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OS08.5 Stereotactic radiosurgery for the treatment of meningiomas eligible for complete resection

Authors :
Martin Kocher
M. I. Ruge
Roland Goldbrunner
J. Tutunji
Stefan Grau
Harald Treuer
Daniel Rueß
Publication Year :
2017
Publisher :
Oxford University Press, 2017.

Abstract

Objective: Microsurgical resection is the first recommended treatment for meningiomas especially if sufficient resection can be achieved (Simpson Grade I&II). Stereotactic radiosurgery (SRS) is established as treatment option for meningiomas considered inoperable due to critical localisation or involvement of vulnerable structures. In this study, we evaluated the efficacy and safety of SRS in cases where a Simpson Grade I or II resection could be achieved but either patient´s wish or condition excluded surgery. Methods: In this retrospective single-center analysis (1995–2014) we included all patients who underwent single fraction LINAC based SRS for microsurgically resectable (Simpson Grade I&II) cranial meningiomas with clinical follow-up of ≥6 months. Histologically confirmed WHO II&III tumors were excluded. We analyzed local tumor control by magnetic resonance imaging, early (first 6 month after SRS) and late treatment related complications, including symptomatic peritumoral edema requiring steroids (rated by the Common Terminology Criteria for Adverse Events; CTCAEv4.03). Local control was estimated by Kaplan-Meier method. Results: 85 patients (f:m=65:20, mean age 60 years) were treated with LINAC-SRS for 92 supra- (67.4%) or infratentorial (32.6%) meningiomas localized in skull base (63.0%), convexity (20.7%), parafalcine (14.1%) or other areas (2.2%). Treatment indication was based on documented tumor growth in 71.7 % or recurrence after surgery in 28.3%. Mean follow-up was 68.7 ± 48.8 months. Mean tumor volume was 4.1 ± 3.6ml, mean radiation parameters were 13.2 ± 2.2 Gy surface dose at 65.8 ± 13.9% isodose level. The estimated 2-,5-, and 10-year tumor control rate was 99%, 93% and 93%, respectively. Local recurrence was observed in one case after 180.4 months (1.2%) and loco-regional (out of dose) recurrence in five patients after 17.7–155.7 months (5.9%). Minor early complications (headache, dizziness) occurred in 4.7%; one patient suffered from seizures. Late complications encompassed permanent deterioration of cranial nerve function in two cases (CTCAE:1;2) and transient seizures in one patient. Temporary steroid use due to symptomatic peritumoral edema was observed in 7.1%. Conclusion: SRS can be considered as treatment alternative for patients with meningiomas eligible for Simpson Grade (I&II) resection either refusing or harboring ­contraindications to microsurgery. SRS treatment provides reasonable long term tumor control with low morbidity rates.

Details

Language :
English
Database :
OpenAIRE
Accession number :
edsair.doi.dedup.....226b12be3ac0508f15fc652e7364cf43