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Ohira S, Imae T, Minamitani M, Katano A, Aoki A, Ohta T, Umekawa M, Shinya Y, Hasegawa H, Nishio T, Koizumi M, Yamashita H, Saito N, Nakagawa K. Long-term geometric quality assurance of radiation focal point and cone-beam computed tomography for Gamma Knife radiosurgery system. Radiol Phys Technol 2024; 17:389-395. [PMID: 38466497 PMCID: PMC11128398 DOI: 10.1007/s12194-024-00788-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 03/13/2024]
Abstract
To investigate the geometric accuracy of the radiation focal point (RFP) and cone-beam computed tomography (CBCT) over long-term periods for the ICON Leksell Gamma Knife radiosurgery system. This phantom study utilized the ICON quality assurance tool plus, and the phantom was manually set on the patient position system before the implementation of treatment for patients. The deviation of the RFP position from the unit center point (UCP) and the positions of the four ball bearings (BBs) in the CBCT from the reference position were automatically analyzed. During 544 days, a total of 269 analyses were performed on different days. The mean ± standard deviation (SD) of the deviation between measured RFP and UCP was 0.01 ± 0.03, 0.01 ± 0.03, and -0.01 ± 0.01 mm in the X, Y, and Z directions, respectively. The deviations with offset values after the cobalt-60 source replacement (0.00 ± 0.03, -0.01 ± 0.01, and -0.01 ± 0.01 mm in the X, Y, and Z directions, respectively) were significantly (p = 0.001) smaller than those before the replacement (0.02 ± 0.03, 0.02 ± 0.01, and -0.02 ± 0.01 mm in the X, Y, and Z directions, respectively). The overall mean ± SD of four BBs was -0.03 ± 0.03, -0.01 ± 0.05, and 0.01 ± 0.03 mm in the X, Y, and Z directions, respectively. Geometric positional accuracy was ensured to be within 0.1 mm on most days over a long-term period of more than 500 days.
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Affiliation(s)
- Shingo Ohira
- Department of Comprehensive Radiation Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Toshikazu Imae
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Masanari Minamitani
- Department of Comprehensive Radiation Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Atsushi Aoki
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Takeshi Ohta
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Motoyuki Umekawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuki Shinya
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
- Department of Neurologic Surgery, Mayo Clinic, Rochester Minnesota, USA
| | - Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Teiji Nishio
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideomi Yamashita
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Keiichi Nakagawa
- Department of Comprehensive Radiation Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Cho HJ, Lee JM, Park SH, Park JB, Jung NY. The Efficacy and Tolerability of Radiosurgery in Treating Benign Meningiomas: A Dose Comparison Study from a Single-Center Analysis. Life (Basel) 2024; 14:664. [PMID: 38929650 PMCID: PMC11204394 DOI: 10.3390/life14060664] [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: 04/13/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
This retrospective study aimed to evaluate the impact of radiation dose on the outcomes of stereotactic radiosurgery (SRS) for benign meningiomas and determine an optimal dosing strategy for balancing tumor control and treatment-related toxicity. Clinical data of 147 patients with 164 lesions treated between 2014 and 2022 were reviewed. Primary outcomes included progression-free survival (PFS), local control rate (LCR), and radiation-induced toxicity, with secondary outcomes focusing on LCR and radiation-induced peritumoral edema (PTE) in two dose groups (≥14 Gy and <14 Gy). The results revealed a median follow-up duration of 47 months, with 1-year, 2-year, and 5-year PFS rates of 99.3%, 96.7%, and 93.8%, respectively, and an overall LCR of 95.1%. Radiation-induced toxicity was observed in 24.5% of patients, primarily presenting mild symptoms. Notably, no significant difference in LCR was found between the two dose groups (p = 0.628), while Group 2 (<14 Gy) exhibited significantly lower PTE (p = 0.039). This study concludes that SRS with a radiation dose < 14 Gy demonstrates comparable tumor control with reduced toxicity, advocating consideration of such dosing to achieve a balance between therapeutic efficacy and safety.
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Affiliation(s)
- Hyun-Jeong Cho
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea; (H.-J.C.); (J.-M.L.); (J.-B.P.)
| | - Jong-Min Lee
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea; (H.-J.C.); (J.-M.L.); (J.-B.P.)
| | - Sung-Ho Park
- Department of Neurosurgery, TrueBeam Radiosurgery Center, Ulsan University Hospital, Ulsan 44033, Republic of Korea;
| | - Jun-Bum Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea; (H.-J.C.); (J.-M.L.); (J.-B.P.)
| | - Na-Young Jung
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea; (H.-J.C.); (J.-M.L.); (J.-B.P.)
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Polemikos M, Nakamura M, Merten R, Hermann EJ, Bronzlik P, Christiansen H, Krauss JK. Extended Long-Term Outcome After Conservative Decompressive Microsurgery and Routine Adjuvant Fractionated Stereotactic Radiotherapy for Symptomatic Cavernous Sinus Meningiomas. Neurosurgery 2024:00006123-990000000-01117. [PMID: 38973738 DOI: 10.1227/neu.0000000000002940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/08/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cavernous sinus meningiomas (CSM) pose one of the most difficult to treat subgroup of skull base meningiomas. The purpose of this study was to evaluate the efficacy of an interdisciplinary treatment approach for symptomatic CSM which incorporated conservative function preserving microsurgery and routine adjuvant fractionated stereotactic radiotherapy (FSRT). METHODS A homogenous group of patients with symptomatic primary CSM with extracavernous extension was treated between 2005 and 2012. All patients were available for a minimum follow-up of 5 years. Clinical follow-up included detailed examination of oculomotor deficits, visual status, and endocrinologic function. Radiologic follow-up was conducted by tumor volumetry. RESULTS Overall, 23 patients were included in this study (78.3% women; median age 58 years). Diplopia was the most common presenting symptom, followed by headache and visual disturbances. Surgical morbidity was low (3/23; 13%). FSRT was applied after a median of 2 months after surgery. At a median clinical follow-up of 113 months, 70.45% of the presenting symptoms had improved, 25% remained unchanged, and in 2 cases (4.54%), worsening occurred. Overall tumor regression was evident in 19/21 World Health Organization 1 and in 1/2 of World Health Organization 2 CSM, respectively, at a median radiological follow-up of 103 months. CONCLUSION Our findings demonstrate the efficacy of an interdisciplinary treatment approach for symptomatic primary CSM with extracavernous extension with decompression of neurovascular elements followed by FSRT. Precise preoperative planning and intraoperative decision making in combination with routine postoperative radiotherapy can achieve excellent tumor control, improve neurologic function, and minimize long-term morbidity.
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Affiliation(s)
- Manolis Polemikos
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Makoto Nakamura
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
- Department of Neurosurgery, Hospital Merheim of the Clinics Cologne, University of Witten/Herdecke, Witten, Germany
| | - Roland Merten
- Department of Radiation Oncology, Hannover Medical School, Hannover, Germany
| | - Elvis J Hermann
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Paul Bronzlik
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Hans Christiansen
- Department of Radiation Oncology, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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Zhao Z, Nie C, Zhao L, Xiao D, Zheng J, Zhang H, Yan P, Jiang X, Zhao H. Multi-parametric MRI-based machine learning model for prediction of WHO grading in patients with meningiomas. Eur Radiol 2024; 34:2468-2479. [PMID: 37812296 PMCID: PMC10957672 DOI: 10.1007/s00330-023-10252-8] [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: 10/27/2022] [Revised: 07/05/2023] [Accepted: 07/15/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE The purpose of this study was to develop and validate a nomogram combined multiparametric MRI and clinical indicators for identifying the WHO grade of meningioma. MATERIALS AND METHODS Five hundred and sixty-eight patients were included in this study, who were diagnosed pathologically as having meningiomas. Firstly, radiomics features were extracted from CE-T1, T2, and 1-cm-thick tumor-to-brain interface (BTI) images. Then, difference analysis and the least absolute shrinkage and selection operator were orderly used to select the most representative features. Next, the support vector machine algorithm was conducted to predict the WHO grade of meningioma. Furthermore, a nomogram incorporated radiomics features and valuable clinical indicators was constructed by logistic regression. The performance of the nomogram was assessed by calibration and clinical effectiveness, as well as internal validation. RESULTS Peritumoral edema volume and gender are independent risk factors for predicting meningioma grade. The multiparametric MRI features incorporating CE-T1, T2, and BTI features showed the higher performance for prediction of meningioma grade with a pooled AUC = 0.885 (95% CI, 0.821-0.946) and 0.860 (95% CI, 0.788-0.923) in the training and test groups, respectively. Then, a nomogram with a pooled AUC = 0.912 (95% CI, 0.876-0.961), combined radiomics score, peritumoral edema volume, and gender improved diagnostic performance compared to radiomics model or clinical model and showed good calibration as the true results. Moreover, decision curve analysis demonstrated satisfactory clinical effectiveness of the proposed nomogram. CONCLUSIONS A novel nomogram is simple yet effective in differentiating WHO grades of meningioma and thus can be used in patients with meningiomas. CLINICAL RELEVANCE STATEMENT We proposed a nomogram that included clinical indicators and multi-parameter radiomics features, which can accurately, objectively, and non-invasively differentiate WHO grading of meningioma and thus can be used in clinical work. KEY POINTS • The study combined radiomics features and clinical indicators for objectively predicting the meningioma grade. • The model with CE-T1 + T2 + brain-to-tumor interface features demonstrated the best predictive performance by investigating seven different radiomics models. • The nomogram potentially has clinical applications in distinguishing high-grade and low-grade meningiomas.
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Affiliation(s)
- Zhen Zhao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuansheng Nie
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhao
- International Education College of Henan University, Kaifeng, China
| | - Dongdong Xiao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianglin Zheng
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Zhang
- Department of Geriatric Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pengfei Yan
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaobing Jiang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Hongyang Zhao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Goyal-Honavar A, Pateriya V, Chauhan S, Sadashiva N, Vazhayil V, Konar S, Beniwal M, Ar P, Arimappamagan A, B J, Natesan P. Factors Influencing Long-Term Outcomes of Single-Session Gamma Knife Radiosurgery in Large-Volume Meningiomas >10 cc. Stereotact Funct Neurosurg 2024; 102:109-119. [PMID: 38432224 DOI: 10.1159/000536409] [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: 11/08/2023] [Accepted: 01/15/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Meningiomas are the most common primary intracranial tumour. Gamma knife radiosurgery (GKRS) is a frequently employed non-invasive method of treatment, with good remission rates and low morbidity in literature. However, the role of GKRS in the management of "large" meningiomas is unclear, with reported outcomes that vary by centre. We aimed to assess the factors that influence long-term outcomes following GKRS in meningiomas >10 cc in volume. METHODS A retrospectively analysed all patients with meningiomas exceeding 10 cc in volume who underwent GKRS between January 2006 and December 2021 at the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. Demographic, clinical, radiological, and follow-up data were acquired, and factors associated with progression following GKRS were assessed. RESULTS The cohort comprised 76 patients 29 males (38.2%) and 47 females (61.8%) with a mean age of 46.3 ± 11.02 years. Thirty-nine patients had been previously operated (51.3%). Meningiomas were most frequently located in the parasagittal region (26 tumours, 34.2%) and sphenopetroclival region (23 tumours, 30.3%), with mean lesion volume of 12.55 ± 5.22 cc, ranging 10.3 cc-25 cc. The mean dose administered to the tumour margin was 12.5 Gy ± 1.2 Gy (range 6-15 Gy). The median duration of clinical follow-up was 48 months, over which period radiological progression occurred in 14 cases (20%), with unchanged tumour volume in 20 cases (28.6%) and reduction in size of the tumour in 36 cases (51.4%). Progression-free survival after GKRS was 72% at 5 years, was significantly poorer among meningiomas with tumour volume >14 cc (log-rank test p = 0.045), tumours presenting with limb motor deficits (log-rank test p = 0.012), and tumours that underwent prior Simpson grade 3 or 4 excision (log-rank test p = 0.032). CONCLUSIONS Meningiomas >10 cc in volume appear to display a high rate of progression and subsequent need for surgery following GKRS. Primary surgical resection, when not contraindicated, may be considered with GKRS serving an adjuvant role, especially in tumours exceeding 14 cc in volume, and presenting with limb motor deficits. Long-term clinical and radiological follow-up is essential following GKRS as the response of large meningiomas may be unpredictable.
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Affiliation(s)
- Abhijit Goyal-Honavar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Vibhor Pateriya
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Sonal Chauhan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Vikas Vazhayil
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Manish Beniwal
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Prabhuraj Ar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Arivazhagan Arimappamagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Jeeva B
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Ponnusamy Natesan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Kim YJ, Moon KS, Park SJ, Jung TY, Kim IY, Jung S. Gamma knife radiosurgery as primary management for intracranial meningioma identified as growing on serial imaging. Medicine (Baltimore) 2024; 103:e37082. [PMID: 38306534 PMCID: PMC10843379 DOI: 10.1097/md.0000000000037082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/05/2024] [Indexed: 02/04/2024] Open
Abstract
Gamma knife radiosurgery (GKRS) has emerged as a highly effective therapeutic modality for the management of intracranial meningiomas. However, the role of GKRS in treating growing meningiomas detected during active surveillance remains unclear. This study seeks to investigate the long-term outcomes of GKRS treatment for growing meningiomas. A retrospective analysis was conducted on patients who underwent GKRS as the primary treatment for growing meningiomas between 2004 and 2021. Growing meningiomas were defined as those exhibiting a > 10% increase in tumor volume (TV) compared to the previous imaging. Fifty-nine patients who received GKRS as their initial treatment were included, with a minimum follow-up period of 12 months. Comprehensive clinical, radiological, and procedural data were analyzed. Serial TV assessments were performed for all tumors before and after GKRS. Tumor progression and regression were defined as a > 10% increase or decrease in TV, respectively, compared to the pretreatment image. At a median follow-up of 41 months (range 15-197 months), TV was unchanged in 16 patients (27.1%), decreased in 41 patients (69.5%), and increased in 2 patients (3.4%). Multivariate analysis revealed that both TV (cm3) (hazard ratio [HR], 1.107; 95% confidence interval [CI], 1.002-1.222; P = .045) and volume growing rate (%/yr) (HR, 1.013; 95% CI, 1.000-1.025; P = .04) significantly correlated with tumor progression. Eleven patients (18.6%) experienced new or worsening symptoms. In multivariate analysis, factor predicting new or worsening neurological function was preexisting calcification (HR, 5.297; 95% CI, 1.328-21.124; P = .018). GKRS demonstrates a promising level of tumor control with minimal risk of neurological deterioration when applied to growing meningiomas. These findings provide compelling support for considering GKRS as a valuable therapeutic option following an initial period of active surveillance for these tumors.
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Affiliation(s)
- Yeong Jin Kim
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - Sue Jee Park
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - Tae-Young Jung
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - In-Young Kim
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
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Li X, Lu Y, Liu L, Wang D, Zhao Y, Mei N, Geng D, Ma X, Zheng W, Duan S, Wu PY, Wen H, Tan Y, Sun X, Sun S, Li Z, Yu T, Yin B. Predicting peritumoral edema development after gamma knife radiosurgery of meningiomas using machine learning methods: a multicenter study. Eur Radiol 2023; 33:8912-8924. [PMID: 37498381 DOI: 10.1007/s00330-023-09955-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Edema is a complication of gamma knife radiosurgery (GKS) in meningioma patients that leads to a variety of consequences. The aim of this study is to construct radiomics-based machine learning models to predict post-GKS edema development. METHODS In total, 445 meningioma patients who underwent GKS in our institution were enrolled and partitioned into training and internal validation datasets (8:2). A total of 150 cases from multicenter data were included as the external validation dataset. In each case, 1132 radiomics features were extracted from each pre-treatment MRI sequence (contrast-enhanced T1WI, T2WI, and ADC maps). Nine clinical features and eight semantic features were also generated. Nineteen random survival forest (RSF) and nineteen neural network (DeepSurv) models with different combinations of radiomics, clinical, and semantic features were developed with the training dataset, and evaluated with internal and external validation. A nomogram was derived from the model achieving the highest C-index in external validation. RESULTS All the models were successfully validated on both validation datasets. The RSF model incorporating clinical, semantic, and ADC radiomics features achieved the best performance with a C-index of 0.861 (95% CI: 0.748-0.975) in internal validation, and 0.780 (95% CI: 0.673-0.887) in external validation. It stratifies high-risk and low-risk cases effectively. The nomogram based on the predicted risks provided personalized prediction with a C-index of 0.962 (95%CI: 0.951-0.973) and satisfactory calibration. CONCLUSION This RSF model with a nomogram could represent a non-invasive and cost-effective tool to predict post-GKS edema risk, thus facilitating personalized decision-making in meningioma treatment. CLINICAL RELEVANCE STATEMENT The RSF model with a nomogram built in this study represents a handy, non-invasive, and cost-effective tool for meningioma patients to assist in better counselling on the risks, appropriate individual treatment decisions, and customized follow-up plans. KEY POINTS • Machine learning models were built to predict post-GKS edema in meningioma. The random survival forest model with clinical, semantic, and ADC radiomics features achieved excellent performance. • The nomogram based on the predicted risks provides personalized prediction with a C-index of 0.962 (95%CI: 0.951-0.973) and satisfactory calibration and shows the potential to assist in better counselling, appropriate treatment decisions, and customized follow-up plans. • Given the excellent performance and convenient acquisition of the conventional sequence, we envision that this non-invasive and cost-effective tool will facilitate personalized medicine in meningioma treatment.
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Affiliation(s)
- Xuanxuan Li
- Department of Radiology, Huashan Hospital, Fudan University, 12, Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China
| | - Yiping Lu
- Department of Radiology, Huashan Hospital, Fudan University, 12, Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China
| | - Li Liu
- Department of Radiology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Dongdong Wang
- Department of Radiology, Huashan Hospital, Fudan University, 12, Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China
| | - Yajing Zhao
- Department of Radiology, Huashan Hospital, Fudan University, 12, Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China
| | - Nan Mei
- Department of Radiology, Huashan Hospital, Fudan University, 12, Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, 12, Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China
| | - Xin Ma
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu Province, China
| | - Weiwei Zheng
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | | | | | - Hongkai Wen
- Department of Computer Science, University of Warwick, Coventry, UK
| | - Yongli Tan
- Neurosurgery Gamma Knife Centre, Zibo Wanjie Cancer Hospital, Zibo City, Shandong, China
| | - Xiaogang Sun
- Neurosurgery Gamma Knife Centre, Zibo Wanjie Cancer Hospital, Zibo City, Shandong, China
| | - Shibin Sun
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhiwei Li
- Neurosurgery Department, Wenzhou Central Hospital, Wenzhou, Zhejiang Province, China
| | - Tonggang Yu
- Department of Radiology, Shanghai Gamma Hospital, Huashan Hospital, Fudan University, 518, Middle Wuzhong Rd., Xuhui District, Shanghai, 200235, China.
| | - Bo Yin
- Department of Radiology, Huashan Hospital, Fudan University, 12, Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China.
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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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9
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Patel A, Abdelsalam A, Shariff RK, Mallela AN, Andrews EG, Tonetti DA, Lunsford LD, Abou-Al-Shaar H. Bibliometric analysis of the top 100 cited articles on stereotactic radiosurgery of intracranial meningiomas. Br J Neurosurg 2023; 37:1088-1093. [PMID: 35142245 DOI: 10.1080/02688697.2022.2034745] [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: 10/18/2021] [Accepted: 01/23/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Sterotactic radiosurgery is becoming an integral modality in the management of intracranial meningiomas, both as the primary treatment or as adjuvant therapy. This study analyzes the scholarly impact of the top 100 cited articles on the stereotactic radiosurgical management of intracranial meningiomas. METHODS A ranked list of the 100 most-cited articles was generated using the Scopus database by searching the keywords 'intracranial meningioma' and 'stereotactic radiosurgery'. All articles were then evaluated on multiple criteria regarding both the publication of the articles (year of publication, journal, country of origin, and authors) as well as their methods and foci (type of study, location of studied meningiomas, and type of radiosurgical modality). Quantitaitve and qualitative analyses were then performed from the collected data. RESULTS The most frequently cited articles on stereotactic radiosurgical management of intracranial meningiomas were published between 1990 and 2016. The average citation-per-year across all papers in the list was 6.1. The most studied anatomic area of intracranial meningiomas was the skull base, with the cavernous sinus being the most well-studied specific site. The most utilized stereotactic radiosurgical modality was Gamma Knife radiosurgery. The country with the highest number of publications was the United States. Twenty-six percent of the articles were published in the journal Neurosurgery; Lunsford, Kondziolka, Flickinger, Sheehan, and Pollock were respectively the most frequent listed authors among this list. The most active academic institute publishing on this topic was the University of Pittsburgh Medical Center. CONCLUSION Stereotactic radiosurgery is an integral modality in the management of intracranial meningiomas. This bibliometric analysis sheds the light on the ways in which intracranial meningiomas have been studied in the past two decades in order to identify trends among neurosurgeons and radiation oncologists and to reveal areas of rising and declining focus.
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Affiliation(s)
- Aneek Patel
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Ahmed Abdelsalam
- Department of Neurology, Saint Louis University Hospital, St. Louis, MO, USA
| | - Rimsha K Shariff
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arka N Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Edward G Andrews
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Daniel A Tonetti
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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10
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Schmutzer M, Skrap B, Thorsteinsdottir J, Fürweger C, Muacevic A, Schichor C. Meningioma involving the superior sagittal sinus: long-term outcome after robotic radiosurgery in primary and recurrent situation. Front Oncol 2023; 13:1206059. [PMID: 37496660 PMCID: PMC10367096 DOI: 10.3389/fonc.2023.1206059] [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: 04/14/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023] Open
Abstract
Objective Treatment for meningiomas involving the superior sagittal sinus (SSS) is challenging and proved to be associated with higher risks compared to other brain locations. Therapeutical strategies may be either microsurgical (sub-)total resection or adjuvant radiation, or a combination of both. Thrombosis or SSS occlusion following resection or radiosurgery needs to be further elucidated to assess whether single or combined treatment is superior. We here present tumor control and side effect data of robotic radiosurgery (RRS) in combination with or without microsurgery. Methods From our prospective database, we identified 137 patients with WHO grade I meningioma involving the SSS consecutively treated between 2005 and 2020. Treatment decisions were interdisciplinary. Patients underwent RRS as initial/solitary treatment (group 1), as adjuvant treatment after subtotal resection (group 2), or due to recurrent tumor growth after preceding microsurgery (group 3). Positive tumor response was assessed by MRI and defined as reduction of more than 50% of volume. Study endpoints were time to recurrence (TTR), time to RRS, risk factors for decreased survival, and side effects. Overall and specific recurrence rates for treatment groups were analyzed. Side effect data included therapy-related morbidity during follow-up (FU). Results A total of 137 patients (median age, 58.3 years) with SSS meningiomas WHO grade I were analyzed: 51 patients (37.2%) in group 1, 15 patients (11.0%) in group 2, and 71 patients (51.8%) in group 3. Positive MR (morphological response) to therapy was achieved in 50 patients (36.4%), no response was observed in 25 patients (18.2%), and radiological tumor progression was detected in 8 patients (5.8%). Overall 5-year probability of tumor recurrence was 15.8% (median TTR, 41.6 months). Five-year probabilities of recurrence were 0%, 8.3.%, and 21.5% for groups 1-3 (p = 0.06). In multivariate analysis, tumor volume was significantly associated with extent of SSS occlusion (p = 0.026) and sex (p = 0.011). Tumor volume significantly correlated with TTR (p = 0.0046). Acute sinus venous thrombosis or venous congestion-associated bleedings did not occur in any of the groups. Conclusion RRS for grade I meningiomas with SSS involvement represents a good option as first-line treatment, occasionally also in recurrent and adjuvant scenarios as part of a multimodal treatment strategy.
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Affiliation(s)
- Michael Schmutzer
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Benjamin Skrap
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jun Thorsteinsdottir
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | | | | | - Christian Schichor
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
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11
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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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12
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Troude L, Avinens V, Farah K, Boucekine M, Balossier A, Regis J, Baucher G, Roche PH. Surgical management of large cerebellopontine angle meningiomas: long-term results of a less aggressive resection strategy. J Neurosurg 2023; 138:1630-1639. [PMID: 36208440 DOI: 10.3171/2022.8.jns221329] [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: 06/08/2022] [Accepted: 08/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cerebellopontine angle (CPA) meningiomas present many surgical challenges depending on their volume, site of dural attachment, and connection to surrounding neurovascular structures. Assuming that systematic radical resection of large CPA meningiomas carries a high risk of permanent morbidity, the authors adopted an alternative strategy of optimal resection followed by radiosurgery or careful observation of the residual tumor and assessed the efficiency and safety of this approach to meningioma treatment management. METHODS This single-center retrospective cohort study included 50 consecutive patients who underwent surgery for meningioma between January 2003 and February 2020. RESULTS The most common main dural attachments of the meningiomas were posterior (42%) and superior (26%) to the internal auditory meatus. The suboccipital retrosigmoid route was the most routinely used (92%). At the last follow-up examination, 93% of the patients with normal preoperative facial nerve (FN) function retained good House-Brackmann (HB) grades of I and II, whereas 3 patients (7%) displayed intermediate HB grade III FN function. Hearing preservation was achieved in 86% of the patients who presented with preoperative serviceable hearing, and recovery after surgery was achieved in 19% of the patients experiencing preoperative hearing loss. In order to preserve all cranial nerve function, gross-total resection was obtained in 26% of patients. Of the 35 patients who had undergone subtotal resection, 20 (57%) had been allocated into a wait-and-rescan treatment approach and 15 (43%) underwent upfront Gamma Knife surgery (GKS). The mean postoperative tumor volume was 1.20 cm3 in the upfront GKS group and 0.73 cm3 in the wait-and-rescan group (p = 0.08). Tumor control was achieved in 87% and 55% of cases (p < 0.001), with a mean follow-up of 85 and 69 months in the GKS and wait-and-rescan groups, respectively. The 1-, 5-, and 7-year tumor progression-free survival rates were 100%, 100%, and 89% in the GKS group and 95%, 59%, and 47% in the wait-and-rescan group, respectively (p < 0.001). CONCLUSIONS Optimal nonradical resection of large CPA meningiomas provides favorable long-term tumor control and functional preservation. Adjuvant GKS does not carry additional morbidity and appears to be an efficient adjuvant treatment.
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Affiliation(s)
- Lucas Troude
- 1Department of Neurosurgery, North University Hospital, APHM-Aix-Marseille Université (AMU), Marseille
| | - Valentin Avinens
- 1Department of Neurosurgery, North University Hospital, APHM-Aix-Marseille Université (AMU), Marseille
| | - Kaissar Farah
- 2Department of Neurosurgery, Timone University Hospital, APHM-AMU, Marseille; and
| | - Mohamed Boucekine
- 3Department of Statistical Analysis, Faculté des Sciences Médicales et Paramédicales, AMU, Marseille, France
| | - Anne Balossier
- 2Department of Neurosurgery, Timone University Hospital, APHM-AMU, Marseille; and
| | - Jean Regis
- 2Department of Neurosurgery, Timone University Hospital, APHM-AMU, Marseille; and
| | - Guillaume Baucher
- 1Department of Neurosurgery, North University Hospital, APHM-Aix-Marseille Université (AMU), Marseille
| | - Pierre-Hugues Roche
- 1Department of Neurosurgery, North University Hospital, APHM-Aix-Marseille Université (AMU), Marseille
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13
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Yu J, Zeng J, Hu G, Wang J, Chen G, Huang M, Liang S, He Y, Deng Y, Gong Y, Fu J. Post-operative gamma knife radiosurgery for WHO grade I intracranial meningiomas: A single-center, retrospective study. Front Neurol 2023; 14:1094032. [PMID: 36860575 PMCID: PMC9968875 DOI: 10.3389/fneur.2023.1094032] [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: 11/09/2022] [Accepted: 01/13/2023] [Indexed: 02/15/2023] Open
Abstract
Objective To explore the results of the Gamma Knife radiosurgery (GKRS) for World Health Organization (WHO) grade I intracranial meningiomas after surgical resection. Methods A total of 130 patients who were pathologically diagnosed as having WHO grade I meningiomas and who underwent post-operative GKRS were retrospectively reviewed in a single center. Results Of the 130 patients, 51 patients (39.2%) presented with radiological tumor progression with a median follow-up time of 79.7 months (ranging from 24.0 to 291.3 months). The median time to radiological tumor progression was 73.4 months (ranging from 21.4 to 285.3 months), whereas 1-, 3-, 5-, and 10-year radiological progression-free survival (PFS) was 100, 90, 78, and 47%, respectively. Moreover, 36 patients (27.7%) presented with clinical tumor progression. Clinical PFS at 1, 3, 5, and 10 years was 96, 91, 84, and 67%, respectively. After GKRS, 25 patients (19.2%) developed adverse effects, including radiation-induced edema (n = 22). In a multivariate analysis, a tumor volume of ≥10 ml and falx/parasagittal/convexity/intraventricular location were significantly associated with radiological PFS [hazard ratio (HR) = 1.841, 95% confidence interval (CI) = 1.018-3.331, p = 0.044; HR = 1.761, 95% CI = 1.008-3.077, p = 0.047]. In a multivariate analysis, a tumor volume of ≥10 ml was associated with radiation-induced edema (HR = 2.418, 95% CI = 1.014-5.771, p = 0.047). Of patients who presented with radiological tumor progression, nine were diagnosed with malignant transformation. The median time to malignant transformation was 111.7 months (ranging from 35.0 to 177.2 months). Clinical PFS after repeat GKRS was 49 and 20% at 3 and 5 years, respectively. Secondary WHO grade II meningiomas were significantly associated with a shorter PFS (p = 0.026). Conclusions Post-operative GKRS is a safe and effective treatment for WHO grade I intracranial meningiomas. Large tumor volume and falx/parasagittal/convexity/intraventricular location were associated with radiological tumor progression. Malignant transformation was one of the main cause of tumor progression in WHO grade I meningiomas after GKRS.
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Affiliation(s)
- Jinxiu Yu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiamin Zeng
- Department of Pathology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guanye Hu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jing Wang
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guohao Chen
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Minyi Huang
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shunyao Liang
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yong He
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yinhui Deng
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ye Gong
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Junyi Fu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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14
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Tuleasca C, Ruess D, Ruge M, Régis J. Stereotactic Therapies for Meningiomas. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1416:107-119. [PMID: 37432623 DOI: 10.1007/978-3-031-29750-2_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Although surgery remains the mainstay of treatment for most meningiomas, radiotherapy, specifically stereotactic radiosurgery, has become more commonplace as first-line therapy for select meningioma cases, particularly small meningiomas in challenging or high-risk anatomic locations. Radiosurgery for specific groups of meningiomas have been found to provide local control rates comparable to surgery alone. In this chapter stereotactic techniques for the treatment of meningiomas such as stereotactic radiosurgery by using Gamma knife or Linear Accelerator-based techniques (modified LINAC, Cyberknife, etc.) as well as stereotactically guided implantation or radioactive seeds for brachytherapy are introduced.
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Affiliation(s)
- Constantin Tuleasca
- Clinical Neurosurgery Service, Centre Hospitalier Universitaire de Lille, Roger Salengro Hospital, Lille, France
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (Unil), Lausanne, Switzerland
- Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Daniel Ruess
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Maximilian Ruge
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Jean Régis
- Clinical Neurosurgery Service, Centre Hospitalier Universitaire de Lille, Roger Salengro Hospital, Lille, France.
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
- Faculty of Biology and Medicine (FBM), University of Lausanne (Unil), Lausanne, Switzerland.
- Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
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15
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Sümer E, Tek E, Türe OA, Şengöz M, Dinçer A, Özcan A, Pamir MN, Özduman K, Ozturk-Isik E. The effect of tumor shape irregularity on Gamma Knife treatment plan quality and treatment outcome: an analysis of 234 vestibular schwannomas. Sci Rep 2022; 12:21809. [PMID: 36528740 PMCID: PMC9759589 DOI: 10.1038/s41598-022-25422-9] [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: 04/28/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
The primary aim of Gamma Knife (GK) radiosurgery is to deliver high-dose radiation precisely to a target while conforming to the target shape. In this study, the effects of tumor shape irregularity (TSI) on GK dose-plan quality and treatment outcomes were analyzed in 234 vestibular schwannomas. TSI was quantified using seven different metrics including volumetric index of sphericity (VioS). GK treatment plans were created on a single GK-Perfexion/ICON platform. The plan quality was measured using selectivity index (SI), gradient index (GI), Paddick's conformity index (PCI), and efficiency index (EI). Correlation and linear regression analyses were conducted between shape irregularity features and dose plan indices. Machine learning was employed to identify the shape feature that predicted dose plan quality most effectively. The treatment outcome analysis including tumor growth control and serviceable hearing preservation at 2 years, were conducted using Cox regression analyses. All TSI features correlated significantly with the dose plan indices (P < 0.0012). With increasing tumor volume, vestibular schwannomas became more spherical (P < 0.05) and the dose plan indices varied significantly between tumor volume subgroups (P < 0.001 and P < 0.01). VioS was the most effective predictor of GK indices (P < 0.001) and we obtained 89.36% accuracy (79.17% sensitivity and 100% specificity) for predicting PCI. Our results indicated that TSI had significant effects on the plan quality however did not adversely affect treatment outcomes.
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Affiliation(s)
- Esra Sümer
- grid.11220.300000 0001 2253 9056Institute of Biomedical Engineering, Boğaziçi University, Kandilli Campus, Rasathane Cad, 34684 Üsküdar, Istanbul Turkey
| | - Ece Tek
- grid.411117.30000 0004 0369 7552Department of Radiation Oncology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - O. Artunç Türe
- grid.411117.30000 0004 0369 7552Department of Radiation Oncology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Meriç Şengöz
- grid.411117.30000 0004 0369 7552Department of Neurosurgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Alp Dinçer
- grid.411117.30000 0004 0369 7552Department of Radiology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Alpay Özcan
- grid.11220.300000 0001 2253 9056Department of Electrical and Electronics Engineering, Boğaziçi University, Istanbul, Turkey
| | - M. Necmettin Pamir
- grid.411117.30000 0004 0369 7552Department of Neurosurgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Koray Özduman
- grid.411117.30000 0004 0369 7552Department of Neurosurgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Esin Ozturk-Isik
- grid.11220.300000 0001 2253 9056Institute of Biomedical Engineering, Boğaziçi University, Kandilli Campus, Rasathane Cad, 34684 Üsküdar, Istanbul Turkey
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Huang SH, Chuang CC, Wang CC, Wei KC, Chen HC, Hsu PW. Risk factors for peritumoral edema after radiosurgery for intracranial benign meningiomas: a long-term follow-up in a single institution. Neurosurg Focus 2022; 53:E7. [DOI: 10.3171/2022.8.focus22377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE
Peritumoral edema (PTE) is recognized as a complication following stereotactic radiosurgery (SRS). The aim of this paper was to evaluate the risk of post-SRS PTE for intracranial benign meningiomas and determine the predictive factors.
METHODS
Between 2006 and 2021, 227 patients with 237 WHO grade I meningiomas were treated with Novalis linear accelerator SRS. All patients were treated with a single-fraction dose of 11–20 Gy (median 14 Gy). The median tumor volume was 3.32 cm3 (range 0.24–51.7 cm3).
RESULTS
The median follow-up was 52 months (range 12–178 months). The actuarial local tumor control rates at 2, 5, and 10 years after SRS were 99.0%, 96.7%, and 86.3%, respectively. Twenty-seven (11.9%) patients developed new or worsened post-SRS PTE, with a median onset time of 5.2 months (range 1.2–50 months). Only 2 patients developed post-SRS PTE after 24 months. The authors evaluated factors related to new-onset or worsened PTE after SRS. In univariate analysis, initial tumor volume > 10 cm3 (p = 0.03), total marginal dose > 14 Gy (p < 0.001), preexisting edema (p < 0.0001), tumor location (p < 0.001), parasagittal location (p < 0.0001), superior sagittal sinus (SSS) involvement (p < 0.0001), and SSS invasion (p < 0.015) were found to be significant risk factors. In multivariate analysis, total marginal dose > 14 Gy (HR 3.38, 95% CI 1.37–8.33, p = 0.008), preexisting SRS edema (HR 12.86, 95% CI 1.09–4.15, p < 0.0001), tumor location (HR 2.13, 95% CI 1.04–3.72, p = 0.027), parasagittal location (HR 8.84, 95% CI 1.48–52.76, p = 0.017), and SSS invasion (HR 0.34, 95% CI 0.13–0.89, p = 0.027) were significant risk factors. Twelve (5.3%) patients were symptomatic. Ten of 27 patients had complete resolution of neurological symptoms and edema improvement with steroid treatment. Steroid treatment failed in 2 patients, who subsequently required resection for PTE.
CONCLUSIONS
Radiosurgery is a safe and effective method of treating benign intracranial meningiomas according to long-term follow-up. We also identified total marginal dose > 14 Gy, preexisting PTE, parasagittal location, and SSS invasion as predictors of post-SRS PTE. Risk factors for post-SRS PTE should be considered in meningioma treatment.
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Affiliation(s)
- Sheng-Han Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan
| | - Chun-Chieh Wang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan; and
| | - Kuo-Chen Wei
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan
| | - Hsien-Chih Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Keelung, Chang Gung University, Keelung, Taiwan
| | - Peng-Wei Hsu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan
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17
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Gong X, Ding J, Knisely JPS, Wang E, Pan L, Wang B, Zhang N, Wu H, Dai J, Yu T, Tang X. Dose-staged Gamma Knife radiosurgery for meningiomas: A retrospective study in a single center. Front Neurol 2022; 13:893480. [PMID: 36313491 PMCID: PMC9606413 DOI: 10.3389/fneur.2022.893480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aimed to study the efficiency and safety of a dose-staged Gamma Knife radiosurgery strategy for large meningiomas or meningiomas close to important nerve structures.MethodsThis study evaluates the outcome of a prospectively accrued series of 71 consecutive patients with meningiomas treated with staged dose-fractionated Gamma Knife radiosurgery. The average peripheral doses for the first and second fractions were 9.0 ± 0.9 Gy (8–12 Gy) and 8.6 ± 0.7 Gy (range, 7–10 Gy), respectively. The interval between fractions was 6.1 ± 1.9 months (range, 3–12 months). The median follow-up time was 36 months (12–96 months).ResultsDuring the follow-up period after the second fraction, 97.2% achieved tumor control in our series. A total of 2 patients exhibited local recurrence at 30 and 60 months after the second fraction, respectively. No treatment-related complications or new long-term neurological dysfunctions were reported. MRIs observed slightly or moderately increased peritumoral edema in six patients, but no specific neurological complaints are attributed to this finding.ConclusionThis study investigates the efficiency and safety of dose-staged Gamma Knife radiosurgery as an alternative option for meningiomas that were large in volume, adjacent to crucial structures, or in patients with contraindications to craniotomy.
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Affiliation(s)
- Xiu Gong
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jianbo Ding
- Department of Neurosurgery, Shanghai Gamma Hospital, Shanghai, China
- Department of Neurosurgery, Gamma Knife Center of Huashan Hospital, Shanghai, China
- *Correspondence: Jianbo Ding
| | - Jonathan P. S. Knisely
- Department of Radiation Oncology, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, NY, United States
| | - Enmin Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Li Pan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Binjiang Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Nan Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hanfeng Wu
- Department of Neurosurgery, Shanghai Gamma Hospital, Shanghai, China
- Department of Neurosurgery, Gamma Knife Center of Huashan Hospital, Shanghai, China
| | - Jiazhong Dai
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tonggang Yu
- Department of Neurosurgery, Shanghai Gamma Hospital, Shanghai, China
- Department of Neurosurgery, Gamma Knife Center of Huashan Hospital, Shanghai, China
| | - Xuqun Tang
- Department of Neurosurgery, Shanghai Gamma Hospital, Shanghai, China
- Department of Neurosurgery, Gamma Knife Center of Huashan Hospital, Shanghai, China
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18
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Santacroce A, Tuleasca C, Liščák R, Motti E, Lindquist C, Radatz M, Gatterbauer B, Lippitz BE, Martínez Álvarez R, Martínez Moreno N, Kamp MA, Sandvei Skeie B, Schipmann S, Longhi M, Unger F, Sabin I, Mindermann T, Bundschuh O, Horstmann GA, van Eck AJ, Walier M, Berres M, Nakamura M, Steiger HJ, Hänggi D, Fortmann T, Alsofy SZ, Régis J, Ewelt C. Stereotactic Radiosurgery for Benign Cavernous Sinus Meningiomas: A Multicentre Study and Review of the Literature. Cancers (Basel) 2022; 14:cancers14164047. [PMID: 36011041 PMCID: PMC9406912 DOI: 10.3390/cancers14164047] [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: 04/17/2022] [Revised: 06/17/2022] [Accepted: 07/02/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Meningiomas are the most common tumours of the central nervous system (CNS). Despite their benign histology, proximity to critical neurovascular structures may lead to significant morbidity with tumour growth. This is the case for cavernous sinus meningiomas (CSMs), as their growth may surround critical neuro-vascular structures and cause significant morbidity. Radical microsurgical resection carries a high risk of additional neurological deficits, as well as the risk of death. Current management of these tumours, where treatment is indicated, has moved away from radical surgery towards radiotherapy/radiosurgery. This is particularly the case for patients who have residual or recurring tumours after previous surgery. There are many reports that describe the effectiveness of using stereotactic radiosurgery (SRS) for CSMs; however, large cohort analyses are lacking. This multicentre analysis reports the outcome data of over 1000 patients with CSMs who were treated with SRS. SRS shows a high local tumour control rate with few complications. These results agree with previous reports in the literature. SRS is a valuable primary or adjuvant treatment option for CSMs. Abstract Cavernous sinus meningiomas (CSMs) remain a surgical challenge due to the intimate involvement of their contained nerves and blood vessels. Stereotactic radiosurgery (SRS) is a safe and effective minimally invasive alternative for the treatment of small- to medium-sized CSMs. Objective: To assess the medium- to long-term outcomes of SRS for CSMs with respect to tumour growth, prevention of further neurological deterioration and improvement of existing neurological deficits. This multicentric study included data from 15 European institutions. We performed a retrospective observational analysis of 1222 consecutive patients harbouring 1272 benign CSMs. All were treated with Gamma Knife stereotactic radiosurgery (SRS). Clinical and imaging data were retrieved from each centre and entered into a common database. All tumours with imaging follow-up of less than 24 months were excluded. Detailed results from 945 meningiomas (86%) were then analysed. Clinical neurological outcomes were available for 1042 patients (85%). Median imaging follow-up was 67 months (mean 73.4, range 24–233). Median tumour volume was 6.2 cc (+/−7), and the median marginal dose was 14 Gy (+/−3). The post-treatment tumour volume decreased in 549 (58.1%), remained stable in 336 (35.6%) and increased in only 60 lesions (6.3%), yielding a local tumour control rate of 93.7%. Only 27 (2.8%) of the 60 enlarging tumours required further treatment. Five- and ten-year actuarial progression-free survival (PFS) rates were 96.7% and 90.1%, respectively. Tumour control rates were higher for women than men (p = 0.0031), and also for solitary sporadic meningiomas (p = 0.0201). There was no statistically significant difference in outcome for imaging-defined meningiomas when compared with histologically proven WHO Grade-I meningiomas (p = 0.1212). Median clinical follow up was 61 months (mean 64, range 6–233). Permanent morbidity occurred in 5.9% of cases at last follow-up. Stereotactic radiosurgery is a safe and effective method for treating benign CSM in the medium term to long term.
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Affiliation(s)
- Antonio Santacroce
- Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, 59073 Hamm, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
- Correspondence:
| | - Constantin Tuleasca
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
- Faculté de Biologie et de Médecine (FBM), Université de Lausanne (Unil), 1005 Lausanne, Switzerland
- Signal Processing Laboratory (LTS 5), Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland
- Faculté de Médecine, Sorbonné Université, 70513 Paris, France
- Assisstance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Centre Hospitalier Universitaire Bicêtre, Service de Neurochirurgie, 94270 Le Kremlin-Bicêtre, France
| | - Roman Liščák
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, 15000 Prague, Czech Republic
| | - Enrico Motti
- Dipartimento di Neuroscienze, Neurochirurgia, Università degli Studi di Milano, 20122 Milano, Italy; Villa Maria Cecilia Hospital, 48033 Cotignola, Italy
| | | | - Matthias Radatz
- National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | | | - Bodo E. Lippitz
- Interdisciplinary Centre for Radiosurgery (ICERA), Radiological Alliance, 22767 Hamburg, Germany
| | | | | | - Marcel A. Kamp
- Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Bente Sandvei Skeie
- Department of Neurosurgery, Haukeland University Hospital, 5021 Bergen, Norway
| | - Stephanie Schipmann
- Department of Neurosurgery, Haukeland University Hospital, 5021 Bergen, Norway
| | - Michele Longhi
- Unit of Radiosurgery and Stereotactic Neurosurgery, Department of Neurosciences, Azienda Ospedaliera Universitaria, 37126 Verona, Italy
| | - Frank Unger
- Department of Neurosurgery, Medical University Graz, 8036 Graz, Austria
| | - Ian Sabin
- Gamma Knife Unit, Wellington Hospital (Platinum Medical Centre), London NW8 7JA, UK
| | - Thomas Mindermann
- Gamma Knife Center Zurich, Klinik Im Park Hirslanden, 8002 Zurich, Switzerland
| | | | | | | | - Maja Walier
- Institute of Medical Biometry, Epidemiology and Informatics, University Medical Center of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
- Department of Mathematics and Technology, University of Applied Sciences Koblenz, Joseph-Rovan-Allee 2, 53424 Remagen, Germany
| | - Manfred Berres
- Institute of Medical Biometry, Epidemiology and Informatics, University Medical Center of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
- Department of Mathematics and Technology, University of Applied Sciences Koblenz, Joseph-Rovan-Allee 2, 53424 Remagen, Germany
| | - Makoto Nakamura
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
- Department of Neurosurgery, Academic Hospital Köln-Merheim, 51058 Köln, Germany
| | - Hans Jakob Steiger
- Department of Neurosurgery, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
| | - Thomas Fortmann
- Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, 59073 Hamm, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Samer Zawy Alsofy
- Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, 59073 Hamm, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Jean Régis
- Service de Neurochirurgie Fonctionnelle et Stereotaxique, Hôpital D’adulte de la Timone, 13354 Marseille, France
| | - Christian Ewelt
- Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, 59073 Hamm, Germany
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149 Munster, Germany
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19
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Jung IH, Chang KW, Park SH, Jung HH, Chang JH, Chang JW, Chang WS. Pseudoprogression and peritumoral edema due to intratumoral necrosis after Gamma knife radiosurgery for meningioma. Sci Rep 2022; 12:13663. [PMID: 35953695 PMCID: PMC9372131 DOI: 10.1038/s41598-022-17813-9] [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: 03/04/2022] [Accepted: 08/01/2022] [Indexed: 11/09/2022] Open
Abstract
Peritumoral cerebral edema is reported to be a side effect that can occur after stereotactic radiosurgery. We aimed to determine whether intratumoral necrosis (ITN) is a risk factor for peritumoral edema (PTE) when gamma knife radiosurgery (GKRS) is performed in patients with meningioma. In addition, we propose the concept of pseudoprogression: a temporary volume expansion that can occur after GKRS in the natural course of meningioma with ITN. This retrospective study included 127 patients who underwent GKRS for convexity meningioma between January 2019 and December 2020. Risk factors for PTE and ITN were investigated using logistic regression analysis. Analysis of variance was used to determine whether changes in tumor volume were statistically significant. After GKRS, ITN was observed in 34 (26.8%) patients, and PTE was observed in 10 (7.9%) patients. When postoperative ITN occurred after GKRS, the incidence of postoperative PTE was 18.970-fold (p = 0.009) greater. When a 70% dose volume ≥ 1 cc was used, the possibility of ITN was 5.892-fold (p < 0.001) higher. On average, meningiomas with ITN increased in volume by 128.5% at 6 months after GKRS and then decreased to 94.6% at 12 months. When performing GKRS in meningioma, a 70% dose volume ≥ 1 cc is a risk factor for ITN. At 6 months after GKRS, meningiomas with ITN may experience a transient volume expansion and PTE, which are characteristics of pseudoprogression. These characteristics typically improve at 12 months following GKRS.
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Affiliation(s)
- In-Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.,Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.,Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Kyung Won Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - So Hee Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
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20
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Tumor control and radiobiological fingerprint after Gamma Knife radiosurgery for posterior fossa meningiomas: A series of 46 consecutive cases. J Clin Neurosci 2022; 100:196-203. [PMID: 35489255 DOI: 10.1016/j.jocn.2022.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/16/2022] [Accepted: 04/24/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Gamma Knife radiosurgery (GKR) can be a valuable treatment option for posterior cranial fossa meningiomas (PCFM). We retrospectively analyzed outcomes of GKR for PCFM. METHODS Were included forty-six patients with 47 PCFM. Primary endpoint was tumor control. Secondary endpoint was clinical improvement. Biologically effective dose (BED) was evaluated in relationship to primary and secondary outcomes. Mean marginal dose was 12.4 Gy (median 12, 12-14). Mean BED was 63.6 Gy (median 65, 49.1-88.3). Mean target volume (TV) was 2.21 cc (range 0.3-8.9 cc). RESULTS Overall tumor control rate was 93.6% (44/47) after mean follow-up of 47.8 months ± 28.46 months (median 45.5, range 6-108). Radiological progression-free survival at 5 years was 94%. Higher pretherapeutic TVs were predictive for higher likelihood of tumor progression (Odds ratio, OR 1.448, 95% confidence interval - CI 1.001-2.093, p = 0.049). At last clinical follow-up, 28 patients (71.8%) remained stable, 10 (25.6%) improved and 1 patient (2.6%) worsened. Using logistic regression, the relationship between BED and clinical improvement was assessed (OR 0.903, standard error 0.59, coefficient 0.79-1.027, CI -0.10; 0.01; p = 0.14). The highest probability of clinical improvement corresponded to a range of BED values between 56 and 61 Gy. CONCLUSION Primary GKR for PCFM is safe and effective. Higher pretherapeutic TV was predictor of volumetric progression. Highest probability of clinical improvement might correspond to a range of BED values between 56 and 61 Gy, although this was not statistically significant. The importance of BED should be further validated in larger cohorts, other anatomical locations and other pathologies.
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21
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Fu J, Zeng J, Huang M, Liang S, He Y, Xie L, Deng Y, Yu J. Primary versus postoperative gamma knife radiosurgery for intracranial benign meningiomas: a matched cohort retrospective study. BMC Cancer 2022; 22:206. [PMID: 35209858 PMCID: PMC8876815 DOI: 10.1186/s12885-022-09321-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
Objective The aims of this study were to investigate the long-term outcomes of primary versus postoperative Gamma Knife radiosurgery (GKRS) for benign meningiomas. Methods Three hundred and forty meningioma patients underwent GKRS were retrospectively reviewed. Patients in the postoperative GKRS group were matched to those in the primary GKRS group, in a 1:1 ratio. Results The study consisted of 122 patients, including primary (n = 61) and postoperative (n = 61) GKRS group. Thirty-four patients (27.9%) occurred radiological progression after a median follow-up of 72.5 (range, 24.2–254.5) months. The median time to radiological progression was 85.1 (range, 20.7–205.1) months. The radiological progression-free survival (PFS) was 100%, 93%, 87%, and 49%, at 1, 3, 5, and 10 years respectively. Thirty-one patients (25.4%) occurred clinical progression. The clinical PFS was 92%, 89%, 84%, and 60%, at 1, 3, 5, and 10 years. In combined group, only max diameter ≥ 50 mm was associated with radiological (p = 0.020) and clinical PFS (hazard ratio [HR] = 2.896, 95% confidence interval [CI] = 1.280–6.553, p = 0.011). Twenty-five patients (20.5%) developed GKRS related adverse effects, including radiation-induced edema (n = 21). Non-skull base tumors (HR = 3.611, 95% CI = 1.489–8.760, p = 0.005) and preexisting peritumoral edema (HR = 3.571, 95% CI = 1.167–10.929, p = 0.026) were significantly related to radiation-induced edema in combined group. There was no significant difference in radiological PFS (p = 0.403), clinical PFS (p = 0.336), and GKRS related adverse effects (p = 0.138) between primary and postoperative GKRS groups. Conclusions Primary GKRS could provide similar radiological and clinical outcomes, as well as similar complication rate compared with postoperative GKRS. For selective benign meningioma patients (asymptomatic or mildly symptomatic tumors; unfavorable locations for surgical resection; comorbidities or an advanced age), GKRS could be an alternative primary treatment.
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Affiliation(s)
- Junyi Fu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China
| | - Jiamin Zeng
- Department of Pathology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China
| | - Minyi Huang
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China
| | - Shunyao Liang
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China
| | - Yong He
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China
| | - Longchang Xie
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China
| | - Yinhui Deng
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China
| | - Jinxiu Yu
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China.
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22
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Stereotactic Radiosurgery (SRS) Induced Higher-Grade Transformation of a Benign Meningioma into Atypical Meningioma. Case Rep Surg 2022; 2022:4478561. [PMID: 35251732 PMCID: PMC8890901 DOI: 10.1155/2022/4478561] [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: 09/18/2021] [Revised: 10/09/2021] [Accepted: 01/19/2022] [Indexed: 12/02/2022] Open
Abstract
Background Stereotactic radiosurgery (SRS) is a widely used treatment modality for the management of meningioma. Whether used as a primary, adjuvant, or salvage procedure, SRS is a safe, less invasive, and effective modality of treatment as microsurgery. The transformation of a meningioma following radiosurgery raises a concern, and our current understanding about it is extremely limited. Only a few case reports have described meningioma dedifferentiation after SRS to a higher grade. Moreover, a relatively small number of cases have been reported in large retrospective studies with little elaboration. Case Description. We report a detailed case description of a 41-year-old man with progressive meningioma enlargement and rapid grade progression after SRS, which was histopathologically confirmed before and after SRS. We discussed the clinical presentation, radiological/histopathological features, and outcome. We also reviewed previous studies that reported the outcome and follow-up of patients diagnosed with grade I meningioma histopathologically or presumed with benign meningioma by radiological features who underwent primary or adjuvant radiosurgery. Conclusion The risk of progression after SRS is low, and the risk of higher-grade transformation after SRS is trivial. The early timing for recurrence and field-related radiation may favor a relationship between SRS and higher-grade transformation (causality) although transformation as a part of the natural history of the disease cannot be fully excluded. Tumor progression (treatment failure) after SRS may demonstrate a transformation, and careful, close, and long follow-up is highly recommended. Also, acknowledging that there is a low risk of early and delayed complications and a trivial risk of transformation should not preclude its use as SRS affords a high level of safety and efficiency.
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23
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Samanci Y, Ardor GD, Peker S. Gamma Knife radiosurgery for tuberculum sellae meningiomas: a series of 78 consecutive patients. Neurosurg Rev 2022; 45:2315-2322. [PMID: 35138486 DOI: 10.1007/s10143-022-01753-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 01/01/2023]
Abstract
Outcomes of Gamma Knife radiosurgery (GKRS) for tuberculum sellae meningiomas (TSMs) have not been reported explicitly within any meningioma series. We present the first and largest TSM series with clinical, radiosurgical, and outcome features for 78 consecutive patients managed with GKRS. Patients who underwent GKRS for TSMs between 2005 and 2021 and had a minimum of 6 months of follow-up were included. Medical records, imaging studies, and follow-up examinations were evaluated retrospectively. A total of 78 patients with a median age of 50.5 years were included. SRS was conducted as an upfront treatment for 38 patients (48.7%). The median target volume was 1.7 cm3 (range, 0.1-14.6). During a median follow-up of 78.5 months, the cumulative PFS rates of the whole cohort at 1, 5, and 10 years by Kaplan-Meier analysis were 100%, 97.9%, and 94.5%, respectively. Of 47 patients with impaired vision, improvement and/or preservation of visual acuity, and visual field were achieved in 55.3% and 42.6%, respectively. No new-onset hormonal deficits were observed. Based on our data, SRS represents an effective and safe modality for unresected or recurrent/residual TSMs. SRS should be offered to patients who are not willing or not ideal candidates for surgery.
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Affiliation(s)
- Yavuz Samanci
- Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey.,Department of Neurosurgery, Gamma Knife Center, Koç University Hospital, Istanbul, Turkey
| | - Gokce Deniz Ardor
- Department of Neurosurgery, Gamma Knife Center, Koç University Hospital, Istanbul, Turkey
| | - Selcuk Peker
- Department of Neurosurgery, Gamma Knife Center, Koç University Hospital, Istanbul, Turkey. .,Department of Neurosurgery, School of Medicine, Koç University, Davutpasa Caddesi No:4, 34010, Zeytinburnu/İstanbul, Turkey.
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24
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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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Islim AI, Millward CP, Piper RJ, Fountain DM, Mehta S, Kolamunnage-Dona R, Ali U, Koszdin SD, Georgious T, Mills SJ, Brodbelt AR, Mathew RK, Santarius T, Jenkinson MD. External validation and recalibration of an incidental meningioma prognostic model - IMPACT: protocol for an international multicentre retrospective cohort study. BMJ Open 2022; 12:e052705. [PMID: 35042706 PMCID: PMC8768908 DOI: 10.1136/bmjopen-2021-052705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Due to the increased use of CT and MRI, the prevalence of incidental findings on brain scans is increasing. Meningioma, the most common primary brain tumour, is a frequently encountered incidental finding, with an estimated prevalence of 3/1000. The management of incidental meningioma varies widely with active clinical-radiological monitoring being the most accepted method by clinicians. Duration of monitoring and time intervals for assessment, however, are not well defined. To this end, we have recently developed a statistical model of progression risk based on single-centre retrospective data. The model Incidental Meningioma: Prognostic Analysis Using Patient Comorbidity and MRI Tests (IMPACT) employs baseline clinical and imaging features to categorise the patient with an incidental meningioma into one of three risk groups: low, medium and high risk with a proposed active monitoring strategy based on the risk and temporal trajectory of progression, accounting for actuarial life expectancy. The primary aim of this study is to assess the external validity of this model. METHODS AND ANALYSIS IMPACT is a retrospective multicentre study which will aim to include 1500 patients with an incidental intracranial meningioma, powered to detect a 10% progression risk. Adult patients ≥16 years diagnosed with an incidental meningioma between 1 January 2009 and 31 December 2010 will be included. Clinical and radiological data will be collected longitudinally until the patient reaches one of the study endpoints: intervention (surgery, stereotactic radiosurgery or fractionated radiotherapy), mortality or last date of follow-up. Data will be uploaded to an online Research Electronic Data Capture database with no unique identifiers. External validity of IMPACT will be tested using established statistical methods. ETHICS AND DISSEMINATION Local institutional approval at each participating centre will be required. Results of the study will be reported through peer-reviewed articles and conferences and disseminated to participating centres, patients and the public using social media.
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Affiliation(s)
- Abdurrahman I Islim
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Christopher P Millward
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Rory J Piper
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Daniel M Fountain
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Shaveta Mehta
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Clinical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | - Ruwanthi Kolamunnage-Dona
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Usama Ali
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - Samantha J Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andrew R Brodbelt
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ryan K Mathew
- Leeds Institute of Medical Research at St James's, University of Leeds School of Medicine, Leeds, UK
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Thomas Santarius
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
- Division of Neurosurgery, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Michael D Jenkinson
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Amide proton transfer and chemical exchange saturation transfer MRI differentiates between growing and non-growing intracranial meningiomas: a pilot study. Clin Radiol 2022; 77:e295-e301. [DOI: 10.1016/j.crad.2021.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022]
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Bunevicius A, Suleiman M, Patel S, Martínez Álvarez R, Martinez Moreno NE, Liscak R, Hanuska J, Langlois AM, Mathieu D, Mau C, Caldwell C, Tuanquin LC, Zacharia BE, McInerney J, Lee CC, Yang HC, Peterson JL, Trifiletti DM, Ogino A, Kano H, Warnick RE, Saylany A, Buch LY, Lee JYK, Strickland BA, Zada G, Chang EL, Lunsford LD, Sheehan J. Stereotactic radiosurgery for treatment of radiation-induced meningiomas: a multiinstitutional study. J Neurosurg 2021; 135:862-870. [PMID: 33385995 DOI: 10.3171/2020.7.jns202064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Radiation-induced meningiomas (RIMs) are associated with aggressive clinical behavior. Stereotactic radiosurgery (SRS) is sometimes considered for selected RIMs. The authors investigated the effectiveness and safety of SRS for the management of RIMs. METHODS From 12 institutions participating in the International Radiosurgery Research Foundation, the authors pooled patients who had prior cranial irradiation and were subsequently clinically diagnosed with WHO grade I meningiomas that were managed with SRS. RESULTS Fifty-two patients underwent 60 SRS procedures for histologically confirmed or radiologically suspected WHO grade I RIMs. The median ages at initial cranial radiation therapy and SRS for RIM were 5.5 years and 39 years, respectively. The most common reasons for cranial radiation therapy were leukemia (21%) and medulloblastoma (17%). There were 39 multiple RIMs (35%), the mean target volume was 8.61 ± 7.80 cm3, and the median prescription dose was 14 Gy. The median imaging follow-up duration was 48 months (range 4-195 months). RIM progressed in 9 patients (17%) at a median duration of 30 months (range 3-45 months) after SRS. Progression-free survival at 5 years post-SRS was 83%. Treatment volume ≥ 5 cm3 predicted progression (HR 8.226, 95% CI 1.028-65.857, p = 0.047). Seven patients (14%) developed new neurological symptoms or experienced SRS-related complications or T2 signal change from 1 to 72 months after SRS. CONCLUSIONS SRS is associated with durable local control of RIMs in the majority of patients and has an acceptable safety profile. SRS can be considered for patients and tumors that are deemed suboptimal, poor surgical candidates, and those whose tumor again progresses after removal.
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Affiliation(s)
- Adomas Bunevicius
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Mohand Suleiman
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Samir Patel
- 2Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Roman Liscak
- 4Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir Hanuska
- 4Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Anne-Marie Langlois
- 5Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada
| | - David Mathieu
- 5Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada
| | - Christine Mau
- 6Penn State Health, Hershey Medical Center, Hershey, Pennsylvania
| | | | | | - Brad E Zacharia
- 6Penn State Health, Hershey Medical Center, Hershey, Pennsylvania
| | - James McInerney
- 6Penn State Health, Hershey Medical Center, Hershey, Pennsylvania
| | - Cheng-Chia Lee
- 7Neurological Institute, Taipei Veterans General Hospital, and National Yang-Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- 7Neurological Institute, Taipei Veterans General Hospital, and National Yang-Ming University, Taipei, Taiwan
| | | | | | - Akiyoshi Ogino
- 9Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- 9Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Anissa Saylany
- 11Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Love Y Buch
- 11Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - John Y K Lee
- 11Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | | | - Gabriel Zada
- 12University of Southern California, Los Angeles, California
| | - Eric L Chang
- 12University of Southern California, Los Angeles, California
| | - L Dade Lunsford
- 9Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jason Sheehan
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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Giammattei L, di Russo P, Starnoni D, Passeri T, Bruneau M, Meling TR, Berhouma M, Cossu G, Cornelius JF, Paraskevopoulos D, Zazpe I, Jouanneau E, Cavallo LM, Benes V, Seifert V, Tatagiba M, Schroeder HWS, Goto T, Ohata K, Al-Mefty O, Fukushima T, Messerer M, Daniel RT, Froelich S. Petroclival meningiomas: update of current treatment and consensus by the EANS skull base section. Acta Neurochir (Wien) 2021; 163:1639-1663. [PMID: 33740134 DOI: 10.1007/s00701-021-04798-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/03/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The optimal management of petroclival meningiomas (PCMs) continues to be debated along with several controversies that persist. METHODS A task force was created by the EANS skull base section along with its members and other renowned experts in the field to generate recommendations for the management of these tumors. To achieve this, the task force reviewed in detail the literature in this field and had formal discussions within the group. RESULTS The constituted task force dealt with the existing definitions and classifications, pre-operative radiological investigations, management of small and asymptomatic PCMs, radiosurgery, optimal surgical strategies, multimodal treatment, decision-making, and patient's counselling. CONCLUSION This article represents the consensually derived opinion of the task force with respect to the management of PCMs.
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Affiliation(s)
- Lorenzo Giammattei
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France.
| | - P di Russo
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - D Starnoni
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - T Passeri
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - M Bruneau
- Department of Neurosurgery, Erasme Hospital, Brussels, Belgium
| | - T R Meling
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - M Berhouma
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France
| | - G Cossu
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - J F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - D Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
| | - I Zazpe
- Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - E Jouanneau
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France
| | - L M Cavallo
- Department of Neurosurgery, University Hospital of Naples Federico II, Napoli, NA, Italy
| | - V Benes
- Department of Neurosurgery, First Medical Faculty, Military University Hospital and Charles University, Prague, Czech Republic
| | - V Seifert
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - M Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - H W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - T Goto
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - K Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - O Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - T Fukushima
- Department of Neurosurgery, Carolina Neuroscience Institute, Raleigh, NC, USA
| | - M Messerer
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - R T Daniel
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - S Froelich
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
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Predictors of Survival in Subtotally Resected WHO Grade I Skull Base Meningiomas. Cancers (Basel) 2021; 13:cancers13061451. [PMID: 33810089 PMCID: PMC8004937 DOI: 10.3390/cancers13061451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/10/2021] [Accepted: 03/19/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although gross total resection (GTR) is the goal in meningioma surgery, this can sometimes be difficult to achieve in skull base meningiomas. We analyzed clinical outcomes and predictors of survival for subtotally resected benign meningiomas. METHODS A total of 212 consecutive patients who underwent subtotal resection (STR) for benign skull base meningioma between 1990-2010 were investigated. RESULTS Median age was 57.7 [IQR 18.8] years, median preoperative Karnofsky performance status (KPS) was 80.0 [IQR 20.0], 75 patients (35.4%) had posterior fossa meningioma. After a median follow-up of 6.2 [IQR 7.9] years, retreatment (either radiotherapy or repeated surgery) rate was 16% at 1-year, 27% at 3-years, 34% at 5-years, and 38% at 10-years. Ten patients (4.7%) died perioperatively, 9 (3.5%) had postoperative hematomas, and 2 (0.8%) had postoperative infections. Neurological outcome at final visit was improved/stable in 122 patients (70%). Multivariable analysis identified advanced age and preoperative KPS < 70 as negative predictors for overall survival (OS). Patients who underwent retreatment had no significant reduction of OS. CONCLUSIONS Advanced age and preoperative KPS were independent predictors of OS. Retreatments did not prolong nor shorten the OS. Clinical outcomes in STR skull base meningiomas were generally worse compared to cohorts with high rates of GTR.
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Nwachuku E, Duehr J, Pease MW, Lunsford LD, Monaco EA. Successful management of an intraluminal superior sagittal sinus meningioma causing elevated intracranial pressure using gamma knife radiosurgery in subacute setting: A case report. Surg Neurol Int 2021; 12:86. [PMID: 33767890 PMCID: PMC7982102 DOI: 10.25259/sni_562_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/07/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Gamma Knife stereotactic radiosurgery (GKRS) facilitates precisely focused radiation to an intracranial target while minimizing substantial off-target radiation in the surrounding normal tissue. Meningiomas attached to or invading the superior sagittal sinus may result in sinus occlusion and are often impossible to completely resect safely. The authors describe successful management of a patient with a meningioma located completely inside the posterior aspect of the superior sagittal sinus. Case Description: A 46-year-old woman presented to the emergency department with progressive generalized headaches accompanied by worsening vision. The patient underwent a diagnostic brain magnetic resonance imaging which showed a solitary a 7 × 6 × 10 mm homogeneously contrast-enhancing lesion within the lumen of the posterior aspect of superior sagittal sinus without ventricular enlargement or peritumoral edema. The lesion was thought to be a meningioma radiographically. To evaluate the suspected increased intracranial pressure, a lumbar puncture was subsequently performed and demonstrated an opening pressure of 30 cm H2O. After drainage of 40 cc of CSF, the spinal closing pressure was 9 cm H2O. After failure of conservative management with acetazolamide, and determination of surgical inoperability due to the critical intraluminal location of the mass lesion, the patient underwent Gamma Knife radiosurgery. The 0.36 cc tumor was treated as an outpatient in the Perfexion® model Gamma Knife with a highly conformal and selective plan that enclosed the 3D geometry of the tumor with a minimal margin tumor dose of 14 gy at the 50% isodose. Three months after GKRS, the patient reported continued reduction in the frequency and severity of both her headaches and her visual disturbance. Ophthalmological consultation noted progressive resolution of her optic disc edema confirmed by formal optical coherence tomography. The patient is now 3 years out from GKRS with complete resolution of headache symptoms along with persistent reduction in tumor size (3 × 1 × 4 mm) on serial period imaging and resolution of papilledema. Conclusion: Tumors located in such critical anatomic regions, as in our patient, should be considered for primary GKRS when the risks of biopsy or removal are too high. GKRS was able to provide great radiographic and clinical result in an intricately located meningioma.
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Affiliation(s)
- Enyinna Nwachuku
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pennsylvania, United States
| | - James Duehr
- Department of School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Matthew W Pease
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pennsylvania, United States
| | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pennsylvania, United States
| | - Edward A Monaco
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pennsylvania, United States
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Tuleasca C, Aboukais R, Vannod-Michel Q, Leclerc X, Reyns N, Lejeune JP. Intraoperative MRI for the microsurgical resection of meningiomas close to eloquent areas or dural sinuses: patient series. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE20149. [PMID: 35855309 PMCID: PMC9241345 DOI: 10.3171/case20149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Meningiomas are the most commonly encountered nonglial primary intracranial tumors. The authors report on the usefulness of intraoperative magnetic resonance imaging (iMRI) during microsurgical resection of meningiomas located close to eloquent areas or dural sinuses and on the feasibility of further radiation therapy. OBSERVATIONS Six patients benefited from this approach. The mean follow-up period after surgery was 3.3 (median 3.2, range 2.1–4.6) years. Five patients had no postoperative neurological deficit, of whom two with preoperative motor deficit completely recovered. One patient with preoperative left inferior limb deficit partially recovered. The mean interval between surgery and radiation therapy was 15.8 (median 16.9, range 1.4–40.5) months. Additional radiation therapy was required in five cases after surgery. The mean preoperative tumor volume was 38.7 (median 27.5, range 8.6–75.6) mL. The mean postoperative tumor volume was 1.2 (median 0.8, range 0–4.3) mL. At the last follow-up, all tumors were controlled. LESSONS The use of iMRI was particularly helpful to (1) decide on additional tumor resection according to iMRI findings during the surgical procedure; (2) evaluate the residual tumor volume at the end of the surgery; and (3) judge the need for further radiation and, in particular, the feasibility of single-fraction radiosurgery.
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Affiliation(s)
- Constantin Tuleasca
- Neurosurgery and Neurooncology Service and
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland; and
- Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | | | - Xavier Leclerc
- Neuroradiology Department, Lille University Hospital, Lille, France
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Islim AI, Kolamunnage-Dona R, Mohan M, Moon RDC, Crofton A, Haylock BJ, Rathi N, Brodbelt AR, Mills SJ, Jenkinson MD. A prognostic model to personalize monitoring regimes for patients with incidental asymptomatic meningiomas. Neuro Oncol 2021; 22:278-289. [PMID: 31603516 PMCID: PMC7032634 DOI: 10.1093/neuonc/noz160] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Asymptomatic meningioma is a common incidental finding with no consensus on the optimal management strategy. We aimed to develop a prognostic model to guide personalized monitoring of incidental meningioma patients. METHODS A prognostic model of disease progression was developed in a retrospective cohort (2007-2015), defined as: symptom development, meningioma-specific mortality, meningioma growth or loss of window of curability. Secondary endpoints included non-meningioma-specific mortality and intervention. RESULTS Included were 441 patients (459 meningiomas). Over a median of 55 months (interquartile range, 37-80), 44 patients had meningioma progression and 57 died (non-meningioma-specific). Forty-four had intervention (at presentation, n = 6; progression, n = 20; nonprogression, n = 18). Model parameters were based on statistical and clinical considerations and included: increasing meningioma volume (hazard ratio [HR] 2.17; 95% CI: 1.53-3.09), meningioma hyperintensity (HR 10.6; 95% CI: 5.39-21.0), peritumoral signal change (HR 1.58; 95% CI: 0.65-3.85), and proximity to critical neurovascular structures (HR 1.38; 95% CI: 0.74-2.56). Patients were stratified based on these imaging parameters into low-, medium- and high-risk groups and 5-year disease progression rates were 3%, 28%, and 75%, respectively. After 5 years of follow-up, the risk of disease progression plateaued in all groups. Patients with an age-adjusted Charlson comorbidity index ≥6 (eg, an 80-year-old with chronic kidney disease) were 15 times more likely to die of other causes than to receive intervention at 5 years following diagnosis, regardless of risk group. CONCLUSIONS The model shows that there is little benefit to rigorous monitoring in low-risk and older patients with comorbidities. Risk-stratified follow-up has the potential to reduce patient anxiety and associated health care costs.
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Affiliation(s)
- Abdurrahman I Islim
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,School of Medicine, University of Liverpool, Liverpool, UK.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Midhun Mohan
- School of Medicine, University of Liverpool, Liverpool, UK.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Richard D C Moon
- School of Medicine, University of Liverpool, Liverpool, UK.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Anna Crofton
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Brian J Haylock
- Department of Clinical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | - Nitika Rathi
- Department of Neuropathology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andrew R Brodbelt
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Samantha J Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D Jenkinson
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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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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Rueß D, Weyer V, Tutunji J, Grau S, Kocher M, Hoevels M, Treuer H, Baues C, Ruge MI. Stereotactic radiosurgery of benign brain tumors in elderly patients: evaluation of outcome and toxicity. Radiat Oncol 2020; 15:274. [PMID: 33298109 PMCID: PMC7724716 DOI: 10.1186/s13014-020-01714-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is widely accepted as a therapeutic option for meningiomas (M) and vestibular schwannomas (VS). However, data on outcome and toxicity in the elderly population have rarely been reported in detail. METHODS All patients aged ≥ 65 years with M or VS who underwent single fraction SRS were included. Patient data were analyzed in terms of clinical tumor control and incidence of early and late treatment related complications, which were graded according to the Common Terminology Criteria for Adverse Events (CTCAE), RESULTS: We identified 245 patients with benign brain tumors (129 M and 116 VS, median tumor volume 2.9 ml, range 0.1-28). The median age was 71 years (range 65-86) and the mean follow-up times were 42 months (range 2-181). Tumors were irradiated with a median dose of 12.4 Gy. Actuarial clinical and radiological tumor control rates at 2, 5, and 10 years after SRS were 98%, 93%, and 88%, respectively. Recurrent tumors after previous treatment had a higher probability of post-radiosurgical progression (p < 0.001). Permanent toxicity (CTCAE I/II) were noted in 5.7%. No severe adverse events were observed during early and late follow up, although patients > 70 years had a slightly higher risk for toxicity (p = 0.027). The presence and extent of co-morbidities had no significant influence on local tumor control or toxicity. CONCLUSION SRS provides favorable tumor control with low risk for treatment-related severe complications. Thus, SRS should always be considered as treatment option for benign intracranial tumors (meningiomas, schwannomas), especially in the group of elderly patients.
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Affiliation(s)
- Daniel Rueß
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Vera Weyer
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Juman Tutunji
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Stefan Grau
- Department of Neurosurgery, Centre of Neurosurgery, Faculty of Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Martin Kocher
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Mauritius Hoevels
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Harald Treuer
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Christian Baues
- Institute of Radiation Oncology, Faculty of Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Maximilian I Ruge
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Fu J, Wu L, Peng C, Yang X, You H, Cao L, Deng Y, Yu J. Initial Gamma Knife Radiosurgery for Large or Documented Growth Asymptomatic Meningiomas: Long-Term Results From a 27-Year Experience. Front Oncol 2020; 10:598582. [PMID: 33330094 PMCID: PMC7732633 DOI: 10.3389/fonc.2020.598582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/20/2020] [Indexed: 12/04/2022] Open
Abstract
Objective The aims of this study were to investigate the long-term outcomes of initial Gamma Knife radiosurgery (GKRS) for large (≥20 mm) or documented growth asymptomatic meningiomas. Design and Methods This was a single-center retrospective study. Fifty-nine patients with large (≥20 mm) or documented growth asymptomatic meningiomas undergoing initial GKRS were enrolled. The median age was 56 (range, 27–83) years. The median time of follow-up was 66.8 (range, 24.6–245.6) months, and the median tumor margin dose was 13.0 Gy (range, 11.6–22.0 Gy). Results Tumors shrunk in 35 patients (59.3%) and remained stable in 23 (39.0%). One patient (1.7%) experienced radiological progression at 54 months after GKRS. The PFS was 100%, 97%, and 97% at 3, 5, and 10 years, respectively. Nine patients (15.3%) occurred new neurological symptoms or signs at a median time of 8.1 (range, 3.0–81.6) months. The symptom PFS was 90% and 78% at 5 and 10 years, respectively. Fifteen patients (25.4%) occurred peritumoral edema (PTE) at a median time of 7.2 (range, 2.0–81.6) months. One patient underwent surgical resection for severe PTE. In univariate and multivariate analysis, Only tumor size (≥25 mm) and maximum dose (≥34 Gy) were significantly associated with PTE [hazard ratio (HR)= 3.461, 95% confidence interval (CI)=1.157-10.356, p=0.026 and HR=3.067, 95% CI=1.068-8.809, P=0.037, respectively]. Conclusions In this study, initial GKRS can provide a high tumor control rate as well as an acceptable rate of complications in large or documented growth asymptomatic meningiomas. GKRS may be an alternative initial treatment for asymptomatic meningiomas.
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Affiliation(s)
- Junyi Fu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lisha Wu
- Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chao Peng
- Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xin Yang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongji You
- Department of Nuclear Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Linhui Cao
- Department of Traditional Chinese Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yinhui Deng
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jinxiu Yu
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Yu Z, Huang B, Liang R. Radiation-induced cavernous malformation after stereotactic radiosurgery for cavernous sinus meningioma: a case report. BMC Neurol 2020; 20:422. [PMID: 33218314 PMCID: PMC7678286 DOI: 10.1186/s12883-020-01995-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/09/2020] [Indexed: 01/24/2023] Open
Abstract
Background Radiation-induced cavernous malformation (RICM) is a rare sequela of stereotactic radiosurgery (SRS) treatment of intracranial tumors. To date, no study reported on RICM after SRS for meningiomas originating from the skull base. The relationship between locus of initial meningioma and RICM has not been studied. Case presentation A 57-year-old woman presented with persistent headaches and blepharoptosis at initial episode. MRI disclosed a right parasellar lesion, diagnosed as a cavernous sinus meningioma (CSM). After receiving a single-fractionated SRS, headache relieved, but blepharoptosis did not significantly improve. Three years and three months later, she returned with headaches and dizziness. MRI showed an enlarged CSM. Moreover, a new mass-like lesion, suspected hemangioma, appeared in the nearby right temporal lobe. After surgical removal of the new lesion and the CSM, the patient’s neurological symptoms significantly improved. Pathology confirmed CSM and temporal RICM. Conclusions We report the first rare case of RICM occurring after SRS for CSM. The RICM may be in the same region as the initial tumor. Surgical intervention was preferred for symptomatic RICM and initial meningioma. We recommend long-term regular followup MRIs for patients with meningioma after SRS treatment.
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Affiliation(s)
- Zuan Yu
- Department of Neurosurgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Gulou District, Fuzhou City, Fujian Province, China
| | - Bin Huang
- Department of Neurosurgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Gulou District, Fuzhou City, Fujian Province, China
| | - Risheng Liang
- Department of Neurosurgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Gulou District, Fuzhou City, Fujian Province, China.
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Nakasu S, Notsu A, Na K, Nakasu Y. Malignant transformation of WHO grade I meningiomas after surgery or radiosurgery: systematic review and meta-analysis of observational studies. Neurooncol Adv 2020; 2:vdaa129. [PMID: 33305267 PMCID: PMC7712809 DOI: 10.1093/noajnl/vdaa129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The incidence and clinical features of the malignant transformation of benign meningiomas are poorly understood. This study examined the risk of the malignant transformation of benign meningiomas after surgery or stereotactic radiosurgery. Methods We systematically reviewed studies published between 1979 and 2019 using PubMed, Scopus, and other sources. We analyzed pooled data according to the PRISMA guideline to clarify the incidence rate of malignant transformation (IMT) and factors affecting malignant transformation in surgically or radiosurgically treated benign meningiomas. Results IMT was 2.98/1000 patient-years (95% confidence interval [CI] = 1.9–4.3) in 13 studies in a single-arm meta-analysis. Although the evidence level of the included studies was low, the heterogeneity of the incidence was mostly explained by the tumor location. In meta-regression analysis, skull base tumors had a significantly lower IMT than non-skull base tumors, but no gender association was observed. IMT after radiosurgery in 9 studies was 0.50/1000 person-years (95% CI = 0.02–1.38). However, a higher proportion of skull base tumors, lower proportion of males, and lower salvage surgery rate were observed in the radiosurgery group than in the surgery group. The median time to malignant change was 5 years (interquartile range = 2.5–8.2), and the median survival after malignant transformation was 4.7 years (95% CI = 3.7–8) in individual case data. Conclusion IMT of benign meningioma was significantly affected by the tumor location. Radiosurgery did not appear to increase IMT, but exact comparisons were difficult because of differences in study populations.
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Affiliation(s)
- Satoshi Nakasu
- Division of Neurosurgery, Kusatsu General Hospital, Kusatsu, Japan.,Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Japan
| | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Kiyong Na
- Department of Pathology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Yoko Nakasu
- Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Japan.,Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi, Japan
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Lippitz BE, Bartek J, Mathiesen T, Förander P. Ten-year follow-up after Gamma Knife radiosurgery of meningioma and review of the literature. Acta Neurochir (Wien) 2020; 162:2183-2196. [PMID: 32591948 PMCID: PMC7415024 DOI: 10.1007/s00701-020-04350-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 04/14/2020] [Indexed: 02/03/2023]
Abstract
Objectives With regard to the generally slow growth of meningioma, it is essential to analyse clinical treatment results in a long-term perspective. The purpose of the present analysis is to provide clinical data after Gamma Knife radiosurgery of meningioma in a 10-year perspective together with a review of the current literature. Methods The current study is a retrospective analysis of 86 consecutive Swedish patients with meningiomas treated using Gamma Knife radiosurgery at the Karolinska Hospital Stockholm between March 1991 and May 2001. A total of 130 tumours were treated in 115 treatment sessions. The median radiological follow-up was 10 years (1.8–16.5 years), and the median clinical follow-up was 9.4 years (2.1–17.4 years). Results After a median follow-up period of 10 years, local tumour control was achieved in 87.8% of meningiomas (108/123 tumours). The median latency between initial treatment and local (in-field) recurrence (n = 15) was 5.8 years (1.9–11.5). Recurrences adjacent but outside the initial radiation field occurred in 15.1% of patients (13/86) at a median of 7.5 years (1.3–15.7). New meningiomas were seen in 10.5% after a median of 5.4 years (0.9–10.8). In 72% of patients, no further treatment was required, 17.4% (15/86) underwent a second Gamma Knife treatment, 4.7% (4/86) required later open surgery and 5.8% (5/86) required both secondary treatments. Eighty-six percent of patients were neurologically unchanged or improved. A significantly lower rate of local (in-field) recurrences was seen in meningiomas treated with a prescription dose of > 13.4 Gy (7.1% vs. 24%, p = 0.02). Conclusions The current retrospective analysis provides a 10-year follow-up and comprises one of the longest available follow-up studies of radiosurgically treated meningiomas. The current series documents a persistent high local tumour control after Gamma Knife treatment, while providing an estimation of a necessary minimum dose for long-term tumour control in meningiomas. The study confirms the validity of previous short-term data in a long-term perspective.
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Affiliation(s)
- Bodo E Lippitz
- Interdisciplinary Centre for Radiosurgery (ICERA), Radiological Alliance Hamburg, Mörkenstr.47, 22767, Hamburg, Germany.
- Department of Clinical Neuroscience, Karolinska Institute, Centre for Molecular Medicine L8:04, Karolinska University Hospital, S-17176, Stockholm, Sweden.
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska Hospital, S-17176, Stockholm, Sweden
- Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tiit Mathiesen
- Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej3, 2200, Copenhagen, Denmark
- Department of Neurosurgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Petter Förander
- Department of Neurosurgery, Karolinska Hospital, S-17176, Stockholm, Sweden
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Hasegawa H, Hanakita S, Shin M, Koga T, Takahashi W, Nomoto AK, Sakuramachi M, Saito N. Single-Fractionated Stereotactic Radiosurgery for Intracranial Meningioma in Elderly Patients: 25-Year Experience at a Single Institution. Oper Neurosurg (Hagerstown) 2019; 14:341-350. [PMID: 29554374 DOI: 10.1093/ons/opx109] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 04/07/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) has been accepted as a therapeutic option for intracranial meningiomas; however, the detailed data on outcomes in elderly patients remain unclear. OBJECTIVE To delineate the efficacy of SRS for meningiomas in elderly patients. METHODS The outcomes of 67 patients aged ≥65 yr who underwent SRS for benign intracranial meningioma (World Health Organization grade I) between 1990 and 2014 at our institution were retrospectively analyzed. The median age was 71 yr (range, 65-83 yr), and the mean and median follow-up were 62 and 52 mo (range, 7-195 mo), respectively. Tumor margins were irradiated with a median dose of 16 Gy, and the median tumor volume was 4.9 cm3 (range, 0.7-22.9 cm3). RESULTS Actuarial local tumor control rates at 3, 5, and 10 yr after SRS were 92%, 86%, and 72%, respectively. Previous surgery and parasagittal/falcine location were statistically significant predictive factors for failed tumor control. Mild or moderate adverse events were noted in 9 patients. No severe adverse event was observed. A higher margin dose was significantly associated with adverse events by univariate analysis. CONCLUSION SRS is one of the standard therapies for meningiomas in elderly patients, providing both favorable tumor control and a low risk of adverse events under minimum invasiveness.
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Affiliation(s)
- Hirotaka Hasegawa
- Department of Neurosurgery, The Uni-versity of Tokyo Hospital, Tokyo, Japan
| | - Shunya Hanakita
- Department of Neurosurgery, The Uni-versity of Tokyo Hospital, Tokyo, Japan
| | - Masahiro Shin
- Department of Neurosurgery, The Uni-versity of Tokyo Hospital, Tokyo, Japan
| | - Tomoyuki Koga
- Department of Neurosurgery, The Uni-versity of Tokyo Hospital, Tokyo, Japan
| | - Wataru Takahashi
- Department of Radiation Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Akihiro K Nomoto
- Department of Radiation Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Madoka Sakuramachi
- Department of Radiation Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The Uni-versity of Tokyo Hospital, Tokyo, Japan
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Jahanbakhshi A, Azar M, Kazemi F, Jalessi M, Chanideh I, Amini E. Gamma Knife stereotactic radiosurgery for cerebellopontine angle meningioma. Clin Neurol Neurosurg 2019; 187:105557. [PMID: 31731053 DOI: 10.1016/j.clineuro.2019.105557] [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: 05/07/2019] [Revised: 10/02/2019] [Accepted: 10/06/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Meningiomas comprise 6-15 % of cerebellopontine angle (CPA) tumors. Surgical treatment is a real challenge because this area is occupied by several critical neurovascular elements. Currently, surgery is the first choice of treatment, however several factors may be present that necessitate choosing the alternative treatments such as Gamma Knife Stereotactic Radiosurgery (GKS). PATIENTS AND METHODS Ninety-three patients with CPA meningioma who were treated by GKS for a period of 8 years, were retrospectively reviewed. Factors affecting clinical and radiological improvement were analyzed. RESULTS The median tumor volume was 6 cm3. The mean values for maximal and marginal dose were 20.2 and 13.6 Gy, respectively. The mean follow-up time was 31.5 months. Tumor control (lack of progression) was achieved in 96.8% of the patients and 55.9% of the patients showed tumor regression on follow-up MRI. The actuarial 3-year progression-free survival (PFS) rate was 96%. Clinical improvement was seen in 49.5% of the patients while 11.8% experienced worsening or new-onset symptoms. Adverse radiation effects were seen in 4.3% of the patients. A worse symptomatic outcome, male sex, a lower tumor coverage, and marginal doses <13.5 Gy were associated with worse radiologic outcomes. Worse radiologic outcomes and higher tumor volumes, especially tumor volumes ≥8.5 cc, were associated with worse symptomatic outcomes. The male sex was associated with a lower PFS. CONCLUSION Gamma Knife radiosurgery, either primarily or post- operatively, offers a decent long-term tumor control in CPA meningioma, and is associated with an acceptable complication profile, especially in tumors with lower volumes.
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Affiliation(s)
- Amin Jahanbakhshi
- Skull Base Research Center, Neurosurgery Department, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Maziar Azar
- Skull Base Research Center, Neurosurgery Department, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Farid Kazemi
- Skull Base Research Center, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Maryam Jalessi
- Skull Base Research Center, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | | | - Elahe Amini
- Skull Base Research Center, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Fogarty T, Choong D, Gill S, Harper C, Robbins P. Stereotactic radiosurgery for intracranial IgG4‐related disease. J Med Imaging Radiat Oncol 2019; 63:707-710. [DOI: 10.1111/1754-9485.12931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/09/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Tamara Fogarty
- Department of Radiation Oncology Sir Charles Gairdner Hospital Nedlands Western Australia Australia
| | - Dean Choong
- Department of Radiation Oncology Sir Charles Gairdner Hospital Nedlands Western Australia Australia
| | - Suki Gill
- Department of Radiation Oncology Sir Charles Gairdner Hospital Nedlands Western Australia Australia
| | - Chris Harper
- Department of Radiation Oncology Sir Charles Gairdner Hospital Nedlands Western Australia Australia
| | - Peter Robbins
- Tissue Pathology PathWest QE II Medical Centre Nedlands Western Australia Australia
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Linear Accelerator-Based Radiosurgery of Grade I Intracranial Meningiomas. World Neurosurg X 2019; 3:100027. [PMID: 31225520 PMCID: PMC6584458 DOI: 10.1016/j.wnsx.2019.100027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/18/2019] [Indexed: 11/20/2022] Open
Abstract
Objective To determine the local control rate and complication rate in the treatment of grade I intracranial meningiomas. Methods A retrospective study was performed of patients with grade I meningioma who received radiosurgery with a dedicated linear accelerator from January 2002 to August 2012 with a minimum follow-up of 2 years. We performed descriptive statistics, logistic regression, and progression-free survival analysis through a Kaplan-Meier curve. Results Seventy-five patients with 78 grade I meningiomas received radiosurgery, 39 underwent surgery plus adjuvant radiosurgery, and 36 only radiosurgery. The follow-up median time was 68 months (range, 35–120 months). The tumor control rate was 93%, the 5-year progression-free survival was 92% (95% confidence interval, 77%–98%). Acute toxicity was 2.6%, and grade 1–2 late toxicity was 26.6%. Postradiosurgery edema was the main late morbidity. Age >55 years was the only significant factor for attaining a response >75%. The background of surgery before radiosurgery was the only significant prognostic factor for showing edema (odds ratio 5.78 [95% confidence interval, 2.14–15.64]). Conclusions The local control rate attained in our series is similar to that reported in other series worldwide; the acute toxicity rate was low and late toxicity was moderate.
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Park KJ, Kano H, Iyer A, Liu X, Tonetti DA, Lehocky C, Faramand A, Niranjan A, Flickinger JC, Kondziolka D, Lunsford LD. Gamma Knife stereotactic radiosurgery for cavernous sinus meningioma: long-term follow-up in 200 patients. J Neurosurg 2019; 130:1799-1808. [PMID: 30028261 DOI: 10.3171/2018.2.jns172361] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors of this study evaluate the long-term outcomes of stereotactic radiosurgery (SRS) for cavernous sinus meningioma (CSM). METHODS The authors retrospectively assessed treatment outcomes 5-18 years after SRS in 200 patients with CSM. The median patient age was 57 years (range 22-83 years). In total, 120 (60%) patients underwent Gamma Knife SRS as primary management, 46 (23%) for residual tumors, and 34 (17%) for recurrent tumors after one or more surgical procedures. The median tumor target volume was 7.5 cm3 (range 0.1-37.3 cm3), and the median margin dose was 13.0 Gy (range 10-20 Gy). RESULTS Tumor volume regressed in 121 (61%) patients, was unchanged in 49 (25%), and increased over time in 30 (15%) during a median imaging follow-up of 101 months. Actuarial tumor control rates at the 5-, 10-, and 15-year follow-ups were 92%, 84%, and 75%, respectively. Of the 120 patients who had undergone SRS as a primary treatment (primary SRS), tumor progression was observed in 14 (11.7%) patients at a median of 48.9 months (range 4.8-120.0 months) after SRS, and actuarial tumor control rates were 98%, 93%, 85%, and 85% at the 1-, 5-, 10-, and 15-year follow-ups post-SRS. A history of tumor progression after microsurgery was an independent predictor of an unfavorable response to radiosurgery (p = 0.009, HR = 4.161, 95% CI 1.438-12.045). Forty-four (26%) of 170 patients who had presented with at least one cranial nerve (CN) deficit improved after SRS. Development of new CN deficits after initial microsurgical resection was an unfavorable factor for improvement after SRS (p = 0.014, HR = 0.169, 95% CI 0.041-0.702). Fifteen (7.5%) patients experienced permanent CN deficits without evidence of tumor progression at a median onset of 9 months (range 2.3-85 months) after SRS. Patients with larger tumor volumes (≥ 10 cm3) were more likely to develop permanent CN complications (p = 0.046, HR = 3.629, 95% CI 1.026-12.838). Three patients (1.5%) developed delayed pituitary dysfunction after SRS. CONCLUSIONS This long-term study showed that Gamma Knife radiosurgery provided long-term tumor control for most patients with CSM. Patients who underwent SRS for progressive tumors after prior microsurgery had a greater chance of tumor growth than the patients without prior surgery or those with residual tumor treated after microsurgery.
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Affiliation(s)
- Kyung-Jae Park
- 1Department of Neurosurgery, College of Medicine, Korea University, Seoul, Korea
| | | | - Aditya Iyer
- 5Department of Neurological Surgery, Stanford University, Stanford, California
| | - Xiaomin Liu
- 6Gamma Knife Center, Department of Neurosurgery, Tianjin Huanhu Hospital, Nankai University, Tianjin, People's Republic of China; and
| | | | | | | | | | - John C Flickinger
- Departments of2Neurological Surgery
- 3Radiation Oncology, and Center for Image-Guided Neurosurgery
| | - Douglas Kondziolka
- 7Department of Neurosurgery, New York University Langone Medical Center, New York, New York
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Fega KR, Fletcher GP, Waddle MR, Peterson JL, Ashman JB, Barrs DM, Bendok BR, Patel NP, Porter AB, Vora SA. Analysis of MRI Volumetric Changes After Hypofractionated Stereotactic Radiation Therapy for Benign Intracranial Neoplasms. Adv Radiat Oncol 2019; 4:43-49. [PMID: 30706009 PMCID: PMC6349623 DOI: 10.1016/j.adro.2018.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 08/02/2018] [Accepted: 08/10/2018] [Indexed: 01/08/2023] Open
Abstract
Purpose To quantitatively assess volumetric changes after hypofractionated stereotactic radiation therapy (HFSRT) in patients treated for vestibular schwannomas and meningiomas. Methods and materials We retrospectively reviewed records of patients treated with HFSRT at our institution from 2002 to 2014. Patients received a median dose of 25 Gy in 5 fractions. After treatment, they underwent clinical and radiologic follow-up with magnetic resonance imaging (MRI) at 3- to 12-month intervals. Gross tumor volume was outlined on each thin slice of contrast-enhanced T1 series before and on each scan after HFSRT. Volumetric changes were calculated and compared with neuroradiologist interpretations. Results Forty-three patients underwent 182 MRI scans. Tumor types included vestibular schwannoma (n = 34) and meningioma (n = 9). Median follow-up time was 29 months. Median gross tumor volume was 3.1 cm3. Local control was 81.4% for the entire cohort at the time of last follow-up. Transient volume expansion was noted in 17 patients (50%) with vestibular schwannoma and 2 (22%) with meningioma. For all patients, transient volume expansion and subsequent regression occurred at a median time of 5.5 and 12 months, respectively. Neuroradiologist agreement with regard to tumor regression, progression, or stability occurred in 155 of 182 total reports (85%). The largest discordance identified was a stable finding on the MRI interpretation when the measured volumetric change exceeded 20% (n = 24 [13%]). Conclusions HFSRT is associated with excellent local control and a low incidence of toxicity. With volumetric MRI measurement, transient volume expansion was a common finding and was associated with temporary adverse effects. Although the neuroradiologist’s interpretation generally agreed with the volumetric MRI measurement, the overall 15% discordance rate emphasizes the potential benefit of considering volumetric measurements, which may help clinicians correlate posttreatment symptoms with MRI findings.
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Affiliation(s)
- Kathryn R Fega
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona
| | | | - Mark R Waddle
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Jonathan B Ashman
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona
| | - David M Barrs
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, Arizona
| | - Bernard R Bendok
- Department of Neurologic Surgery, Mayo Clinic Hospital, Phoenix, Arizona
| | - Naresh P Patel
- Department of Neurologic Surgery, Mayo Clinic Hospital, Phoenix, Arizona
| | - Alyx B Porter
- Department of Neurology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Sujay A Vora
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona
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Sadik ZHA, Lie ST, Leenstra S, Hanssens PEJ. Volumetric changes and clinical outcome for petroclival meningiomas after primary treatment with Gamma Knife radiosurgery. J Neurosurg 2018; 129:1623-1629. [PMID: 29372884 DOI: 10.3171/2017.7.jns17380] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 07/24/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPetroclival meningiomas (PCMs) can cause devastating clinical symptoms due to mass effect on cranial nerves (CNs); thus, patients harboring these tumors need treatment. Many neurosurgeons advocate for microsurgery because removal of the tumor can provide relief or result in symptom disappearance. Gamma Knife radiosurgery (GKRS) is often an alternative for surgery because it can cause tumor shrinkage with improvement of symptoms. This study evaluates qualitative volumetric changes of PCM after primary GKRS and its impact on clinical symptoms.METHODSThe authors performed a retrospective study of patients with PCM who underwent primary GKRS between 2003 and 2015 at the Gamma Knife Center of the Elisabeth-Tweesteden Hospital in Tilburg, the Netherlands. This study yields 53 patients. In this study the authors concentrate on qualitative volumetric tumor changes, local tumor control rate, and the effect of the treatment on trigeminal neuralgia (TN).RESULTSLocal tumor control was 98% at 5 years and 93% at 7 years (Kaplan-Meier estimates). More than 90% of the tumors showed regression in volume during the first 5 years. The mean volumetric tumor decrease was 21.2%, 27.1%, and 31% at 1, 3, and 6 years of follow-up, respectively. Improvement in TN was achieved in 61%, 67%, and 70% of the cases at 1, 2, and 3 years of follow-up, respectively. This was associated with a mean volumetric tumor decrease of 25% at the 1-year follow-up to 32% at the 3-year follow-up.CONCLUSIONSGKRS for PCMs yields a high tumor control rate with a low incidence of neurological deficits. Many patients with TN due to PCM experienced improvement in TN after radiosurgery. GKRS achieves significant volumetric tumor decrease in the first years of follow-up and thereafter.
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Affiliation(s)
- Zjiwar H A Sadik
- 1Gamma Knife Center and
- 2Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg; and
- 3Department of Neurosurgery, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Suan Te Lie
- 1Gamma Knife Center and
- 2Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg; and
| | - Sieger Leenstra
- 1Gamma Knife Center and
- 2Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg; and
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Park YW, Oh J, You SC, Han K, Ahn SS, Choi YS, Chang JH, Kim SH, Lee SK. Radiomics and machine learning may accurately predict the grade and histological subtype in meningiomas using conventional and diffusion tensor imaging. Eur Radiol 2018; 29:4068-4076. [DOI: 10.1007/s00330-018-5830-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/19/2018] [Accepted: 10/12/2018] [Indexed: 11/27/2022]
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Patibandla MR, Lee CC, Tata A, Addagada GC, Sheehan JP. Stereotactic radiosurgery for WHO grade I posterior fossa meningiomas: long-term outcomes with volumetric evaluation. J Neurosurg 2018; 129:1249-1259. [PMID: 29303453 DOI: 10.3171/2017.6.jns17993] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/30/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEResearch over the past 2 decades has been characterizing the role of stereotactic radiosurgery (SRS) in the treatment of benign intracranial tumors, including meningiomas. However, few studies have examined the long-term outcomes of SRS treatment for posterior fossa meningiomas (PFMs). Furthermore, previous studies have typically used single diameter measurements when reporting outcomes, which can yield misleading results. The authors describe the use of SRS in the treatment of benign WHO grade I PFMs and correlate volumetric analysis with long-term outcomes.METHODSThis study is a retrospective analysis of a prospectively maintained IRB-approved database. Inclusion criteria were a diagnosis of WHO grade I PFM with subsequent treatment via single-session SRS and a minimum of 3 follow-up MRI studies available. Volumetric analysis was performed on the radiosurgical scan and each subsequently available follow-up scan by using slice-by-slice area calculations of the meningioma and numerical integration with the trapezoid rule.RESULTSThe final cohort consisted of 120 patients, 76.6% (92) of whom were female, with a median age of 61 years (12-88 years). Stereotactic radiosurgery was the primary treatment for 65% (78) of the patients, whereas 28.3% (34) had 1 resection before SRS treatment and 6.7% (8) had 2 or more resections before SRS. One patient had prior radiotherapy. Tumor characteristics included a median volume of 4.0 cm3 (0.4-40.9 cm3) at treatment with a median margin dose of 15 Gy (8-20 Gy). The median clinical and imaging follow-ups were 79.5 (15-224) and 72 (6-213) months, respectively. For patients treated with a margin dose ≥ 16 Gy, actuarial progression-free survival rates during the period 2-10 years post-SRS were 100%. In patients treated with a margin dose of 13-15 Gy, the actuarial progression-free survival rates at 2, 4, 6, 8, and 10 years were 97.5%, 97.5%, 93.4%, 93.4%, and 93.4%, respectively. Those who were treated with ≤ 12 Gy had actuarial progression-free survival rates of 95.8%, 82.9%, 73.2%, 56.9%, and 56.9% at 2, 4, 6, 8, and 10 years, respectively. The overall tumor control rate was 89.2% (107 patients). Post-SRS improvement in neurological symptoms occurred in 23.3% (28 patients), whereas symptoms were stable in 70.8% (85 patients) and worsened in 5.8% (7 patients). Volumetric analysis demonstrated that a change in tumor volume at 3 years after SRS reliably predicted a volumetric change and tumor control at 5 years (R2 = 0.756) with a p < 0.001 and at 10 years (R2 = 0.421) with a p = 0.001. The authors also noted that the 1- to 5-year tumor response is predictive of the 5- to 10-year tumor response (R2 = 0.636, p < 0.001).CONCLUSIONSStereotactic radiosurgery, as an either upfront or adjuvant treatment, is a durable therapeutic option for WHO grade I PFMs, with high tumor control and a low incidence of post-SRS neurological deficits compared with those obtained using alternate treatment modalities. Lesion volumetric response at the short-term follow-up of 3 years is predictive of the long-term response at 5 and 10 years.
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Affiliation(s)
- Mohana Rao Patibandla
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Cheng-Chia Lee
- 2Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan; and
| | - Athreya Tata
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | | | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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Park HR, Lee JM, Park KW, Kim JH, Jeong SS, Kim JW, Chung HT, Kim DG, Paek SH. Fractionated Gamma Knife Radiosurgery as Initial Treatment for Large Skull Base Meningioma. Exp Neurobiol 2018; 27:245-255. [PMID: 30022876 PMCID: PMC6050410 DOI: 10.5607/en.2018.27.3.245] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/02/2018] [Accepted: 05/24/2018] [Indexed: 11/19/2022] Open
Abstract
We present our experience on the hypofractionated Gamma Knife radiosurgery (FGKS) for large skull base meningioma as an initial treatment. We retrospectively reviewed 23 patients with large skull base meningioma ≥10 cm3 who underwent FGKS as the initial treatment option. The mean volume of tumors prior to radiosurgery was 21.2±15.63 cm3 (range, 10.09~71.42). The median total margin dose and marginal dose per fraction were 18 Gy (range, 15~20) and 6 Gy (range, 5~6), respectively. Patients underwent three or four fractionations in consecutive days with the same Leksell® frame. The mean follow-up duration was 38 months (range, 17~78). There was no mortality. At the last follow-up, the tumor volume was stationary in 15 patients (65.2%) and had decreased in 8 patients (34.8%). Six patients who had cranial neuropathy at the time of FGKS showed improvement at the last clinical follow-up. Following FGKS, 4 patients (17%) had new cranial neuropathy. The trigeminal neuropathy was the most common and all were transient. The mean Karnofsky Performance Status score at pre-FGKS and the last clinical follow-up was 97.0±10.4 points (median, 100) and 98.6±6.9 (median, 100) points, respectively. FGKS has showed satisfactory tumor control with functional preservation for large skull base meningiomas. Further prospective studies of large cohorts with long term follow-up are required to clarify the efficacy in the tumor control and functional outcome as well as radiation toxicity.
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Affiliation(s)
- Hye Ran Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Jae Meen Lee
- Department of Neurosurgery, Pusan National University Hospital, Busan 49241, Korea
| | - Kwang-Woo Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Jung Hoon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Sang Soon Jeong
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyun-Tai Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Dong Gyu Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea.,Cancer Research Institute, Seoul National University, Seoul 03080, Korea.,Ischemia Hypoxia Disease Institute, Seoul National University, Seoul 03080, Korea
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Ganau M, Foroni RI, Gerosa M, Zivelonghi E, Longhi M, Nicolato A. Radiosurgical Options in Neuro-oncology: A Review on Current Tenets and Future Opportunities. Part I: Therapeutic Strategies. TUMORI JOURNAL 2018. [DOI: 10.1177/1636.17912] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mario Ganau
- Department of Neurosciences, University Hospital, Azienda Ospedaliera Universitaria Integrata, Verona
- Department of Biomedical Engineering, University of Cagliari, Cagliari
| | - Roberto Israel Foroni
- Department of Pathology and Diagnosis, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Massimo Gerosa
- Department of Neurosciences, University Hospital, Azienda Ospedaliera Universitaria Integrata, Verona
| | - Emanuele Zivelonghi
- Department of Pathology and Diagnosis, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Michele Longhi
- Department of Neurosciences, University Hospital, Azienda Ospedaliera Universitaria Integrata, Verona
| | - Antonio Nicolato
- Department of Neurosciences, University Hospital, Azienda Ospedaliera Universitaria Integrata, Verona
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Milano MT, Sharma M, Soltys SG, Sahgal A, Usuki KY, Saenz JM, Grimm J, El Naqa I. Radiation-Induced Edema After Single-Fraction or Multifraction Stereotactic Radiosurgery for Meningioma: A Critical Review. Int J Radiat Oncol Biol Phys 2018; 101:344-357. [PMID: 29726362 DOI: 10.1016/j.ijrobp.2018.03.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE Potential dosimetric and clinicopathologic predictors of radiation-induced brain edema after single-fraction or multifraction stereotactic radiosurgery (SRS) for non-base of skull (non-BOS) meningiomas are summarized based on a systematic review of the published literature. METHODS AND MATERIALS Reviewed studies (PubMed indexed from 1998 through 2017) included all or some non-BOS meningioma patients, reported risks of edema after SRS, and correlated dosimetric and/or nondosimetric measures with the magnitude of risk. RESULTS Twenty-six studies reporting risks of edema after SRS for meningioma are reviewed. The treatment techniques as well as distribution of tumor locations, target dosing, and target volume varied across studies. Among 13 studies that included only non-BOS tumors or separately grouped non-BOS tumors, symptomatic edema occurred in 5% to 43% of patients and any edema occurred in 28% to 50%. The reported average time to onset of edema ranged from approximately 3 to 9 months in most studies. Factors reported to significantly correlate with increased risks of edema and/or symptomatic edema after SRS for meningioma include the following: greater tumor margin and/or maximum dose, greater tumor size and/or volume, non-BOS (particularly parasagittal) location, no prior resection for meningioma, and presence of pretreatment edema. Nevertheless, the extent and significance of these factors were inconsistent across studies. Potentially important dosimetric factors, such as volume of brain or tissue receiving single-fraction doses > 10 to 12 Gy, are not well studied. CONCLUSIONS The variability in risks of edema and in factors impacting those risks is likely a result of differences across studies in the clinicopathologic characteristics of the patient populations, as well as differences in treatment modalities and SRS planning and delivery parameters. More studies on pooled populations, grouped by potential prognostic factors such as tumor location and prior therapy, are needed to better understand dosimetric and nondosimetric factors predictive of edema risk after SRS for meningioma.
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Affiliation(s)
- Michael T Milano
- Department of Radiation Oncology, University of Rochester, Rochester, New York.
| | - Manju Sharma
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth Y Usuki
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - Jon-Michael Saenz
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - Jimm Grimm
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan Hospital, Ann Arbor, Michigan
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