Treatment Of Intracranial Meningiomas Research Articles

The influence of facility type on intracranial meningioma treatment and outcomes: predicting overall survival using the National Cancer Database.

There is a growing body of evidence demonstrating improved outcomes for patients with CNS neoplasms treated at academic centers (ACs) versus nonacademic centers (non-ACs), which represents a potential healthcare disparity within neurosurgery. In this paper, the authors sought to investigate the relationship between facility type and surgical outcomes in meningioma patients. The National Cancer Database was queried for adult patients diagnosed with intracranial meningioma between 2004 and 2019. Patients were stratified by facility type, and the Mann-Whitney U-test and Fisher exact test were used for bivariate comparisons of continuous and categorical variables, respectively. Multivariate logistic regression was used to assess whether demographic variables were associated with treatment at ACs. Furthermore, multivariate Cox proportional hazards models were used to determine whether facility type was associated with overall survival (OS) outcomes. Data on 139,304 patients (74% male, 84% White) were retrieved. Patients were stratified by facility type, with 50,349 patients (36%) treated at ACs and 88,955 patients (64%) treated at non-ACs. Patients treated at ACs were more likely to have private insurance (41% vs 34%, p < 0.001) and less likely to have Medicare (46% vs 57%, p < 0.001). Patients treated at ACs were more likely to have larger tumors (36.91 mm vs 33.57 mm, p < 0.001) and more likely to undergo surgery (47% vs 34%, p < 0.001). Interestingly, patients treated at ACs had decreased comorbidities (Charlson Comorbidity Index rating 0: 74% vs 69%) and similar income levels (income ≥ $46,000: 44% vs 43%). With respect to survival outcomes, patients treated at ACs demonstrated a higher median OS at 10 years than patients treated at non-ACs (65.2% vs 54.1%). The association of improved OS in patients treated at ACs continued to be true when adjusting for all other clinical and demographic variables (HR 0.900, 95% CI 0.882-0.918; p < 0.001). The results of this study indicate that facility type is associated with disparate survival outcomes in the treatment of intracranial meningiomas. Namely, patients treated at non-ACs appear to have a survival disadvantage even when controlling for additional comorbidities.

Robotic Stereotactic Radiotherapy for Intracranial Meningiomas-An Opportunity for Radiation Dose De-Escalation.

To evaluate the possibility of dose de-escalation, with consideration of the efficacy and safety of robotic stereotactic CyberKnife radiotherapy in patients diagnosed with intracranial meningiomas. The study group consisted of 172 patients (42 men and 130 women) treated in III Radiotherapy and Chemotherapy Clinic of Maria Sklodowska-Curie National Research Institute of Oncology in Gliwice between January 2011 and July 2018. The qualification for dose de-escalation was based on MRI (magnetic resonance imaging) features: largest tumor diameter less than 5 cm, well-defined tumor margins, no edema, and no brain infiltration. The age of patients was 21-79 years (median 59 years) at diagnosis and 24-80 years (median 62 years) at radiotherapy. Sixty-seven patients (Group A) were irradiated after initial surgery. Histopathological findings were meningioma grade WHO 1 in 51 and WHO 2 in 16 cases. Group B (105 patients) had no prior surgery and the diagnosis was based on the typical features of meningioma on MRI. All patients qualified for the robotic stereotactic CyberKnife radiotherapy, and the total dose received was 18 Gy in three fractions to reference isodose 78-92%. Follow-up period was 18 to 124 months (median 67.5 months). Five- and eight-year progression free survival was 90.3% and 89.4%, respectively. Two patients died during the follow-up period. Progression of tumor after radiotherapy was registered in 16 cases. Four patients required surgery due to progressive disease, and three of them were progression free during further follow-up. Twelve patients received a second course of robotic radiotherapy, 11 of them had stable disease, and one patient showed further tumor growth but died of heart failure. Crude progression free survival after both primary and secondary treatment was 98.8%. Radiotherapy was well-tolerated: acute toxicity grade 1/2 (EORTC-RTOG scale) was seen in 10.5% of patients. We did not observe any late effects of radiotherapy. Stereotactic CyberKnife radiotherapy with total dose of 18 Gy delivered in three fractions showed comparable efficacy to treatment schedules with higher doses. This could support the idea of dose de-escalation in the treatment of intracranial meningiomas.

EPID-19. THE INFLUENCE OF FACILITY TYPE ON INTRACRANIAL MENINGIOMA TREATMENT AND OUTCOMES: PREDICTING OVERALL SURVIVAL USING THE NATIONAL CANCER DATABASE

Abstract There is a growing body of evidence demonstrating improved outcomes for patients with CNS neoplasms treated at academic centers (ACs) versus non-academic centers (non-ACs). This represents a potential healthcare disparity within neurosurgery. Herein, we investigate the relationship between facility type and surgical outcomes in meningioma patients. METHODS: The National Cancer Database was queried for adult patients diagnosed with intracranial meningioma requiring intervention between 2004 and 2019. Patients were stratified by facility type and the Mann-Whitney U and Fisher exact tests were used for bivariate analysis of continuous and categorical variables. Multivariable logistic and linear regression were used to assess whether demographic variables predicted treatment at non-ACs. Furthermore, multivariate cox proportion hazard and log-rank tests were used to determine whether facility type was related to overall survival (OS). RESULTS: In total, 314,651 patients diagnosed with meningioma were included; 122,112 (38.8%) patients were treated at an AC and 192,539 patients (61.2%) were treated at a non-AC. On bivariate analysis, patients treated at an AC were more likely to be white (30.7% vs 24.7%, p&amp;lt; 0.001), have an income higher than $63,000 (31.8% vs 29% p&amp;lt; 0.001) and have a larger tumor (43.3±113.6 vs 39.3±106.8, p&amp;lt; 0.001). On multivariate Cox models, the risk of death for patients treated at ACs was 16.7% lower than that of non-AC patients (HR = 0.883, 95% CI 0.858–0.908, p &amp;lt; 0.001). When controlling for demographic and clinical variables, patients treated at ACs were more likely to undergo surgical intervention (OR = 1.059, 95% CI 1.033-1.087, p &amp;lt; 0.001) but less likely to receive radiotherapy (OR = 0.921, 95% CI 0.897-0.947, p &amp;lt; 0.001). CONCLUSIONS: Our results indicate that AC facility type is associated with disparate survival outcomes in treatment of intracranial meningiomas. Namely, patients treated at non-ACs appear to suffer a survival disadvantage.

Hypofractionated Radiosurgery for Large or in Critical-Site Intracranial Meningioma: Results of a Phase 2 Prospective Study

Radiosurgery is a well-known, safe, and effective technique used in the treatment of intracranial meningiomas. However, single-fraction radiosurgery can lead to high toxicity rates when large-volume or critically located lesions are targeted. Multisession-also called hypofractionated-radiosurgery (hypo-RS) might overcome these limitations. Accordingly, we carried out a prospective phase 2 trial, aiming to establish whether a fractionated RS schedule of 25 Gy in 5 fractions would be safe and effective in treating large (≥ 3 cm) and/or critically located (<3 mm from critical structures) grade 1 intracranial meningiomas. The main aim was to evaluate the safety of hypo-RS in terms of absence of adverse events. The secondary aim was to evaluate tumor response in terms of local control, defined as stability or reduction of lesion volume. We prospectively enrolled patients with diagnoses of grade 1 meningiomas, large size and/or critically located lesions, either histologically diagnosed or imaging defined. Additional inclusion criteria were signed informed consent, an age of ≥18 years, and Karnofsky Performance Status ≥70. Between 2011 and 2016, 178 patients were consecutively enrolled. The median follow-up was 53 months (range, 4-101 months). Overall, the toxicity rate was 12.7% (21 of 166 patients). At a 5-year minimum follow-up, the patients' toxicity rates were 11.7 % (9 of 77 patients). Symptom evaluation at both 3-year and last follow-up showed an improvement in most of the patients. Five-year local tumor control was 97% (95% confidence interval, 92%-99%). Hypo-RS schedule of 25 Gy in 5 fractions is a well-tolerated option in the treatment of large-volume and/or critically located benign meningiomas. Early results suggest favorable local control, although longer-term follow-up is needed.

Intracranial meningiomas: clinical, intrascopic and pathomorphological causes of recurrence (literature review)

Introduction. Meningiomas are the second most common central nervous system (CNS) tumors in adults. most meningiomas are benign tumors. Anaplastic and atypical meningiomas account for 25% and have a high recurrence rate even after radical tumor resection and radiotherapy. The prognosis of patients with anaplastic meningiomas remains disappointing; most of them die within the first 2 to 5 years after surgery. Purpose: to discuss the challenges in diagnosis and treatment of recurrent meningiomas, to identify the causes of tumor progression, and to assess the clinical features and radiographic findings as well as specific pathomorphological and molecular genetic characteristics. material and methods. We searched for publications in the Pubmed, EMBASE, Cohrane Library and eLibrary databases published between January 2000 and January 2019 on the issue of recurrent intracranial meningiomas, in particular atypical and anaplastic meningiomas. Results. The review systematizes data on the prognostic factors for survival, relapse-free period, and disease progression. particular attention was paid to the radical resection of the tumor and the assessment of the grade of anaplasia. The current data on radiotherapy and drug therapy were presented. the controversial issues of approaches to the assessment of morphological prognostic criteria were discussed. The current knowledge on the most common genetic mutations in meningiomas, the prospects for their study and use for targeted therapy were presented. Conclusion. The management of meningioma still presents some unresolved issues. There are no optimal standards for diagnosis and treatment of patients with meningiomas that would take into account biological characteristics, including growth characteristics and molecular genetic profile. There are no clear prognostic criteria for recurrence and continuity in further management after surgical treatment, which affects the mortality rate and quality of life in this category of patients. New fundamental data that will determine a different strategy in the treatment of intracranial meningiomas are needed.

Single session versus multisession stereotactic radiosurgery for the management of intracranial meningiomas: a systematic review and meta-analysis.

To compare the efficacy, outcomes, and complications of single session (SS-SRS) and multisession (MS-SRS) stereotactic radiosurgery in the treatment of intracranial meningiomas. Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane. A systematic review and meta-analysis of treatment protocols and outcomes were conducted. After the selection process, 20 articles describing 1483 cases were included. A total of 1303 patients who underwent SS-SRS and 180 patients who underwent MS-SRS for the management of their intracranial meningioma were reported in the included studies. SS-SRS and MS-SRS had comparable one-year (SS-SRS: 98% vs. MS-SRS: 100%, p > 0.99) and five-year (SS-SRS: 94% vs. MS-SRS: 93%, p = 0.71) tumor control rates. The groups also had comparable tumor volume reduction/tumor regression rates (SS-SRS: 44% vs. MS-SRS: 25%, p = 0.25), tumor volume stability rates (SS-SRS: 51% vs. MS-SRS: 75%, p = 0.12), and tumor progression rates (SS-SRS: 4% vs. MS-SRS: 4%, p = 0.89). SS-SRS and MS-SRS yielded similar complication rates (10.4% vs. 11.4%, p = 0.68) and comparable functional improvement rates (MS-SRS: 44% vs. SS-SRS: 36%, p = 0.57). However,MS-SRS was used for significantly larger tumor volumes (MS-SRS: 23.8 cm3 vs. SS-SRS: 6.1 cm3, p = 0.02). SS-SRS and MS-SRS resulted in comparable tumor control, tumor volumetric change, and functional outcomes despite significant biases in selecting patients for SS- or MS-SRS.

두개저 수막종 환자에 대한 저분할 방사선 수술의 임상적 효용성

Background : Various modalities of stereotactic radiosurgery (SRS) have been proven to be effective and safe in the treatment of intracranial meningiomas. Depending on the characteristics of each modality, various results can be obtained. To analyze the therapeutic effect of hypofractionated SRS (hSRS) on skull base meningioma, we retrospectively reviewed the results of clinical and follow-up image studies. Materials and Methods : Between January 2011 and December 2020, thirty-two patients (median age, 58 years; 5 males and 27 females) had been treated with hSRS using the Novalis Tx system for skull base meningiomas (mean volume, 7.86 cm3). Tumor was located in most frequently cavernous sinus (n = 7, 21.9%), cerebellopontine angle (n = 7, 21.9%), clinoidal (n = 6, 18.8%) locations. Thirteen patients had previously undergone surgical treatment including radiosurgery. The median cumulative dose was 25 Gy (range, 21.0-27.5 Gy) in five fractions (range, 3-5 fractions). Results : During a median follow-up of 50 months (range, 13-98 months) hSRS achieves 100% tumor control rate in all patients without tumor progression. As a result of volumetric analysis using magnetic resonance imaging showed partial response (volume decrease &gt; 20%) in 26 patients (81.3%), stable in 4 patients (12.5%). The tumor volume decreased by an average of 55.5% when compared with the beginning. Conclusions : This study showed that hSRS is an effective and safe treatment modality with a high tumor control rate and functional outcomes for skull base meningioma.

Treatment of intracranial meningioma with single-session and fractionated radiosurgery: a propensity score matching study

Single-session stereotactic radiosurgery (SSRS) is recognized as a safe and efficient treatment for meningioma. We aim to compare the long-term efficacy and safety of fractionated stereotactic radiotherapy (FSRT) with SSRS in the treatment of grade I meningioma. A total of 228 patients with 245 tumors treated with radiosurgery between March 2006 and June 2017were retrospectively evaluated. Of these, 147 (64.5%) patients were treated with SSRS. The remaining 81 patients (35.5%) were treated with a fractionated technique. Protocols to treat meningioma were classified as 12–16 Gy per fraction for SSRS and 7 Gy/fraction/day for three consecutive days to reach a total dose of 21 Gy for FSRT. In univariate and multivariate analyses, tumor volume was found to be associated with local control rate (hazard ratio = 4.98, p = 0.025). The difference in actuarial local control rate (LCR) between the SSRS and FSRT groups after propensity score matching (PSM) was not statistically significant during the 2-year (96.86% versus 100.00%, respectively; p = 0.175), 5-year (94.76% versus 97.56%, respectively; p = 0.373), and 10-year (74.40% versus 91.46%, respectively; p = 0.204) follow-up period. FSRT and SSRS were equally well-tolerated and effective for the treatment of intracranial benign meningioma during the10-year follow-up period.

Surgical treatment of rostrotentorial meningioma complicated by foraminal herniation in the cat.

This study was performed to evaluate retrospectively the clinical signs, complications and postoperative outcomes of feline intracranial meningioma (IM) with concurrent cingulate, transtentorial and foramen magnum herniations. The medical records and MRI scans of cats with IM and cerebral herniation were reviewed. Cases involving concurrent cingulate, transtentorial and foramen magnum herniations were included. Owners were contacted to obtain long-term follow-up information. Seven cats (four castrated males and three spayed females) met the inclusion criteria. Median age was 13.0 years (range 9.9-16.1 years) and median duration of clinical signs was 35 days (range 21-163 days). The clinical signs of cats with cerebral herniation included visual impairment (n = 5 [71.4%]), ataxia (n = 4 [57.1%]), impaired consciousness (n = 2 [28.6%]), head pressing (n = 2 [28.6%]), paresis (n = 1 [14.3%]), torticollis (n = 1 [14.3%]) and personality changes (n = 1 [14.3%]). Median tumour volume, cranial cavity volume and tumour volume:intracranial volume ratio before surgery were 3.37 cm3 (range 3.23-11.5 cm3), 32.6 cm3 (range 29.8-78.3 cm3) and 10.4% (range 5.3-35.3%), respectively. Median overall tumour excision rate was 90.6%. Preoperative intracranial pressure (ICP) ranged from 15 to 32 mmHg (median 29 mmHg). In all cases, the ICP dropped to 0 mmHg immediately after tumour removal. No adjuvant therapy was required after surgery. The median survival period was 612 days (range 55-1453 days). The results of this study indicate that surgical treatment of rostrotentorial IM is effective and allows prolonged survival, even in cats with concurrent cingulate, transtentorial and foramen magnum herniations.

Stereotactic radiosurgery versus stereotactic radiotherapy in the management of intracranial meningiomas: a systematic review and meta-analysis.

OBJECTIVEStereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) have been used as a primary treatment or adjuvant to resection in the management of intracranial meningiomas (ICMs). The aim of this analysis is to compare the safety and long-term efficacy of SRS and SRT in patients with primary or recurrent ICMs.METHODSA systematic review of the literature comparing SRT and SRS in the same study was conducted using PubMed, the Cochrane Library, Google Scholar, and EMBASE from January 1980 to December 2018. Randomized controlled trials, case-control studies, and cohort studies (prospective and retrospective) analyzing SRS versus SRT for the treatment of ICMs in adult patients (age > 16 years) were included. Pooled and subgroup analyses were based on the fixed-effect model.RESULTSA total of 1736 patients from 12 retrospective studies were included. The treatment modality used was: 1) SRS (n = 306), including Gamma Knife surgery (n = 36), linear accelerator (n = 261), and CyberKnife (n = 9); or 2) SRT (n = 1430), including hypofractionated SRT (hFSRT, n = 268) and full-fractionated SRT (FSRT, n = 1162). The median age of patients at the time of treatment was 59 years. The median follow-up duration after treatment was 35.5 months. The median tumor volumes at the time of treatment with SRS, hFSRT, and FSRT were 2.84 cm3, 5.45 cm3, and 12.75 cm3, respectively. The radiographic tumor control at last follow-up was significantly worse in patients who underwent SRS than SRT (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.27-0.82, p = 0.007) with 7% less volume of tumor shrinkage (OR 0.93, 95% CI 0.61-1.40, p = 0.72). Compared to SRS, the radiographic tumor control was better achieved by FSRT (OR 0.46, 95% CI 0.26-0.80, p = 0.006) than by hFSRT (OR 0.81, 95% CI 0.21-3.17, p = 0.76). Moreover, SRS leads to a significantly higher risk of clinical neurological worsening during follow-up (OR 2.07, 95% CI 1.06-4.06, p = 0.03) and of immediate symptomatic edema (OR 4.58, 95% CI 1.67-12.56, p = 0.003) with respect to SRT. SRT could produce a better progression-free survival at 4-10 years compared to SRS, but this was not statistically significant (p = 0.29).CONCLUSIONSSRS and SRT are both safe options in the management of ICMs. However, SRT carries a better radiographic tumor control rate and a lower incidence of posttreatment symptomatic worsening and symptomatic edema, with respect to SRS. However, further prospective studies are still needed to validate these results.

Multisession radiosurgery for perioptic meningiomas: medium-to-long term results from a CyberKnife cooperative study

Most recent literature has confirmed the efficacy of single-session radiosurgery (sRS) in the treatment of intracranial meningioma. Unfortunately, sRS is not always applicable due to large tumor volume and the proximity of the tumor to critical structures. When sRS is not recommended, multi-session radiosurgery (mRS) can be the solution. The best treatment schedule for mRS, however, is not well established. The aim of the present retrospective study is to validate the effectiveness of one approach, 25Gy delivered in 5 fractions in 5 consecutive days, to treat skull base meningiomas. This is a retrospective multicenter study. Patients with an anterior or a medium skull base meningioma that could not be treated by sRS due to large volume or proximity to the anterior optic pathways (AOPs) underwent 5-fraction mRS. Only patients with at least 36months follow-up were included in the analysis. Local control and visual outcomes were investigated. One-hundred-sixty-seven patients were included in the analysis. One-hundred-one patients underwent RS as a primary indication and 66 were treated after a previous surgery. The median follow-up period was 51months (range 36-129months). Progression-free survival at 3, 5 and 8years were, respectively, 98%, 94% and 90%. Excluding the progressive disease patients, the visual worsening rate was 3.7%. The 42% of the patients with a pre-treatment visual deficit experienced improvement in vision. 25Gy delivered in 5 fractions is an effective modality for meningiomas that are near the AOP or are too large to be treated by sRS. The treatment schedule controlled the tumors while sparing visual function.

Racial Differences in Disease Presentation and Management of Intracranial Meningioma.

Objective/Hypothesis The aim of the study was to determine the impact of race on disease presentation and treatment of intracranial meningioma in the United States. Study Design This study comprised of the analysis of a national population-based tumor registry. Methods Analysis of the surveillance, epidemiology, and end results (SEER) database was performed, including all patients identified with a diagnosis of intracranial meningioma. Associations between race, disease presentation, treatment strategy, and overall survival were analyzed in a univariate and multivariable model. Results A total of 65,973 patients with intracranial meningiomas were identified. Of these, 45,251 (68.6%) claimed white, 7,796 (12%) black, 7,154 (11%) Hispanic, 4,902 (7%) Asian, and 870 (1%) patients reported "other-unspecified" or "other-unknown." The median annual incidence of disease was lowest among black (3.43 per 100,000 persons) and highest among white (9.52 per 100,000 persons) populations ( p < 0.001). Overall, Hispanic patients were diagnosed at the youngest age and white patients were diagnosed at the oldest age (mean of 59 vs. 66 years, respectively; p < 0.001). Compared with white populations, black, Hispanic, and Asian populations were more likely to present with larger tumors ( p < 0.001). After controlling for tumor size, age, and treatment center in a multivariable model, Hispanic patients were more likely to undergo surgery than white, black, and Asian populations. Black populations had the poorest disease specific and overall survival rates at 5 years following surgery compared with other groups. Conclusion Racial differences among patients with intracranial meningioma exist within the United States. Understanding these differences are of vital importance toward identifying potential differences in the biological basis of disease or alternatively inequalities in healthcare delivery or access Further studies are required to determine which factors drive differences in tumor size, age, annual disease incidence, and overall survival between races.

Role of bevacizumab for treatment-refractory meningiomas: A systematic analysis and literature review.

Background:Meningiomas are the most prevalent primary tumor of the central nervous system (CNS), and although the majority of these neoplasms are classified as benign, nearly one fourth of the lesions display an aggressive profile characterized by pleomorphic histology, high recurrence rates, and overall resistance to standard treatment. Despite the ubiquitous nature of these tumors, no adjuvant therapeutic regimen has been identified which effectively controls disease recurrence and progression after surgery and radiation, leading to a dismal prognosis in this patient population. The primary focus of this research study is, hence, to assess the recently emerging use of bevacizumab, an anti-angiogenic agent, in the treatment of meningiomas. This systematic literature review analyzes the efficacy and safety of therapeutic bevacizumab for treatment-refractory meningiomas.Methods:A systematic PubMed search was conducted according to PRISMA guidelines to identify all relevant reports investigating the anti-angiogenic agent bevacizumab in the treatment of intracranial meningiomas. The reported parameters from pertinent retrospective reviews, prospective studies, and case studies were volumetric reduction, radiographic response, clinical stability, overall survival (OS), and progression free survival (PFS) measured at 6 and 12 months postinitiation of treatment. Complications were cataloged based on the range and severity of the therapy-related toxicities.Results:A total of 11 articles, 5 retrospective series, 2 prospective trials, and 4 case reports, reporting on a total of 92 patients, were included in this review. The use of bevacizumab therapy for intracranial meningiomas demonstrated median overall PFS of 16.8 months (range: 6.5-22 months) and PFS-6 of 73% (range: 44%-93%).Conclusions:Therapeutic bevacizumab, either alone or with combination chemotherapies, for select patient populations with recurrent or progressive meningiomas, offers a treatment option that confers improved overall progression-free survival. To assess OS parameters, larger randomized controlled trials assessing the use of anti-angiogenic agents for recurrent/progressive meningiomas are warranted.

Outcomes of Hypofractionated Stereotactic Radiotherapy for Intracranial Meningioma: A Systematic Review of the Literature

The availability of image guidance and intensity modulation has led to the increasing use of hypofractionated stereotactic radiotherapy (hSRT) as an alternative to conventionally fractionated radiotherapy or radiosurgery for intracranial meningioma (ICM). As the safety and efficacy of this approach is not well characterized, we conducted a systematic review of the literature to assess the clinical outcomes of hSRT in the setting of ICM. A systematic review of Medline and EMBASE databases was performed following the PRISMA guidelines. Included studies were retrospective or prospective series that 1) examined an ICM population of ≥ 10 patients, 2) delivered >1 fraction of photon hSRT (≥ 2.5 Gy per fraction), 3) used a LINAC-based platform, Cyberknife (CK) or multisession Gammaknife, 4) reported on clinical outcomes, and 5) had a median follow-up of ≥ 2 years. Reviews, editorials and planning studies without reported clinical outcomes were excluded. Studies that combined data from different histologies or treatment modalities – precluding the evaluation of hSRT in the meningioma subset – were also excluded. Descriptive statistics were generated for included studies. Of 1480 initial studies, 14 met eligibility criteria for inclusion, reporting on 630 patients (age range 18-90) treated for 638 tumors. Primary RT was delivered in 37% of patients, 36% had radiation following surgery, and surgical details were unavailable in 27%. Seven patients had previous RT to the treatment site. Tumor size ranged from 0.1cc to 126.3cc with 66% located in the skull base and 8% involving optic structures (nerve or chiasm). Treatment platforms included LINAC-based hSRT (57%) or CK (43%). Total dose ranged from 15-45Gy (median = 20-37.5Gy) in 2-15 fractions and was prescribed to a median isodose line of 80% (range=63-100%). The most common fractionation regimen reported was 25/5. In 474 tumors assessed for radiologic response (median follow-up = 24.5-57.5 months), 78% remained stable, 18% decreased in size and 4% increased in size. Of 327 patients who were symptomatic prior to treatment, 17% had complete resolution, 41% had improvement, 36% had stability and 6% had deterioration post treatment. Crude local control (LC) was 90-100% as reported in 10 studies. Actuarial LC, reported in 2 studies, was 89% and 92±3% at 3 years. Overall, the median late toxicity rate was 10% (range=0-21%). The median late toxicity rates for tumors involving the skull base and optic structures were 5% (range=0-21%) and 9% (range=8-10%) respectively. Most common significant late toxicities were new decrease in vision (n=8) and new cranial neuropathy (n=11). While the available literature of hSRT for treatment of ICM suggests that local control and toxicity profiles are comparable to other radiotherapy approaches, confirmation in larger patient cohorts with longer follow-up is required.

Trends in Management of Intracranial Meningiomas: Analysis of 49,921 Cases from Modern Cohort.

We sought to characterize patterns and treatment for intracranial meningiomas in the Surveillance, Epidemiology, and End Results set of cancer registries. SEER data was queried from 2004-2012 for cases of intracranial meningioma using appropriate topography and histology codes. A total of 49,921 patients with intracranial meningioma were identified. The vast majority of cases were associated with a benign histology (n= 47,047, 94.2%). There were 21,145 patients (42.4%) who underwent surgical management, 2783 who received radiation alone (5.6%), and 25,993 who underwent surveillance only (52.1%). Surgical management decreased in frequency from 48.8% of all cases in 2004 to 38.3% of cases in 2012 (P < 0.001). Radiation alone remained stable over time with a range of 4.8%-6.3% of cases. Observation increased from 45.0% of cases in 2004 to 56.7% of cases in 2012 (P < 0.001). On unadjusted analysis, surgical management was associated with younger age and larger tumor size. The incidence of tumors <2 cm in size increased significantly over the study period from 29.7% in 2004 to 41.7% in 2012 (P < 0.001). After adjusting for tumor size, multivariable analysis demonstrated that the odds of observation as a primary management strategy were greater in 2012 relative to 2004 (odds ratio 1.33, 95% confidence interval 1.21-1.45). The incidence of intracranial meningiomas increased, while tumor size at the time of diagnosis decreased. Moreover, the number undergoing no treatment increased as a treatment strategy and was more likely employed for older patients, those of African-American race, and those with smaller tumors.

Predictors of Symptomatic Edema After Treatment of Intracranial Meningiomas With Single-Fraction Stereotactic Radiosurgery

Stereotactic radiosurgery (SRS) provides a 10 year local control (LC) rate of up to 99% for intracranial meningiomas, but may be associated with higher post-treatment symptomatic edema rates. Prior reports have combined single and multi-fraction SRS when analyzing edema rates. The objective was to determine factors predictive of post-treatment edema after single fraction SRS alone to identify patients who may require either surgery or fractionated RT.

P06.15 * LONG TERM QUALITY OF LIFE OF ELDERLY PEOPLE IN DIFFERENT AGE GROUPS AFTER MENINGIOMA SURGERY

OBJECTIVE: Surgery is usually the standard treatment for intracranial meningiomas in patients of all ages. The incidence of meningiomas increases progressively with age. Considering the fact, that the median age for the diagnosis of meningiomas is 65 years, general health condition, morbidity and mortality rates as well as the postoperative outcome regarding quality of life should carefully be noted in advance. It remains still a controversial topic, if meningioma resection should be performed in higher ages under weighing up the risks and benefits of the intervention. There have actually been only few studies which have investigated the health related quality of life in the postoperative course. The results of these studies are yet controversial and there is a need for further investigations regarding the postoperative health related long term quality of life. Furthermore to this point of time there have been no studies that compare the impairments of the HRQOL after meningioma resection in different age groups. METHODS: We analyzed the health related quality of life of 133 elderly patients ranging from 55 to 84 years who underwent surgical meningioma resection between 2004 and 2010. 50 of them were male and 83 female (3M: 5F). The median age was 67.3 ± 7.4 years. The average time between surgery and interview was 3.8 ± 2.5 years. Six different age groups each compromising 5 years of age were established. Patients were interviewed with the SF36 questionnaire and compared to general population. RESULTS: We found significant lower levels of physical function, vitality, social role function, mental health, general health perception and significant higher levels of pain when comparing the older groups (especially from 75 to 79 years) with younger patients from 55 to 59 years of age. The physical component summary showed a steadily and stepwise decline of levels from younger patients to older patients even with significant differences. CONCLUSION: In total, former studies have shown that meningioma surgery in elderly patients can be performed under higher but acceptable morbidity and mortality rates compared to younger patients. However, our findings suggest that meningioma resection affects long term quality of life especially in higher ages and should be a substantial part of the surgery decision making process in advance.

Surgery followed by radiosurgery: A deliberate valuable strategy in the treatment of intracranial meningioma

ObjectiveThe aim of our study is to show that surgery followed by Gamma Knife Radiosurgery is an effective and safe combined treatment for the control of intracranial meningiomas located close to critical structures. Materials and methodsThis retrospective study followed 31 patients with intracranial meningioma between 2005 and 2010. We included patients when initial therapeutic decision was deliberate subtotal surgical resection preparing a target for early postoperative GKR. Early MRI was performed to evaluate the tumor residual volume after surgical procedure. Annual MRI was performed to detect any tumor progression. ResultsThe mean follow-up was 4.5 years. The mean margin dose was 14.5Gy and the mean target volume was 2.4cm3. The mean progression free survival after combined treatment was 4.4 years in the irradiated target volume and 3.9 years on the limit or remotely of irradiated target volume. Of all patients, we recorded 5 tumor progressions after combined treatment, in-field in 1 case and out-of-field in 4 cases. All tumor progressions were high-grade meningiomas. ConclusionSurgery followed by radiosurgery is a safe and effective combined treatment for intracranial meningiomas. We recommend it in case of meningioma located close to critical structures for which it is safer to leave in place a tumor remnant to reduce morbidity.

EP-1047: Cyberknife stereotactic radiotherapy as the first-line treatment of intracranial meningiomas

EP-1047: Cyberknife stereotactic radiotherapy as the first-line treatment of intracranial meningiomas

The role of chemotherapy and targeted therapy in the treatment of intracranial meningioma

Outline current chemotherapy and targeted therapy treatments for intracranial meningiomas. At present, there is no defined role for adjuvant chemotherapy for meningioma of any grade following initial diagnosis. In the subpopulation of patients with an unresectable meningioma and refractory to radiotherapy, hormonal chemotherapy-targeted therapy may be prescribed. Notwithstanding limited data, hydroxyurea, somatostatin analogues and interferon-α have been modestly successful in patients with recurrent meningiomas. Emerging targeted therapies, particularly angiogenic inhibitors, may prove useful in refractory meningiomas as recently demonstrated with sunitinib and novel somatostatin analogues. A number of challenges are apparent with respect to the use of chemotherapy or targeted therapy for intracranial meningioma. First, there is very limited published literature that provides compelling evidence from which to determine appropriate therapy. Second, there is a paucity of clinical trials for patients with recurrent meningioma. Third, there remains a lack of agreement or standardization as to what constitutes a meaningful response to medical therapy recognizing these metrics differ between low-grade and high-grade recurrent meningioma. As a consequence, there remains a significant unmet need in neuro-oncology for defining the role of chemotherapy or targeted therapy in recurrent meningioma.