivares Granados G. Long-term Experience of LINAC Single-Dose Radiosurgery for Skull Base Meningiomas: A Retrospective Single-Center Study of 241 Cases. Oper Neurosurg (Hagerstown) 2023; 25:529-537. [PMID: 37655877 DOI: 10.1227/ons.0000000000000887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/27/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Stereotactic radiosurgery (SRS) is increasingly applied to treat meningiomas, attributable to their increased incidence in older individuals at greater surgical risk. To evaluate the effectiveness of treatment with linear accelerator (LINAC)-based stereotactic radiosurgery in skull base meningiomas as either primary treatment or postresection adjuvant therapy. METHODS This study included 241 patients diagnosed with skull base meningiomas treated by single-dose SRS, with a median age of 59 years. SRS was primary treatment in 68.1% (n = 164) and adjuvant treatment in 31.9% (n = 77), using LINAC (Varian 600, 6 MeV). The median tumor volume was 3.2 cm 3 , and the median coverage dose was 14 Gy. Bivariate and multivariate analyses were performed to determine predictive factors for tumor progression, clinical deterioration, and complications. Kaplan-Meier analysis was used for survival analysis. RESULTS After the median follow-up of 102 months, the tumor control rate was 91.2% (n = 220). Progression-free survival rates were 97.07%, 90.1%, and 85.7% at 5, 10, and 14 years, respectively. Clinical improvement was observed in 56 patients (23.2%). In multivariate analysis, previous surgery (hazard ratio 3.8 [95%CI 1.136-12.71], P = .030) and selectivity (hazard ratio .21 [95%CI 0.066-0.677], P = .009) were associated with tumor progression and increased maximum dose (odds ratio [OR] 4.19 [95% CI 1.287-13.653], P = .017) with clinical deterioration. The permanent adverse radiation effect rate was 6.2% (n = 15) and associated with maximum brainstem dose >12.5 Gy (OR 3.36 [95% CI .866-13.03], P = .08) and cerebellopontine angle localization (OR 3.93 [95% CI 1.29-11.98], P = .016). CONCLUSION Treatment of skull base meningiomas with single-dose SRS using LINAC is effective over the long term. Superior tumor control is obtained in patients without previous surgery. Adverse effects are related to localization in the cerebellopontine angle, and maximum brainstem radiation dose was >12.5 Gy.
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Affiliation(s)
- Isabel M Ortiz García
- Department of Neurological Surgery, "Virgen de las Nieves" University Hospital, Granada , Spain
| | - Paula Rodríguez Valero
- Department of Neurological Surgery, "Virgen de las Nieves" University Hospital, Granada , Spain
| | - Ana M Jorques Infante
- Department of Neurological Surgery, "Virgen de las Nieves" University Hospital, Granada , Spain
| | - Nicolás Cordero Tous
- Department of Neurological Surgery, "Virgen de las Nieves" University Hospital, Granada , Spain
| | - José Expósito Hernández
- Department of Radiotherapy and Oncology, "Virgen de las Nieves" University Hospital, Granada , Spain
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Samanci Y, Askeroglu MO, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Legarreta A, Fernandes Cabral D, Anand S, Niranjan A, Lunsford LD, Tripathi M, Kumar N, Liščák R, May J, Lee CC, Yang HC, Martínez Moreno N, Martínez Álvarez R, Douri K, Mathieu D, Pikis S, Mantziaris G, Sheehan JP, Bernstein K, Kondziolka D, Peker S. Stereotactic Radiosurgery for Meningiomas in Children and Adolescents: An International Multi-Institutional Study. Neurosurgery 2023; 93:1066-1074. [PMID: 37235980 DOI: 10.1227/neu.0000000000002543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/05/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Meningiomas in children are uncommon, with distinct characteristics that set them apart from their adult counterparts. The existing evidence for stereotactic radiosurgery (SRS) in this patient population is limited to only case series. The objective of this study was to evaluate the safety and efficacy of SRS in managing pediatric meningiomas. METHODS Children and adolescents who had been treated for meningioma with single-fraction SRS were included in this retrospective, multicenter study. The assessment included local tumor control, any complications related to the tumor or SRS, and the emergence of new neurological deficits after SRS. RESULTS The cohort included 57 patients (male-to-female ratio 1.6:1) with a mean age of 14.4 years who were managed with single-fraction SRS for 78 meningiomas. The median radiological and clinical follow-up periods were 69 months (range, 6-268) and 71 months (range, 6-268), respectively. At the last follow-up, tumor control (tumor stability and regression) was achieved in 69 (85.9%) tumors. Post-SRS, new neurological deficits occurred in 2 (3.5%) patients. Adverse radiation effects occurred in 5 (8.8%) patients. A de novo aneurysm was observed in a patient 69 months after SRS. CONCLUSION SRS seems to be a safe and effective up-front or adjuvant treatment option for surgically inaccessible, recurrent, or residual pediatric meningiomas.
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Affiliation(s)
- Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
| | - M Orbay Askeroglu
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Benha University, Qalubya , Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Clinical Oncology, Ain Shams University, Cairo , Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo , Egypt
| | - Andrew Legarreta
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - David Fernandes Cabral
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Sharath Anand
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh , India
| | - Narendra Kumar
- Department of Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh , India
| | - Roman Liščák
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - Jaromir May
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - Cheng-Chia Lee
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
- National Yang Ming Chiao Tung University School of Medicine, Hsinchu , Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery Neurological Institute, Taipei Veteran General Hospital, Taipei , Taiwan
- National Yang Ming Chiao Tung University School of Medicine, Hsinchu , Taiwan
| | | | | | - Keiss Douri
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Quebec , Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Quebec , Canada
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Kenneth Bernstein
- Department of Radiation Oncology, New York University Langone, New York , USA
| | | | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
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Brown NJ, Pennington Z, Kuo CC, Gendreau J, Chakravarti S, Singh R, Douse DM, Van Gompel JJ. Meningioma: A Biography-Tumor Forever Tied to the Origins and "Soul of Neurosurgery". World Neurosurg 2023; 178:191-201.e1. [PMID: 37562678 DOI: 10.1016/j.wneu.2023.07.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023]
Abstract
Meningiomas are neoplasms derived from the arachnoid cap cells of the leptomeninges and are the most common intracranial tumor. In the present historical vignette, the evolution of the management and diagnosis of meningioma is described. We begin with studies of skulls from the prehistoric record, such as the Steinheim skull, which demonstrate morphologic changes (e.g., hyperostosis) now known to occur with meningioma growth. We then continue with the earliest formal descriptions of meningiomas, including that by Platter, who published the first report of meningioma, along with early histopathologic descriptions by Cushing, who divined the cytological origins of the tumor and was the first to use the term meningioma. We conclude with a description of current management of meningiomas and potential avenues for further discovery. This article is effectively a lifetime biography of a tumor known and loved by neurosurgeons, the simple and yet complex meningioma.
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Affiliation(s)
- Nolan J Brown
- Department of Neurosurgery, University of California Irvine, Orange, California, USA
| | - Zach Pennington
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Cathleen C Kuo
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo, New York, USA
| | - Julian Gendreau
- Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, USA
| | | | - Rohin Singh
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA
| | - Dontré M Douse
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Fernandez C, Hoeltzel G, Werner-Wasik M, Kenyon LC, Shi W. Definitive radiotherapy for meningeal brainstem melanocytoma: a case report. Br J Neurosurg 2023; 37:1307-1310. [PMID: 33356599 DOI: 10.1080/02688697.2020.1864291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
Meningeal melanocytomas are rare, benign tumours of the central nervous system arising from the melanocytes of the leptomeninges. First-line treatment consists of either gross or subtotal resection with or without radiotherapy. However, given the sensitive locations of these tumours, alternative treatment options such as definitive radiotherapy may be warranted in patients deemed high-risk or without accessible tumours. A 67-year-old male presenting with spastic gait, frequent falls, and vertical gaze palsy was diagnosed with a 2.4 cm primary meningeal melanocytoma arising from the interpeduncular fossa. Given the critical tumour position within the brainstem, definitive radiotherapy was recommended. He received fractionated stereotactic radiotherapy (FSRT) to a total dose of 54 Gy in 27 fractions, resulting in a gradual improvement in gait and ocular range of motion. Follow-up imaging over the next three years revealed largely stable disease and an increase in edema with mild upper extremity weakness that improved with steroids. He was followed for three years and expired four years after treatment due to pneumonia. For patients unable to receive surgical resection, definitive RT may provide local control with minimal morbidity.
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Affiliation(s)
- Christian Fernandez
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gerard Hoeltzel
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lawrence C Kenyon
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Wenyin Shi
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
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Mampre D, Mehkri Y, Rajkumar S, Sriram S, Hernandez J, Lucke-Wold B, Chandra V. Treatment of breast cancer brain metastases: radiotherapy and emerging preclinical approaches. DIAGNOSTICS AND THERAPEUTICS 2022; 1:25-38. [PMID: 35782783 PMCID: PMC9249118 DOI: 10.55976/dt.1202216523-36] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The breast is one of the common primary sites of brain metastases (BM). Radiotherapy for BM from breast cancer may include whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and stereotactic radiotherapy (SRT), but a consensus is difficult to reach because of the wide and varied protocols, indications, and outcomes of these interventions. Overall, dissemination of disease, patient functional status, and tumor size are all important factors in the decision of treatment with WBRT or SRS. Thus far, previous studies indicate that WBRT can improve tumor control compared to SRS, but increase side effects, however no randomized trials have compared the efficacy of these therapies in BM from breast cancer. Therapies targeting long non-coding RNAs and transcription factors, such as MALAT1, HOTAIR, lnc-BM, TGL1, and ATF3, have the potential to both prevent metastatic spread and treat BM with improved radiosensitivity. Given the propensity for HER2+ breast cancer to develop BM, the above-mentioned cell lines may represent an important target for future investigations, and the development of everolimus and pyrotinib are equally important.
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Affiliation(s)
- David Mampre
- Department of Neurosurgery, University of Florida, Gainesville, FL
| | - Yusuf Mehkri
- Department of Neurosurgery, University of Florida, Gainesville, FL
| | | | - Sai Sriram
- Department of Neurosurgery, University of Florida, Gainesville, FL
| | - Jairo Hernandez
- Department of Neurosurgery, University of Florida, Gainesville, FL
| | | | - Vyshak Chandra
- Department of Neurosurgery, University of Florida, Gainesville, FL
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8
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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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Chow M, Jeng BP, Paiva WS. Letter to the Editor Regarding "The Effect of Radiation on Meningioma Volume Change". World Neurosurg 2021; 156:152. [PMID: 34802671 DOI: 10.1016/j.wneu.2021.08.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Michael Chow
- Santa Casa, Sao Paulo Medical School, Sao Paulo, Brazil
| | - Brasil Ping Jeng
- Division of Neurosurgery, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Wellingson Silva Paiva
- Division of Neurosurgery, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
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Rahman R, Sulman E, Haas-Kogan D, Cagney DN. Update on Radiation Therapy for Central Nervous System Tumors. Hematol Oncol Clin North Am 2021; 36:77-93. [PMID: 34711456 DOI: 10.1016/j.hoc.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiation therapy has long been a critical modality of treatment of patients with central nervous system tumors, including primary brain tumors, brain metastases, and meningiomas. Advances in radiation technology and delivery have allowed for more precise treatment to optimize patient outcomes and minimize toxicities. Improved understanding of the molecular underpinnings of brain tumors and normal brain tissue response to radiation will allow for continued refinement of radiation treatment approaches to improve clinical outcomes for brain tumor patients. With continued advances in precision and delivery, radiation therapy will continue to be an important modality to achieve optimal outcomes of brain tumor patients.
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Affiliation(s)
- Rifaquat Rahman
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, 75 Francis Street, ASB1-L2, Boston, MA 02115, USA
| | - Erik Sulman
- Department of Radiation Oncology, New York University Grossman School of Medicine, 160 East 34th Street, New York, NY 10016, USA
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, 75 Francis Street, ASB1-L2, Boston, MA 02115, USA
| | - Daniel N Cagney
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, 75 Francis Street, ASB1-L2, Boston, MA 02115, USA.
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Cesme DH, Alkan A, Sari L, Yabul F, Temur HO, Aykan ME, Seyithanoglu MH, Hatiboglu MA. Importance of Pre-treatment Fractional Anisotropy Value in Predicting Volumetric Response in Patients with Meningioma Treated with Gamma Knife Radiosurgery. Curr Med Imaging 2021; 17:871-877. [PMID: 33511956 PMCID: PMC8811611 DOI: 10.2174/2213335608999210128182047] [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: 10/07/2020] [Revised: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 11/22/2022]
Abstract
Background The importance of pre-treatment Diffusion Tensor Imaging (DTI) parameters in determining the response to treatment after radiosurgery in patients with meningioma has not yet been clearly revealed. Objective This study was conducted to determine tumor volume changes in terms of radiological response in patients with meningioma treated with Gamma Knife Radiosurgery (GKR) and to analyze the relationship between Total Tumor Volume (TTV) and Diffusion Tensor Imaging (DTI) parameters. In addition, we investigated whether the response to treatment can be predicted by pre-radiosurgery DTI findings. Methods Fifty-four patients were assessed using MRI and DTI before and after GKR. Mean Diffusivity (MD), Fractional Anisotropy (FA), Radial Diffusivity (RD), and TTV of tumour were determined. Patients with 10% or more decrease in TTV after GKR were classified as group 1 and those with less than 10% decrease in volume or increase in volume were considered group 2. The relationships between MD, RD, and FA values and TTV were investigated. Results A decrease of 46.34% in TTV was detected in group 1 after GKR, while TTV increased by 42.91% in group 2. The lowest pre-treatment FA value was detected in group 1. In addition, after GKR, FA values showed a significant increase in group 1. MD and RD values increased in both groups after radiosurgery. There was a negative correlation between pre-treatment FA, RD, and MD values after radiosurgery. Conclusion Detection of low FA values due to the poor fiber content in meningioma before radiosurgery may be a guide in predicting the response to treatment. Further studies are required to have a better understanding of the relationship between pre- and post-treatment follow-up FA values and tumor volume in determining the efficacy of GKR in patients with meningioma.
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Affiliation(s)
- Dilek H Cesme
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Alpay Alkan
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Lutfullah Sari
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatma Yabul
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Hafize O Temur
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mahmut E Aykan
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet H Seyithanoglu
- Department of Neurosurgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mustafa A Hatiboglu
- Department of Neurosurgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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12
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Association between tumor size and peritumoral brain edema in patients with convexity and parasagittal meningiomas. PLoS One 2021; 16:e0252945. [PMID: 34111188 PMCID: PMC8191970 DOI: 10.1371/journal.pone.0252945] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/25/2021] [Indexed: 12/18/2022] Open
Abstract
Background and purpose Peritumoral brain edema (PTBE) is a common complication in meningioma and disruption of the tumor-brain barrier in meningioma is crucial for PTBE formation. To evaluate the association between meningioma size and PTBE, we measured meningioma volumes using the 3D slicer in patients with convexity and parasagittal meningiomas. Methods Receiver operating characteristic curve analysis was used to determine the optimal cut-off meningioma volume values for predicting PTBE occurrence. Logistic regressions were used to estimate the odds ratios for PTBE occurrence in patients with convexity and parasagittal meningiomas according to several predictive factors. Results A total of 205 convexity or parasagittal meningioma patients with no other brain disease who underwent one or more contrast-enhanced brain MRIs were enrolled in this 10-year analysis in two hospitals. The optimal cut-off meningioma volume value for prediction of PTBE in all study patients was 13.953 cc (sensitivity = 76.1%; specificity = 92.5%). If a meningioma is assumed to be a complete sphere, 13.953 cc is about 2.987 cm in diameter. Conclusions Our study suggests a cut-off value of 3 cm meningioma diameter for prediction of PTBE in patients with convexity and parasagittal meningiomas. We believe that we have revealed why the meningioma diameter of 3 cm is clinically meaningful.
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Sphenoid wing meningiomas. HANDBOOK OF CLINICAL NEUROLOGY 2021; 170:37-43. [PMID: 32586507 DOI: 10.1016/b978-0-12-822198-3.00026-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Meningiomas that arise from the dura along the sphenoid wing can occur in globoid or en plaque forms. Radiographically they can be defined as occurring in the medial, middle, or lateral portions of the sphenoid wing. The medial group carries the highest neurologic risk for surgical treatment, while the hyperostosing en plaque type is the most difficult to remove completely because of orbital and bone involvement. This chapter addresses the clinical presentation and surgical treatment of sphenoid wing meningiomas with an emphasis on the most recent results from the literature.
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Snyder KC, Cunningham J, Huang Y, Zhao B, Dolan J, Wen N, Chetty IJ, Shah MM, Siddiqui SM. Dosimetric Evaluation of Fractionated Stereotactic Radiation Therapy for Skull Base Meningiomas Using HyperArc and Multicriteria Optimization. Adv Radiat Oncol 2021; 6:100663. [PMID: 33997481 PMCID: PMC8099749 DOI: 10.1016/j.adro.2021.100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/07/2021] [Accepted: 01/20/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose Treatment planning of skull based meningiomas can be difficult due to the irregular shaped target volumes and proximity to critical optic structures. This study evaluated the use of HyperArc (HA) radiosurgery optimization and delivery in conjunction with multicriteria optimization (MCO) to create conformal and efficient treatment plans for conventionally fractionated radiation therapy to difficult base-of-skull (BOS) lesions. Methods and Materials Twelve patients with BOS meningioma were retrospectively planned with HA-specific optimization algorithm, stereotactic normal tissue objective (SRS-NTO), and conventional automatic normal tissue objective to evaluate normal brain sparing (mean dose and V20 Gy). MCO was used on both SRS-NTO and automatic normal tissue objective plans to further decrease organ-at-risk doses and target dose maximum to within clinically acceptable constraints. Delivery efficiency was evaluated based on planned monitor units. Results The SRS-NTO in HA can be used to improve the mid- and low-dose spread to normal brain tissue in the irradiation of BOS meningiomas. Improvement in normal brain sparing can be seen in larger, more irregular shaped lesions and less so in smaller spherical targets. MCO can be used in conjunction with the SRS-NTO to reduce target dose maximum and dose to organ at risk without sacrificing the gain in normal brain sparing. Conclusions HA can be beneficial both in treatment planning by using the SRS-NTO and in delivery efficiency through the decrease in monitor units and automated delivery.
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Affiliation(s)
- Karen Chin Snyder
- Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan
| | - Justine Cunningham
- Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan
| | - Yimei Huang
- Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan
| | - Bo Zhao
- Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan
| | - Jennifer Dolan
- Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan
| | - Ning Wen
- Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan
| | - Mira M Shah
- Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan
| | - Salim M Siddiqui
- Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan
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Mahase SS, Roth O'Brien DA, No D, Roytman M, Skafida ME, Lin E, Karakatsanis NA, Osborne JR, Brandmaier A, Pannullo SC, Ramakrishna R, Stieg PE, Knisely JPS, Ivanidze J. [ 68Ga]-DOTATATE PET/MRI as an adjunct imaging modality for radiation treatment planning of meningiomas. Neurooncol Adv 2021; 3:vdab012. [PMID: 33738446 PMCID: PMC7954102 DOI: 10.1093/noajnl/vdab012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Meningiomas express high levels of somatostatin receptor 2 (SSTR2). SSTR2-targeted PET imaging with [68Ga]-DOTATATE can aid with distinguishing residual meningioma from reactive changes in the postoperative setting. We present initial dosimetric analyses, acute events, and local control data utilizing [68Ga]-DOTATATE PET/MRI-assisted target delineation for prospectively-treated intermediate-risk meningiomas. Methods Twenty-nine patients underwent DOTATATE PET/MRI meningioma evaluation in 2019. Eight patients with 9 postoperative meningiomas met RTOG 0539 intermediate-risk criteria (recurrent WHO grade I, 1/9; WHO grade II, 8/9). Target volumes were created using DOTATATE PET/MRI to determine residual disease and received a nominal dose of 35.0 Gy over 5 fractions. For comparison, cases were recontoured and planned with MRI alone per RTOG 0539 guidelines. Mean and maximum equivalent 2 Gy doses were generated for target volumes and organs at risk (OAR) within 1 cm of the PTV and compared using Wilcoxon matched pairs signed rank test. Results DOTATATE PET/MRI-guided planning significantly reduced mean PTV (11.12 cm3 compared to 71.39 cm3 based on MRI alone, P < .05) and mean and max dose to the whole brain, optic nerves, and scalp. PET/MRI plans resulted in at least 50% reduction of mean and max doses to the lens, eyes, chiasm, cochlea, brainstem, and hippocampi. One patient experienced focal alopecia. There were no local recurrences at 6 months. Conclusion Incorporating DOTATATE-PET/MRI for postoperative target delineation in patients with intermediate-risk intracranial meningiomas results in PTV reduction and decreased OAR dose. Our findings warrant larger studies evaluating DOTATATE-PET/MRI in the radiotherapeutic planning of postoperative meningiomas.
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Affiliation(s)
- Sean S Mahase
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Diana A Roth O'Brien
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Diana No
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Michelle Roytman
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Myrto E Skafida
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Eaton Lin
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | | | - Joseph R Osborne
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Andrew Brandmaier
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Jonathan P S Knisely
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Jana Ivanidze
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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Huang SH, Wang CC, Wei KC, Chang CN, Chuang CC, Chen HC, Lin YJ, Chen KT, Pai PC, Hsu PW. Treatment of intracranial meningioma with single-session and fractionated radiosurgery: a propensity score matching study. Sci Rep 2020; 10:18500. [PMID: 33116194 PMCID: PMC7595213 DOI: 10.1038/s41598-020-75559-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 10/14/2020] [Indexed: 11/09/2022] Open
Abstract
Single-session stereotactic radiosurgery (SSRS) is recognized as a safe and efficient treatment for meningioma. We aim to compare the long-term efficacy and safety of fractionated stereotactic radiotherapy (FSRT) with SSRS in the treatment of grade I meningioma. A total of 228 patients with 245 tumors treated with radiosurgery between March 2006 and June 2017were retrospectively evaluated. Of these, 147 (64.5%) patients were treated with SSRS. The remaining 81 patients (35.5%) were treated with a fractionated technique. Protocols to treat meningioma were classified as 12-16 Gy per fraction for SSRS and 7 Gy/fraction/day for three consecutive days to reach a total dose of 21 Gy for FSRT. In univariate and multivariate analyses, tumor volume was found to be associated with local control rate (hazard ratio = 4.98, p = 0.025). The difference in actuarial local control rate (LCR) between the SSRS and FSRT groups after propensity score matching (PSM) was not statistically significant during the 2-year (96.86% versus 100.00%, respectively; p = 0.175), 5-year (94.76% versus 97.56%, respectively; p = 0.373), and 10-year (74.40% versus 91.46%, respectively; p = 0.204) follow-up period. FSRT and SSRS were equally well-tolerated and effective for the treatment of intracranial benign meningioma during the10-year follow-up period.
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Affiliation(s)
- Sheng-Han Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Xing Street, Kwei-shan Dist., Taoyuan, 33305, Taiwan, Republic of China
| | - Chun-Chieh Wang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Kuo-Chen Wei
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Xing Street, Kwei-shan Dist., Taoyuan, 33305, Taiwan, Republic of China
| | - Cheng-Nen Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Xing Street, Kwei-shan Dist., Taoyuan, 33305, Taiwan, Republic of China
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Xing Street, Kwei-shan Dist., Taoyuan, 33305, Taiwan, Republic of China
| | - Hsien-Chih Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Keelung, Chang Gung University, Keelung, Taiwan, Republic of China
| | - Ya-Jui Lin
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Xing Street, Kwei-shan Dist., Taoyuan, 33305, Taiwan, Republic of China
| | - Ko-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Xing Street, Kwei-shan Dist., Taoyuan, 33305, Taiwan, Republic of China
| | - Ping-Ching Pai
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Peng-Wei Hsu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Xing Street, Kwei-shan Dist., Taoyuan, 33305, Taiwan, Republic of China.
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Song AJ, Shi W, Ellenbogen RG, Venur VA, Lo SS. Commentary: Stereotactic Radiosurgery for Intracranial Noncavernous Sinus Benign Meningioma: International Stereotactic Radiosurgery Society Systematic Review, Meta-Analysis and Practice Guideline. Neurosurgery 2020; 87:E537-E538. [PMID: 32570276 DOI: 10.1093/neuros/nyaa264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrew J Song
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Wenyin Shi
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Richard G Ellenbogen
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Vyshak Alva Venur
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
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Fatima N, Pollom E, Soltys S, Chang SD, Meola A. Stereotactic radiosurgery for head and neck paragangliomas: a systematic review and meta-analysis. Neurosurg Rev 2020; 44:741-752. [PMID: 32318920 DOI: 10.1007/s10143-020-01292-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/15/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
Head and neck paragangliomas (HNPs) are rare, usually benign hyper vascularized neuroendocrine tumors that traditionally have been treated by surgery, with or without endovascular embolization, or, more recently stereotactic radiosurgery (SRS). The aim of our study is to determine the clinical and radiographic effectiveness of SRS for treatment of HNPs. A systematic search of electronic databases was performed, and 37 articles reporting 11,174 patients (1144 tumors) with glomus jugulare (GJT: 993, 86.9%), glomus tympanicum (GTT: 94, 8.2%), carotid body tumors (CBTs: 28, 2.4%), and glomus vagale (GVT: 16, 1.4%) treated with SRS definitively or adjuvantly were included. The local control (LC) was estimated from the pooled analysis of the series, and its association with SRS technique as well as demographic and clinical factors was analyzed. The median age was 56 years (44-69 years). With a median clinical and radiological follow-up of 44 months (9-161 months), LC was 94.2%. Majority of the patients (61.0%) underwent Gamma Knife Radiosurgery (GKS), but there was no statistically significant difference in LC depending upon the SRS technique (p = 0.9). Spearmen's correlation showed that LC was strongly and negatively correlated with multiple parameters, which included female gender (r = - 0.4, p = 0.001), right-sided tumor (r = - 0.3, p = 0.03), primary SRS (r = - 0.5, p ≤ 0.001), and initial clinical presentation of hearing loss (r = - 0.4, p = 0.001). To achieve a LC ≥ 90%, a median marginal dose (Gy) of 15 (range, 12-30 Gy) was required. The results corroborate that SRS in HNPs is associated with good clinical and radiological outcome.
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Affiliation(s)
- Nida Fatima
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg, Stanford, CA, USA.
| | - Erqi Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Scott Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg, Stanford, CA, USA
| | - Antonio Meola
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg, Stanford, CA, USA
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Abstract
Radiation therapy (RT) plays an important role in the management of meningioma. Surgery often remains the initial treatment of choice as it reduces mass effect and confirms the diagnosis and grade. However, RT has frequently been successful in the primary setting and is commonly employed as adjuvant therapy for incompletely resected tumors as well as for high-grade meningiomas regardless of resection extent. Some meningiomas develop in locations less amenable to resection or in patients who are poor surgical candidates, in which circumstances RT is particularly appropriate as primary treatment. Recent cooperative group studies including RTOG 0539 have better established the role of RT for meningioma. These studies suggest a role for adjuvant RT for completely resected Grade II meningioma, which was less clear historically. Ongoing clinical trials such as NRG BN 003 and ROAM will further clarify this. This chapter reviews the role of fractionated external beam RT for various grades of meningioma.
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Affiliation(s)
- Samuel Chao
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, United States
| | - Leland Rogers
- Department of Radiation Oncology, Barrow Neurological Institute, Phoenix, AZ, United States.
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Stereotactic Radiosurgery for Large Benign Intracranial Tumors. World Neurosurg 2019; 134:e172-e180. [PMID: 31605862 DOI: 10.1016/j.wneu.2019.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Historically, it is stated that large intracranial tumors, herein defined as a maximum dimension of ≥3 cm or tumor volume ≥14.2 cm3, are not candidates for stereotactic radiosurgery (SRS). We report outcomes of patients with large benign intracranial tumors treated with SRS. METHODS With institutional review board approval, we retrospectively identified 74 patients with large benign intracranial tumors (59 meningiomas, 9 vestibular schwannomas, and 6 glomus jugulare tumors) treated with robotic SRS (2007-2018). Patients received definitive SRS in 47.3% of the cases, adjuvant to surgical resection in 44.6%, and salvage after past radiation treatment in 8.1%. A median tumor volume of 16.0 cm3 (range, 10.1-65.5 cm3) received a median dose of 24.0 Gy (range, 14.0-30.0 Gy) in a median of 3 fractions (range, 1-5), for a median single fraction equivalent dose (with alpha/beta of 3) of 14.8 Gy (range, 11.3-18.0 Gy). The Kaplan-Meier estimate of tumor local control (LC) was calculated from date of SRS. RESULTS With a median clinical follow-up of 32.8 months (range, 0.6-125.9 months) and median radiologic follow-up of 28.5 months (range, 0.6-121.4 months), LC was 96.5% (95% confidence interval, 92.4%-100%) at 3 years and 91.7% (95% confidence interval, 87.6%-95.7%) at 5 years. Adverse radiation effect (ARE) was seen in 10 patients (13.5%) at a median of 13.5 months (range, 7.8-34.5 months). ARE occurred in 9% of those with prior treatment compared with 5% who were radiation-naïve (P = 0.23). With 236.4 person-years of follow-up, no secondary malignancies were seen. CONCLUSIONS Despite the historical adage, we find that SRS provides high rates of LC for these large tumors, with rates of ARE similar to historical reports of SRS for smaller benign tumors.
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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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