Clinical Investigation
Single-fraction Radiosurgery for Presumed Intracranial Meningiomas: Efficacy and Complications From a 22-Year Experience

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Purpose

To define the rate of tumor control and factors associated with radiation-related complications after single-fraction radiosurgery (SRS) for patients with imaging defined intracranial meningiomas.

Materials and Methods

Retrospective review of 251 patients (192 women, 59 men) having SRS for imaging-defined intracranial meningiomas between 1990 and 2008. Excluded were patients with radiation-induced tumors, meningiomatosis, or neurofibromatosis. The mean patient age was 58.6 ± 13.4 years. The majority of tumors involved the skull base/tentorium (n = 210, 83.7%). The mean treatment volume was 7.7 ± 6.2 cm3; the mean tumor margin dose was 15.8 ± 2.0 Gy. Follow-up (mean, 62.9 ± 43.9 months) was censored at last evaluation (n = 224), death (n = 22), or tumor resection (n = 5).

Results

No patient died from tumor progression or radiation-related complications. 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. No patient had a marginal tumor progression. The 3- and 10-year local control rate was 99.4%. One patient had distant tumor progression at 105 months and underwent repeat SRS. Thirty-one patients (12.4%) had either temporary (n = 8, 3.2%) or permanent (n = 23, 9.2%) symptomatic radiation-related complications including cranial nerve deficits (n = 14), headaches (n = 5), hemiparesis (n = 5), new/worsened seizure (n = 4), cyst-formation (n = 1), hemifacial spasm (n = 1), and stroke (n = 1). The 1- and 5-year complication rates were 8.3% and 11.5%, respectively. Radiation-related complications were associated with convexity/falx tumors (HR = 2.8, 95% CI 1.3–6.1, p = 0.009) and increasing tumor volume (HR = 1.05, 95% CI 1.0–1.1, p = 0.04) on multivariate analysis. No patient developed a radiation-induced tumor.

Conclusions

Single-fraction SRS at the used dose range provides a high rate of tumor control for patients with imaging defined intracranial meningiomas. However, treatment failures were noted after 10 years emphasizing the need for long-term imaging follow-up after meningioma SRS.

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.

References (19)

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