OBJECTIVE: Effective treatments for recurrent, previously irradiated intracranial meningiomas are limited, and resection alone is not usually curative. Thus, the authors studied the combination of maximum safe resection and adjuvant radiation using permanent intracranial brachytherapy (R+BT) in patients with recurrent, previously irradiated aggressive meningiomas. METHODS: Patients with recurrent, previously irradiated meningiomas were treated between June 2013 and October 2016 in a prospective single-arm trial of R+BT. Cesium-131 (Cs-131) radiation sources were embedded in modular collagen carriers positioned in the operative bed on completion of resection. The Cox proportional hazards model with this treatment as a predictive term was used to model its effect on time to local tumor progression. RESULTS: Nineteen patients (median age 64.5 years, range 50-78 years) with 20 recurrent, previously irradiated tumors were treated. The WHO grade at R+BT was I in 4 (20%), II in 14 (70%), and III in 2 (10%) cases. The median number of prior same-site radiation courses and same-site surgeries were 1 (range 1-3) and 2 (range 1-4), respectively; the median preoperative tumor volume was 11.3 cm3 (range 0.9-92.0 cm3). The median radiation dose from BT was 63 Gy (range 54-80 Gy). At a median radiographic follow-up of 15.4 months (range 0.03-47.5 months), local failure (within 1.5 cm of the implant bed) occurred in 2 cases (10%). The median treatment-site time to progression after R+BT has not been reached; that after the most recent prior therapy was 18.3 months (range 3.9-321.9 months; HR 0.17, p = 0.02, log-rank test). The median overall survival after R+BT was 26 months, with 9 patient deaths (47% of patients). Treatment was well tolerated; 2 patients required surgery for complications, and 2 experienced radiation necrosis, which was managed medically. CONCLUSIONS: R+BT utilizing Cs-131 sources in modular carriers represents a potentially safe and effective treatment option for recurrent, previously irradiated aggressive meningiomas.
OBJECTIVE: Effective treatments for recurrent, previously irradiated intracranial meningiomas are limited, and resection alone is not usually curative. Thus, the authors studied the combination of maximum safe resection and adjuvant radiation using permanent intracranial brachytherapy (R+BT) in patients with recurrent, previously irradiated aggressive meningiomas. METHODS:Patients with recurrent, previously irradiated meningiomas were treated between June 2013 and October 2016 in a prospective single-arm trial of R+BT. Cesium-131 (Cs-131) radiation sources were embedded in modular collagen carriers positioned in the operative bed on completion of resection. The Cox proportional hazards model with this treatment as a predictive term was used to model its effect on time to local tumor progression. RESULTS: Nineteen patients (median age 64.5 years, range 50-78 years) with 20 recurrent, previously irradiated tumors were treated. The WHO grade at R+BT was I in 4 (20%), II in 14 (70%), and III in 2 (10%) cases. The median number of prior same-site radiation courses and same-site surgeries were 1 (range 1-3) and 2 (range 1-4), respectively; the median preoperative tumor volume was 11.3 cm3 (range 0.9-92.0 cm3). The median radiation dose from BT was 63 Gy (range 54-80 Gy). At a median radiographic follow-up of 15.4 months (range 0.03-47.5 months), local failure (within 1.5 cm of the implant bed) occurred in 2 cases (10%). The median treatment-site time to progression after R+BT has not been reached; that after the most recent prior therapy was 18.3 months (range 3.9-321.9 months; HR 0.17, p = 0.02, log-rank test). The median overall survival after R+BT was 26 months, with 9 patient deaths (47% of patients). Treatment was well tolerated; 2 patients required surgery for complications, and 2 experienced radiation necrosis, which was managed medically. CONCLUSIONS: R+BT utilizing Cs-131 sources in modular carriers represents a potentially safe and effective treatment option for recurrent, previously irradiated aggressive meningiomas.
Entities:
Keywords:
BT = brachytherapy; CTCAE = Common Terminology Criteria for Adverse Events; Cs = cesium; EBRT = external-beam radiation therapy; GTR = gross-total resection; HR = hazard ratio; NGTR = near gross-total resection (≥ 90%); PFS = progression-free survival; R+BT = resection and BT; STR = subtotal resection; TTP = time to progression; brachytherapy; cesium-131; implants; intraoperative; meningiomas; oncology; recurrent
Authors: Dilini S Pinnaduwage; Shiv P Srivastava; Xiangsheng Yan; Shyam Jani; David G Brachman; Stephen P Sorensen Journal: Technol Cancer Res Treat Date: 2022 Jan-Dec
Authors: Menachem Z Yondorf; Shahdabul Faraz; Andrew W Smith; Albert Sabbas; Bhupesh Parashar; Theodore H Schwartz; A Gabriella Wernicke Journal: J Contemp Brachytherapy Date: 2020-08-21
Authors: Michael A Mooney; Wenya Linda Bi; Jonathan M Cantalino; Kyle C Wu; Thomas C Harris; Lucas L Possatti; Parikshit Juvekar; Liangge Hsu; Ian F Dunn; Ossama Al-Mefty; Phillip M Devlin Journal: J Neurooncol Date: 2019-11-19 Impact factor: 4.130
Authors: Dominic J Gessler; Elizabeth C Neil; Rena Shah; Joseph Levine; James Shanks; Christopher Wilke; Margaret Reynolds; Shunqing Zhang; Can Özütemiz; Mehmet Gencturk; Mark Folkertsma; W Robert Bell; Liam Chen; Clara Ferreira; Kathryn Dusenbery; Clark C Chen Journal: Neurooncol Adv Date: 2021-12-27
Authors: Shahil Mehta; April K Vassantachart; Croix C Fossum; Wensha Yang; Zhilei L Shen; Ki-Eun Chang; Jason C Ye; Thomas C Chen; Eric L Chang Journal: Cureus Date: 2021-11-14
Authors: Kwanza T Warren; Andrew Boucher; David P Bray; Sean Dresser; Jim Zhong; Hiu-Kuo Shu; Jeffrey Olson; Kimberly Hoang Journal: Cureus Date: 2021-11-20