Kerstin A Kessel1,2, Hanna Fischer3,4, Markus Oechnser3, Claus Zimmer5, Bernhard Meyer6, Stephanie E Combs3,4. 1. Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany. Kerstin.Kessel@tum.de. 2. Institute for Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Neuherberg, Germany. Kerstin.Kessel@tum.de. 3. Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany. 4. Institute for Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Neuherberg, Germany. 5. Department of Neuroradiology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany. 6. Department of Neurosurgery, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.
Abstract
OBJECTIVE: To evaluate long-term outcome after high-precision radiotherapy (RT) of meningioma patients in terms of survival and side effects. METHODS: We analyzed 275 meningioma cases: 147 low-grade and 43 high-grade meningiomas (WHO II: n = 40, III: n = 3). In all, 85 patients had no pathologically confirmed histology but were determined as low-grade based on multimodal imaging. Surgery was performed in 183 cases. RT was delivered as either radiosurgery (RS, n = 16), fractionated stereotactic radiotherapy (FSRT, n = 241), or intensity-modulated radiation therapy (IMRT, n = 18). Of 218 patients contacted for patient-reported-outcome (PRO), 207 responded (95%). RESULTS: Median follow-up was 7.2 years. For low-grade meningioma the survival rate (OS) was 97% at 3 years, 85% at 10 years, and 64% at 15 years, for atypical meningioma 91% at 3 years, 62% at 10 years, and 50% at 15 years. Local control rate (PFS) for low-grade meningioma was 91% at 3 years, 87% at 5 years, and 86% at 10 years, for atypical cases 67% at 3 years and 55% at 5 years. Of all, 3.0% of patients reported worsened or new symptoms grade ≥3 during RT and the first 6 months thereafter; 17.5% reported a deterioration after more than 2 years. We found the prognostic factors tumor volume and age significantly influencing OS and PFS. CONCLUSION: Complemented by PRO, we found long-term low toxicity rates in addition to excellent local control. Thus, due to the beneficial risk-benefit profile of benign and high-risk meningiomas, RT should be performed as adjuvant treatment and should not be postponed until tumor progression.
OBJECTIVE: To evaluate long-term outcome after high-precision radiotherapy (RT) of meningiomapatients in terms of survival and side effects. METHODS: We analyzed 275 meningioma cases: 147 low-grade and 43 high-grade meningiomas (WHO II: n = 40, III: n = 3). In all, 85 patients had no pathologically confirmed histology but were determined as low-grade based on multimodal imaging. Surgery was performed in 183 cases. RT was delivered as either radiosurgery (RS, n = 16), fractionated stereotactic radiotherapy (FSRT, n = 241), or intensity-modulated radiation therapy (IMRT, n = 18). Of 218 patients contacted for patient-reported-outcome (PRO), 207 responded (95%). RESULTS: Median follow-up was 7.2 years. For low-grade meningioma the survival rate (OS) was 97% at 3 years, 85% at 10 years, and 64% at 15 years, for atypical meningioma 91% at 3 years, 62% at 10 years, and 50% at 15 years. Local control rate (PFS) for low-grade meningioma was 91% at 3 years, 87% at 5 years, and 86% at 10 years, for atypical cases 67% at 3 years and 55% at 5 years. Of all, 3.0% of patients reported worsened or new symptoms grade ≥3 during RT and the first 6 months thereafter; 17.5% reported a deterioration after more than 2 years. We found the prognostic factors tumor volume and age significantly influencing OS and PFS. CONCLUSION: Complemented by PRO, we found long-term low toxicity rates in addition to excellent local control. Thus, due to the beneficial risk-benefit profile of benign and high-risk meningiomas, RT should be performed as adjuvant treatment and should not be postponed until tumor progression.
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Authors: C Leland Rogers; Minhee Won; Michael A Vogelbaum; Arie Perry; Lynn S Ashby; Jignesh M Modi; Anthony M Alleman; James Galvin; Shannon E Fogh; Emad Youssef; Nimisha Deb; Young Kwok; Clifford G Robinson; Hui-Kuo Shu; Barbara J Fisher; Valerie Panet-Raymond; William G McMillan; John F de Groot; Peixin Zhang; Minesh P Mehta Journal: Int J Radiat Oncol Biol Phys Date: 2019-11-29 Impact factor: 7.038
Authors: Kerstin A Kessel; Wolfgang Weber; Igor Yakushev; Hanna Fischer; Theresa Voglhuber; Christian Diehl; Christoph Straube; Claus Zimmer; Benedikt Wiestler; Jens Gempt; Bernhard Meyer; Stephanie E Combs Journal: Eur J Nucl Med Mol Imaging Date: 2019-11-22 Impact factor: 9.236
Authors: Kerstin A Kessel; Rebekka C E Grosser; Kim Melanie Kraus; Hans Hoffmann; Markus Oechsner; Stephanie E Combs Journal: BMC Cancer Date: 2020-05-19 Impact factor: 4.430
Authors: Rami A El Shafie; Maja Czech; Kerstin A Kessel; Daniel Habermehl; Dorothea Weber; Stefan Rieken; Nina Bougatf; Oliver Jäkel; Jürgen Debus; Stephanie E Combs Journal: Radiat Oncol Date: 2018-03-27 Impact factor: 3.481
Authors: Kerstin A Kessel; Christian D Diehl; Markus Oechsner; Bernhard Meyer; Jens Gempt; Claus Zimmer; Friederike Schmidt-Graf; Stephanie E Combs Journal: Cancers (Basel) Date: 2019-11-27 Impact factor: 6.639