International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationSingle-fraction Radiosurgery for Presumed Intracranial Meningiomas: Efficacy and Complications From a 22-Year Experience
Section snippets
Patients
The institutional review board at the Mayo Clinic College of Medicine in Rochester, MN, approved all aspects of this study. A prospectively maintained computer database was used to identify 602 patients with intracranial meningiomas having SRS at our institution between 1990 and 2008. Excluded were patients having prior surgery (n = 267), patients with radiation-induced tumors (n = 28), meningiomatosis (n = 19), and neurofibromatosis (n = 16). Of the remaining 272 patients, 17 (6.3%) had less
Tumor control
Tumor size decreased in 181 patients (72.1%) and was unchanged in 67 patients (26.7%). Three patients (1.2%) had in-field tumor progression noted at 28, 145, and 150 months, respectively. The tumor margin doses were 13 Gy, 15 Gy, and 20 Gy, respectively. No additional tumor treatment has been performed to date for these 3 patients because they remain asymptomatic, 2 patients are elderly (80 years, 82 years), and 2 patients have complex skull-base tumors involving the cavernous sinus and
Discussion
The premise that patients with intracranial meningiomas should undergo complete surgical resection is based on the seminal publication of Simpson in 1957 (5). Simpson described five grades of meningioma removal ranging from Grade I, in which there is a complete removal of all macroscopic tumor with excision of its dural attachments and any abnormal bone, to Grades IV and V, which represent partial tumor resection or cranial decompression, respectively. Based on clinical follow-up that extended
Conclusions
Single-fraction SRS over the used dose range provides a high rate of tumor control for patients with presumed intracranial meningiomas. Patients with small- to medium-sized tumors involving the skull base had lowest risk of radiation-related complications. Surgical resection should remain the primary treatment for the majority of patients with symptomatic or enlarging dural-based masses over the cerebral convexities.
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Conflict of interest: none.