Skip to main content Accessibility help
×
Home
Hostname: page-component-559fc8cf4f-8sgpw Total loading time: 1.456 Render date: 2021-02-25T08:35:28.860Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true }

Single Dose versus Fractionated Stereotactic Radiotherapy for Meningiomas

Published online by Cambridge University Press:  02 December 2014

Simon S. Lo
Affiliation:
Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Hospital and Clinic, Minneapolis, MN, USA
Kwan H. Cho
Affiliation:
Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Hospital and Clinic, Minneapolis, MN, USA
Walter A. Hall
Affiliation:
Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Hospital and Clinic, Minneapolis, MN, USA Department of Neurosurgery, University of Minnesota Hospital and Clinic, Minneapolis, MN, USA
Ronald J. Kossow
Affiliation:
Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Hospital and Clinic, Minneapolis, MN, USA
Wilson L. Hernandez
Affiliation:
Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Hospital and Clinic, Minneapolis, MN, USA
Kim K. McCollow
Affiliation:
Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Hospital and Clinic, Minneapolis, MN, USA
Bruce J. Gerbi
Affiliation:
Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Hospital and Clinic, Minneapolis, MN, USA
Patrick D. Higgins
Affiliation:
Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Hospital and Clinic, Minneapolis, MN, USA
Chung K. Lee
Affiliation:
Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Hospital and Clinic, Minneapolis, MN, USA
Kathryn E. Dusenbery
Affiliation:
Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Hospital and Clinic, Minneapolis, MN, USA
Rights & Permissions[Opens in a new window]

Abstract

Objective:

To evaluate the safety and efficacy of stereotactic radiosurgery (SRS) compared to fractionated stereotactic radiation therapy (FSRT) for meningiomas treated over a seven year period.

Methods and materials:

Of the 53 patients (15 male and 38 female) with 63 meningiomas, 35 were treated with SRS and the 18 patients with tumors adjacent to critical structures or with large tumors were treated with FSRT. The median doses for the SRS and the FSRT groups were 1400 cGy (500- 4500 cGy) and 5400 cGy (4000-6000 cGy) respectively. Median target volumes for SRS and FSRT were 6.8 ml and 8.8 ml respectively. The median follow-up for the SRS and FSRT groups were 38 months (4.1-97 months) and 30.5 months (6.0-63 months) respectively.

Results:

The five-year tumor control probability (TC) for benign versus atypical meningiomas were 92.7% vs. 31% (P=.006). The three-year TC were 92.7% vs. 93.3% for SRS vs. FSRT groups respectively (P=.62). For benign meningiomas, the three-year TC were 92.9% vs. 92.3% for the SRS group (29 patients) vs. FSRT group (14 patients) respectively (P=.77). Two patients in the SRS group and one in the FSRT group developed late complications.

Conclusion:

Preliminary data suggest that SRS is a safe and effective treatment for patients with benign meningiomas. Fractionated stereotactic radiation therapy with conventional fractionation appeared to be an effective and safe treatment alternative for patients not appropriate for SRS. A longer follow-up is required to determine the long-term efficacy and the toxicity of these treatment modalities.

Résumé:

RÉSUMÉ: Objectif:

Évaluer la sécurité et l.efficacité de la radiochirurgie stéréotaxique (RCS) comparée à la radiothérapie stétéotaxique fractionnée (RTSF) dans le traitement des méningiomes sur une période de sept ans.

Méthodes et matériels:

Parmi les 53 patients (15 hommes et 38 femmes) atteints de 63 méningiomes, 35 ont été traités par RCS et 18, dont la tumeur était adjacente à des structures critiques ou était volumineuse, ont été traités par RTSF. Les doses médianes pour le groupe RCS et le groupe RTSF étaient de 1400 cGy (500 à 4500 cGy) et 5400 cGy (4000 à 6000 cGy) respectivement. Les volumes cibles médians pour les groupes RCS et RTSF étaient de 6,8 ml et 8,8 ml respectivement. Le suivi médian pour les groupes RCS et RTSF étaient de 38 (4,1 à 97) mois et 30,5 (6,0 à 63) mois respectivement.

Résultats:

La probabilité de contrôle tumoral (CT) à cinq ans, s.il s.agissait de méningiomes bénins plutôt qu.atypiques, était de 92,7% versus 31% (P = 0,006). Le CT à trois ans était de 92,7% versus 93,3% pour les groupes RCS et RTSF respectivement (P = 0,62). Pour les méningiomes bénins, le CT à trois ans était de 92,9% pour le groupe RCS (29 patients) versus 92,3% pour le groupe RTSF (14 patients) (P = 0,77). Deux patients du groupe RCS et un patient du groupe RTSF ont présenté des complications tardives.

Conclusions:

Les données préliminaires suggèrent que la RCS est un mode de traitement sûr et efficace pour les patients porteurs de méningiomes bénins. La RTSF avec fractionnement conventionnel semble être un traitement alternatif efficace et sûr pour les patients chez qui la RCS n.est pas appropriée. Un suivi plus long est nécessaire pour déterminer l.efficacité à long terme et la toxicité de ces modalités de traitement.

Type
Research Article
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

References

1. Bondy, M, Ligon, BL. Epidemiology and etiology of intracranialmeningiomas: a review. J Neurooncol 1996; 29(3):197205.CrossRefGoogle ScholarPubMed
2. Longstreth, WT Jr, Dennis, LK, McGuire, VM, Drangsholt, MT, Koepsell, TD. Epidemiology of intracranial meningioma. Cancer 1993; 72(3):639648.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
3. Barbaro, NM, Gutin, PH, Wilson, CB, et al. Radiation therapy in thetreatment of partially resected meningiomas. Neurosurgery 1987; 4:525528.CrossRefGoogle Scholar
4. Forbes, AR, Goldberg, ID. Radiation therapy in the treatment ofmeningioma: the Joint Center for Radiation Therapy experience 1970 to 1982. J Clin Oncol 1984; 10:11391143.CrossRefGoogle Scholar
5. Glaholm, J, Bloom, HJ, Crow, JH. The role of radiotherapy in themanagement of intracranial meningiomas: the Royal Marsden Hospital experience with 186 patients. Int J Radiat Oncol BiolPhys 1990;18(4):6175.CrossRefGoogle Scholar
6. Goldsmith, BJ, Wara, WM, Wilson, CB, Larson, DA. Postoperativeirradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 1994; 80(2):195201.CrossRefGoogle Scholar
7. Solan, MJ, Kramer, S. The role of radiation therapy in themanagement of intracranial meningiomas. Int J Radiat OncolBiol Phys 1985; 11(4):675677.Google Scholar
8. Stafford, SL, Perry, A, Suman, VJ, et al. Primarily resectedmeningiomas: outcome and prognostic factors in 581 MayoClinic patients, 1978 through 1988. Mayo Clin Proc 1998; 73(10):936942.CrossRefGoogle Scholar
9. Taylor, BW Jr, Marcus, RB Jr, Friedman, WA, Ballinger, WE Jr, Million, RR. The meningioma controversy: postoperativeradiation therapy. Int J Radiat Oncol Biol Phys 1988; 2:299304.CrossRefGoogle Scholar
10. Kallio, M, Sankila, R, Hakulinen, T, Jaaskelainen, J. Factors affectingoperative and excess long-term mortality in 935 patients with intracranial meningioma. Neurosurgery 1992; 31(1):212.Google ScholarPubMed
11. Mirimanoff, RO, Dosoretz, DE, Linggood, RM, Ojemann, RG, Martuza, RL. Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 1985; 62(1):1824.CrossRefGoogle ScholarPubMed
12. Awad, IA, Kalfas, I, Hahn, JF, Little, JR. Intracranial meningiomas inthe aged: surgical outcome in the era of computed tomography. Neurosurgery 1989; 24(4):557560.CrossRefGoogle Scholar
13. Chan, RC, Thompson, GB. Morbidity, mortality, and quality of lifefollowing surgery for intracranial meningiomas. A retrospective study in 257 cases. J Neurosurg 1984;60(1):5260.CrossRefGoogle ScholarPubMed
14. Djindjian, M, Caron, JP, Athayde, AA, Fevrier, MJ. Intracranialmeningiomas in the elderly (over 70 years old). A retrospective study of 30 surgical cases. Acta Neurochir (Wien) 1988; 90(3-4):121123.CrossRefGoogle ScholarPubMed
15. Papo, I. Intracranial meningiomas in the elderly in the CT scan era. Acta Neurochir (Wien) 1983; 67(3-4):195204.CrossRefGoogle ScholarPubMed
16. Clark, BG, Souhami, L, Pla, C, et al. The integral biologicallyeffective dose to predict brainstem toxicity of hypofractionated stereotactic radiotherapy. Int J Radiat Oncol Biol Phys 1998; 40(3):667675.CrossRefGoogle ScholarPubMed
17. Leber, KA, Bergloff, J, Pendl, G. Dose-response tolerance of thevisual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg 1998; 88(1):4350.CrossRefGoogle Scholar
18. Morita, A, Coffey, RJ, Foote, RL, Schiff, D, Gorman, D. Risk of injuryto cranial nerves after gamma knife radiosurgery for skull base meningiomas: experience in 88 patients. J Neurosurg 1999; 90(1):4249.CrossRefGoogle Scholar
19. Tishler, RB, Loeffler, JS, Lunsford, LD, et al. Tolerance of cranialnerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 1993; 27(2):215221.CrossRefGoogle Scholar
20. Wara, WM, Sheline, GE, Newman, H, Townsend, JJ, Boldrey, EB. Radiation therapy of meningiomas. Am J Roentgenol RadiumTher Nucl Med 1975; 123(3):453458.CrossRefGoogle ScholarPubMed
21. Sekhar, LN, Jannetta, PJ. Cerebellopontine angle meningiomas. Microsurgical excision and follow-up results. J Neurosurg 1984; 60(3):500505.CrossRefGoogle ScholarPubMed
22. Sekhar, LN, Jannetta, PJ, Maroon, JC. Tentorial meningiomas:surgical management and results. Neurosurgery 1984; 14(3):268275.CrossRefGoogle ScholarPubMed
23. Sekhar, LN, Patel, S, Cusimano, M, et al. Surgical treatment ofmeningiomas involving the cavernous sinus: evolving ideas based on a ten year experience. Acta Neurochir Suppl (Wien) 1996; 65:5862.Google ScholarPubMed
24. Sekhar, LN, Sen, CN, Jho, HD, Janecka, IP. Meningiomas involvingthe clivus: a six- year experience with 41 patients. Neurosurgery 1990; 27(5):764781.CrossRefGoogle Scholar
25. Sekhar, LN, Sen, CN, Jho, HD, Janecka, IP. Surgical treatment ofintracavernous neoplasms: a four-year experience. Neurosurgery 1989; 24(1):1830.CrossRefGoogle ScholarPubMed
26. Condra, KS, Buatti, JM, Mendenhall, WM, et al. Benignmeningiomas: primary treatment selection affects survival. Int JRadiat Oncol Biol Phys 1997; 39(2): 427436.CrossRefGoogle Scholar
27. Maguire, PD, Clough, R, Friedman, AH, Halperin, EC. Fractionatedexternal-beam radiation therapy for meningiomas of the cavernous sinus. Int J Radiat Oncol Biol Phys 1999; 44(1):7579.CrossRefGoogle ScholarPubMed
28. Maire, JP, Caudry, M, Guerin, J, et al. Fractionated radiation therapyin the treatment of intracranial meningiomas: local control, functional efficacy, and tolerance in 91 patients. Int J Radiat Oncol Biol Phys 1995; 33(2):315321.CrossRefGoogle Scholar
29. Miralbell, R, Linggood, RM, de la Monte, S, et al. The role ofradiotherapy in the treatment of subtotally resected benign meningiomas. J Neurooncol 1992; 2:157164.CrossRefGoogle Scholar
30. Chang, SD, Adler, JR Jr. Treatment of cranial base meningiomas withlinear accelerator radiosurgery. Neurosurgery 1997; 41(5):10191025.CrossRefGoogle ScholarPubMed
31. Chang, SD, Adler, JR Jr, Martin, DP. LINAC radiosurgery forcavernous sinus meningiomas. Stereotact Funct Neurosurg 1998; 71(1):4350.CrossRefGoogle ScholarPubMed
32. Duma, CM, Lunsford, LD, Kondziolka, D, Harsh, GR 4th, Flickinger, JC. Stereotactic radiosurgery of cavernous sinus meningiomas as an addition or alternative to microsurgery. Neurosurgery 1993; 32(5):699704.CrossRefGoogle ScholarPubMed
33. Engenhart, R, Kimmig, BN, Hover, KH, et al. Stereotactic single highdose radiation therapy of benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 1990; (4):10211026.CrossRefGoogle Scholar
34. Hakim, R, Alexander, E III, Loeffler, JS, et al. Results of linearaccelerator-based radiosurgery for intracranial meningiomas. Neurosurgery 1998; 42(3):436454.Google ScholarPubMed
35. Kondziolka, D, Flickinger, JC, Perez, B. Judicious resection and/orradiosurgery for parasagittal meningiomas: outcomes from multicenter review. Gamma Knife Meningioma Study Group. Neurosurgery 1998, 43(3):405413.CrossRefGoogle ScholarPubMed
36. Kondziolka, D, Lunsford, LD, Coffey, RJ, Flickinger, JC. Stereotacticradiosurgery of meningiomas. J Neurosurg 1991; 74(4):552559.CrossRefGoogle ScholarPubMed
37. Kurita, H, Sasaki, T, Kawamoto, S, et al. Role of radiosurgery in themanagement of cavernous sinus meningiomas. Acta NeurolScand 1997; 96(5):297304.CrossRefGoogle Scholar
38. Nicolato, A, Ferraresi, P, Foroni, R, et al. Gamma Knife radiosurgeryin skull base meningiomas. Preliminary experience with 50 cases. Stereotact Funct Neurosurg 1996; 66 Suppl 1:112120.CrossRefGoogle ScholarPubMed
39. Pendl, G, Schrottner, O, Eustacchio, S, Ganz, JC, Feichtinger, K. Cavernous sinus meningiomas--what is the strategy: upfront or adjuvant gamma knife surgery? Stereotact Funct Neurosurg 1998; 70(Suppl 1):3340.CrossRefGoogle ScholarPubMed
40. Shafron, DH, Friedman, WA, Buatti, JM, Bova, FJ, Mendenhall, WM. Linac radiosurgery for benign meningiomas. Int J Radiat OncolBiol Phys 1999; 43(2): 321327.CrossRefGoogle ScholarPubMed
41. Subach, BR, Lunsford, LD, Kondziolka, D, Maitz, AH, Flickinger, JC. Management of petroclival meningiomas by stereotactic radiosurgery. Neurosurgery 1998; 42(3): 437443.Google ScholarPubMed
42. Tanaka, T, Kobayashi, T, Kida, Y. Growth control of cranial basemeningiomas by stereotactic radiosurgery with a gamma knifeunit. Neurol Med Chir (Tokyo) 1996; 36(1): 710.CrossRefGoogle Scholar
43. Valentino, V, Schinaia, G, Raimondi, AJ. The results of radiosurgical management of 72 middle fossa meningiomas. Acta Neurochir(Wien) 1993; 122(1-2):6070.CrossRefGoogle ScholarPubMed
44. Debus, J, Wuendrich, M, Pirzkall, A, et al. High efficacy of fraction-ated stereotactic radiotherapy of large skull base meningiomas: long term results. J Clin Oncol 2001;19(15): 35473553.CrossRefGoogle ScholarPubMed
45. Goldsmith, BJ, Rosenthal, SA, Wara, WM, Larson, DA. Opticneuropathy after irradiation of meningioma. Radiology 1992; 185(1):7176.CrossRefGoogle Scholar
46. Jiang, GL, Tucker, SL, Guttenberger, R, et al. Radiation-inducedinjury to the visual pathway. Radiother Oncol 1994; 30(1):1725.CrossRefGoogle ScholarPubMed
47. Parsons, JT, Bova, FJ, Fitzgerald, CR, Mendenhall, WM, Million, RR. Radiation optic neuropathy after megavoltage external-beam irradiation: analysis of time-dose factors. Int J Radiat Oncol Biol Phys 1994; 30(4):755763.CrossRefGoogle ScholarPubMed
48. Young, WC, Thornton, AF, Gebarski, SS, Cornblath, WT. Radiation-induced optic neuropathy: correlation of MR imaging andradiation dosimetry. Radiology 1992; 185(3):904907.CrossRefGoogle Scholar
49. Coke, CC, Corn, BW, Werner-Wasik, M, Xie, Y, Curran, WJ Jr. Atypical and malignant meningiomas: an outcome report of seventeen cases. J Neurooncol 1998; 39(1): 6570.CrossRefGoogle ScholarPubMed
50. Dziuk, TW, Woo, S, Butler, EB, et al. Malignant meningioma: anindication for initial aggressive surgery and adjuvant radiotherapy. J Neurooncol 1998; 37(2):177188.CrossRefGoogle ScholarPubMed
51. Milosevic, MF, Frost, PJ, Laperriere, NJ, Wong, CS, Simpson, WJ. Radiotherapy for atypical or malignant intracranial meningioma. Int J Radiat Oncol Biol Phys 1996; 34(4):817822.CrossRefGoogle ScholarPubMed
52. Palma, L, Celli, P, Franco, C, Cervoni, L, Cantore, G. Long-termprognosis for atypical and malignant meningiomas: a study of 71surgical cases. J Neurosurg 1997; 86(5):793800.CrossRefGoogle Scholar
53. Zakhary, R, Brat, DJ, Wharam, M, Williams, J. Stereotacticradiosurgery for atypical and malignant meningiomas. J Radiosurg 1998; 1:251256.Google Scholar
54. de Vries, J, Wakhloo, AK. Repeated multifocal recurrence of grade I,grade II, and grade III meningiomas: regional multicentricity (primary new growth) or metastases? Surg Neurol 1994; 41(4):299305.CrossRefGoogle ScholarPubMed

A correction has been issued for this article:

Altmetric attention score

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 0
Total number of PDF views: 160 *
View data table for this chart

* Views captured on Cambridge Core between September 2016 - 25th February 2021. This data will be updated every 24 hours.

Access

Linked content

Please note a has been issued for this article.

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Single Dose versus Fractionated Stereotactic Radiotherapy for Meningiomas
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Single Dose versus Fractionated Stereotactic Radiotherapy for Meningiomas
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Single Dose versus Fractionated Stereotactic Radiotherapy for Meningiomas
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *