Hypofractionated Radiation for Benign Meningiomas and Vestibular Schwannomas

Abstract

Meningiomas and vestibular schwannomas are generally benign tumors which can be treated with definitive radiation therapy. Both radiosurgery and fractionated intensity-modulated radiotherapy (IMRT) are effective, with radiation schedule guided by tumor characteristics and location. While fractionated IMRT yields favorable tumor control, daily treatments for 5-6 weeks can be burdensome for patients and can be associated with high healthcare-related costs. Thus, hypofractionated radiation may be a reasonable alternative. Here we review the results of patients with benign meningiomas or vestibular schwannomas treated at our institution with hypofractionated IMRT. Following IRB approval, patients treated at our institution from 2008 to 2018 with a primary diagnosis of either meningioma or vestibular schwannoma and who received 30 Gy in 10 fractions were retrospectively reviewed. These patients were offered hypofractionated radiation due to their advanced age, multiple medical comorbidities, or inability to travel to our center for six weeks of treatment. Patient and tumor characteristics as well as follow-up documentation were retrospectively reviewed. Tumor progression was determined by review of patient imaging as well as provider notation. From years 2008 to 2018, 70 patients were treated for meningioma or vestibular schwannoma with 30 Gy in 10 fractions. Median patient age was 73 years (range 43-92 years). At median follow-up of 3.2 years, we observed a local control rate of 97.1%. Two patients (2.9%) had disease progression, which occurred at 9.6 and 6.6 years after treatment. One patient developed asymptomatic radiographic changes consistent with radiation necrosis which resolved without intervention. All patients completed the prescribed course without interruption. In this cohort, the mean tumor size was 18.9 cc (range 3.4-245.5 cc) and tumor volume was not associated with recurrence risk. Hypofractionated radiation with 30 Gy in 10 fractions is an effective, convenient, and well tolerated schedule for patients with benign meningiomas or vestibular schwannomas. This treatment schedule appeared to provide durable control for a wide range of tumor volumes and should be considered for those patients with limited life expectancy or those unable to receive a conventionally fractionated radiotherapy course.