Abstract

BackgroundThis retrospective German and Italian multicenter analysis aimed to compare the role of normofractionated stereotactic radiotherapy (nFSRT) to CyberKnife-based hypofractionated stereotactic radiotherapy (CK-hFSRT) for skull base meningiomas.MethodsOverall, 341 patients across three centers were treated with either nFSRT or CK-hFSRT for skull base meningioma. Treatment planning was based on computed tomography (CT) and magnetic resonance imaging (MRI) following institutional guidelines. Most nFSRT patients received 33 × 1.8 Gy, and most CK-hFSRT patients received 5 × 5 Gy. The median follow-up time was 36 months (range: 1–232 months).ResultsIn the CK-hFSRT group, the 1-, 3-, and 10-year local control (LC) rates were 99.4, 96.8, and 80.3%, respectively. In the nFSRT group, the 1-, 3-, and 10-year LC rates were 100, 99, and 79.1%, respectively. There were no significant differences in LC rates between the nFSRT and CK-hFSRT groups (p = 0.56, hazard ratio = 0.76, 95% confidence interval, 0.3–1.9). In the CK-hFSRT group, only one case (0.49%) of severe toxicity (CTCAE 4.0 ≥ 3) was observed. In the nFSRT group, three cases (2.1%) of grade III toxicity were observed.ConclusionThis analysis of pooled data from three centers showed excellent LC and low side effect rates for patients treated with CK-hFSRT or nFSRT. The efficacy, safety, and convenience of a shortened treatment period provide a compelling case for the use of CK-hFSRT in patients with moderate size skull base meningioma and provided that OAR constraints are met.

Highlights

  • IntroductionThis retrospective German and Italian multicenter analysis aimed to compare the role of normofractionated stereotactic radiotherapy (nFSRT) to CyberKnife-based hypofractionated stereotactic radiotherapy (CK-hFSRT) for skull base meningiomas

  • This retrospective German and Italian multicenter analysis aimed to compare the role of normofractionated stereotactic radiotherapy to CyberKnife-based hypofractionated stereotactic radiotherapy (CK-hFSRT) for skull base meningiomas

  • Several fractionation regimens were used in both groups, the most common being 5 × 5 Gy in the CK-hFSRT group and 33 × 1.8 Gy in the normofractionated stereotactic radiotherapy (nFSRT) group

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Summary

Introduction

This retrospective German and Italian multicenter analysis aimed to compare the role of normofractionated stereotactic radiotherapy (nFSRT) to CyberKnife-based hypofractionated stereotactic radiotherapy (CK-hFSRT) for skull base meningiomas. Complete surgical removal is often difficult to achieve without compromising the intricate neuroanatomic structure of the skull base and the risk of local relapse following incomplete resection without adjuvant treatment is high. Traditional radiotherapeutic approaches consisted of normofractionated stereotactic RT (nFSRT) but recent availability of high-precision devices including the CyberKnife and Gamma Knife in first world have resulted in both hypofractionated stereotactic radiotherapy (hFSRT) and radiosurgery (SRS) to become a fast, safe and convenient alternative approach [3,4,5,6,7]

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