Indications, feasibility, safety, and efficacy of CyberKnife radiotherapy for the treatment of olfactory groove meningiomas: a single institutional retrospective series

Jianmin Liu,Farhan A Mirza,Rafael Rojas,Fred C Lam,Ekkehard M Kasper,Anand Mahadevan

doi:10.1186/s13014-020-01506-6

Abstract

PurposeTo assess the safety and efficacy of CyberKnife® radiotherapy (CKRT) for the treatment of olfactory groove meningiomas (OGMs).MethodsA retrospective review was performed of 13 patients with OGM treated with CKRT from September 2005 to May 2018 at our institution. Nine patients were treated primarily with CKRT, 3 for residual disease following resection, and 1 for disease recurrence.ResultsFive patients were treated with stereotactic radiosurgery (SRS), 6 with hypofractionated stereotactic radiotherapy (HSRT), and 2 with fractionated stereotactic radiotherapy (FSRT). The median tumor volume was 8.12 cm3. The median prescribed dose was 14.8 Gy for SRS, 27.3 Gy for HSRT, and 50.2 Gy for FSRT. The median maximal dose delivered was 32.27 Gy. Median post treatment follow-up was 48 months. Twelve of 13 patients yielded a 100% regional control rate with a median tumor volume reduction of 31.7%. Six of the 12 patients had reduced tumor volumes while the other 6 had no changes. The thirteenth patient had significant radiation-induced edema requiring surgical decompression. Twelve patients were alive and neurologically stable at the time of the review. One patient died from pneumonia unrelated to his CKRT treatment.ConclusionsCKRT appears to be safe and effective for the treatment of OGMs.

Highlights

Olfactory groove meningiomas (OGMs) originate from arachnoid cap cells of the cribriform plate and frontoethmoidal suture in the anterior cranial fossa [1, 2] and contribute to approximately 4–13% of intracranial meningiomas [3]
CyberKnife® radiotherapy (CKRT) can be delivered as stereotactic radiosurgery (SRS), fractionated stereotactic radiotherapy (FSRT) [7], or hypofractionated stereotactic radiotherapy (HSRT) [8] – the appropriate regimen is chosen depending on the patient’s tumor characteristics and its proximity to surrounding critical structures or vasculature
Since RT has recently emerged as an effective alternate modality for treatment of primary intracranial diseases in the nonsurgical and elderly populations or as adjuvant therapy for residual or recurrent disease the question arises whether such therapy is a suitable option for patients with OGMs which require treatment

Summary

Introduction

Olfactory groove meningiomas (OGMs) originate from arachnoid cap cells of the cribriform plate and frontoethmoidal suture in the anterior cranial fossa [1, 2] and contribute to approximately 4–13% of intracranial meningiomas [3]. OGMs which are symptomatic, larger than 3 cm in diameter, or demonstrate progressive growth on sequential imaging, are considered suitable for surgical treatment [9]. Treatment algorithms have not been well established for OGMs smaller than 3 cm in diameter that demonstrate continued growth in patients who are high surgical risk, older patients with significant comorbidities which may preclude conventional open surgical intervention. Surgical resection of OGMs can be complicated by their close proximity to critical neurovascular structures [10]. Since RT has recently emerged as an effective alternate modality for treatment of primary intracranial diseases in the nonsurgical and elderly populations or as adjuvant therapy for residual or recurrent disease the question arises whether such therapy is a suitable option for patients with OGMs which require treatment

Methods

Results

Conclusion