Abstract
BackgroundFor meningiomas, complete resection is recommended as first-line treatment while stereotactic radiosurgery (SRS) is established for meningiomas of smaller size considered inoperable. If the patient´s medical condition or preference excludes surgery, SRS remains a treatment option. We evaluated the efficacy and safety of SRS in a cohort comprising these cases.MethodsIn this retrospective single-centre analysis we included patients receiving single fraction SRS either by modified LINAC or robotic guidance by Cyberknife for potentially resectable intracranial meningiomas. Treatment-related adverse events as well as local and regional control rates were determined from follow-up imaging and estimated by the Kaplan–Meier method.ResultsWe analyzed 188 patients with 218 meningiomas. The median radiological, and clinical follow-up periods were 51.4 (6.2–289.6) and 55.8 (6.2–300.9) months. The median tumor volume was 4.2 ml (0.1–22), and the mean marginal radiation dose was 13.0 ± 3.1 Gy, with reference to the 80.0 ± 11.2% isodose level. Local recurrence was observed in one case (0.5%) after 239 months. The estimated 2-, 5-, 10- and 15-year regional recurrence rates were 1.5%, 3.0%, 6.6% and 6.6%, respectively. Early adverse events (≤ 6 months after SRS) occurred in 11.2% (CTCEA grade 1–2) and resolved during follow-up in 7.4% of patients, while late adverse events were documented in 14.4% (grade 1–2; one case grade 3). Adverse effects (early and late) were associated with the presence of symptoms or neurological deficits prior to SRS (p < 0.03) and correlated with the treatment volume (p < 0.02).ConclusionIn this analysis SRS appears to be an effective treatment for patients with meningiomas eligible for complete resection and provides reliable long-term local tumor control with low rates of mild morbidity.
Highlights
The incidence of meningioma is increasing due to both an aging population and increased use of MR and CT imaging [1]
For tumors in complex locations where surgical treatment is unsuitable in the first place, safety and efficacy of stereotactic radiosurgery have been demonstrated by numerous publications [4, 5]
Twenty patients were treated for two meningiomas at different locations within one SRS session, one patient was treated for 5 neighboring convexity meningiomas
Summary
The incidence of meningioma is increasing due to both an aging population and increased use of MR and CT imaging [1]. Due to their frequent slow growth, meningiomas can develop to a considerable size before elevated intracranial pressure or local irritations cause symptoms such as neurological deficits, seizures, cognitive impairment or psychiatric abnormalities. For tumors in complex locations where surgical treatment is unsuitable in the first place, safety and efficacy of stereotactic radiosurgery have been demonstrated by numerous publications [4, 5]. Complete resection is recommended as first-line treatment while stereotactic radiosurgery (SRS) is established for meningiomas of smaller size considered inoperable. We evaluated the efficacy and safety of SRS in a cohort comprising these cases
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