Hypofractionated Stereotactic Radiotherapy for Patients with Intracranial Meningiomas: impact of radiotherapy regimen on local control

F Meniai-Merzouki,T Lacornerie,E Lartigau,J Geffrelot,D Pasquier,V Bernier-Chastagner,E Tresch,B Coche-Dequeant

doi:10.1038/s41598-018-32124-8

Abstract

We evaluated efficacy and tolerance of hypofractionated stereotactic radiation treatment (hFSRT) in the management of intracranial meningiomas. Between December 2008 and June 2016, 126 patients with 136 intracranial meningiomas were treated with robotic hFSRT. hFSRT was performed as primary irradiation and as a salvage option for the local recurrence after prior radiotherapy. The median prescription dose was 25 Gy (12–40) with a median number of fractions of 5 (3–10). After a median follow-up of 20.3 months (range 1–77 months), the 24-months local control (LC) rate was 81% in the primary hFSRT group and 39% after hFSRT in the re-irradiation group (p=0.002). The clinical control rate of symptoms in the overall population was 95% (95% CI: 89–98%). Progression-free survival (PFS) in the overall population at 24 months was 70% (95% CI: 60%–79%). In the primary hFSRT group, PFS was significantly lower with the most hypofractionated schedules of 21–23 Gy in 3 fractions vs. 25–40 Gy in 5–10 fractions: 62% vs. 92% (p = 0.0006). The incidence of radionecrosis at 24 months was significantly lower in the primary hFSRT group, at 2% vs. 20% in the re-irradiation hFSRT group (p = 0.002).

Highlights

Of meningioma of the skull base[9]
Considering the clinical response, stabilization or improvement neurological symptoms has been reported in 69% to 100% of cases after conventional radiotherapy according to series[13,14]
In an interesting fact for the re-irradiation hypofractionated stereotactic radiation treatment (hFSRT) group, we report a complete and partial clinical response in 14% and 32%, respectively, and stability in 46%, regardless of the location of the meningioma

Summary

Introduction

Of meningioma of the skull base[9]. it is important to adapt the choice of technique to volume and tumor topography. In contrast to conventional fractional radiotherapy, hFSRT is an accurate technique that allows a high dose to be delivered per fraction in a few sessions with a reduction in the margin around the tumor and in the surrounding irradiated tissues. It is an ideal technique for treating small lesions with radiobiologically higher doses to maximize local control[10]. The aim of this retrospective and multi-institutional study is to report the experience of hSRT as a curative approach in management of intracranial meningiomas by using different hypofractionated.

Methods

Results

Conclusion