Bruce E Pollock1. 1. Department of Neurologic Surgery and the Division of Radiation Oncology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA. pollock.bruce@mayo.edu
Abstract
OBJECT: Stereotactic radiosurgery (SRS) has become an important treatment option for patients with intracranial meningiomas. The author reviews the 12-year experience at a single institution and discusses the relative strengths and weakness of this management approach. METHODS: Between January 1990 and December 2002, 330 patients (with 356 tumors) underwent radiosurgery for intracranial meningiomas. One hundred thirty-eight patients (42%) harbored recurrent/residual tumors after having already undergone resection; 192 patients (58%) underwent radiosurgery as primary treatment. The majority of patients (70%) harbored skull base tumors. The median tumor volume was 7.3 cm3 (range 0.5-50.5 cm3). The median tumor margin dose was 16 Gy (range 12-20 Gy). In 278 patients with 297 lesions the mean clinical and imaging follow-up period was 43 months (range 2-138 months). Two hundred seventy-eight tumors (94%) remained stable or decreased in size, and 19 tumors progressed in size. Factors associated with progression were tumor histological type and prior surgery. Treatment-related complications occurred in 8% of the patients and included cranial neuropathies, symptomatic edema, cyst formation, and stenosis of the internal carotid artery. In three patients (1%) tumor dedifferentiation was noted after SRS. CONCLUSIONS: Radiosurgical treatment of meningioma is safe and it has become the primary treatment for patients with small skull base tumors. Further study is needed to determine the long-term tumor control rates after such treatment, especially for patients treated with doses of 14 Gy or less.
OBJECT: Stereotactic radiosurgery (SRS) has become an important treatment option for patients with intracranial meningiomas. The author reviews the 12-year experience at a single institution and discusses the relative strengths and weakness of this management approach. METHODS: Between January 1990 and December 2002, 330 patients (with 356 tumors) underwent radiosurgery for intracranial meningiomas. One hundred thirty-eight patients (42%) harbored recurrent/residual tumors after having already undergone resection; 192 patients (58%) underwent radiosurgery as primary treatment. The majority of patients (70%) harbored skull base tumors. The median tumor volume was 7.3 cm3 (range 0.5-50.5 cm3). The median tumor margin dose was 16 Gy (range 12-20 Gy). In 278 patients with 297 lesions the mean clinical and imaging follow-up period was 43 months (range 2-138 months). Two hundred seventy-eight tumors (94%) remained stable or decreased in size, and 19 tumors progressed in size. Factors associated with progression were tumor histological type and prior surgery. Treatment-related complications occurred in 8% of the patients and included cranial neuropathies, symptomatic edema, cyst formation, and stenosis of the internal carotid artery. In three patients (1%) tumor dedifferentiation was noted after SRS. CONCLUSIONS: Radiosurgical treatment of meningioma is safe and it has become the primary treatment for patients with small skull base tumors. Further study is needed to determine the long-term tumor control rates after such treatment, especially for patients treated with doses of 14 Gy or less.
Authors: Susan C Pannullo; Justin F Fraser; Jennifer Moliterno; William Cobb; Philip E Stieg Journal: J Neurooncol Date: 2010-12-09 Impact factor: 4.130