Marcello Marchetti1, Alfredo Conti2,3, Giancarlo Beltramo4, Valentina Pinzi5, Antonio Pontoriero6, Irene Tramacere7, Carolin Senger8, Stefano Pergolizzi6, Laura Fariselli5. 1. Radiotherapy Unit, Dept. of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Via Celoria 11, 20133, Milan, Italy. marcello.marchetti@istituto-besta.it. 2. Dept. of Neurosurgery, University of Messina, AOU "Policlinico G. Martino", Messina, Italy. 3. Dept. of Neurosurgery, Charité Universitaetmedizin, Berlin, Germany. 4. CyberKnife Center, Centro Diagnostico Italiano, Milan, Italy. 5. Radiotherapy Unit, Dept. of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Via Celoria 11, 20133, Milan, Italy. 6. Dept. of Radiation Oncology, University of Messina, Messina, Italy. 7. Dept of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy. 8. Dept. of Radiation Oncology, Charité Universitaetmedizin, Berlin, Germany.
Abstract
PURPOSE: Most recent literature has confirmed the efficacy of single-session radiosurgery (sRS) in the treatment of intracranial meningioma. Unfortunately, sRS is not always applicable due to large tumor volume and the proximity of the tumor to critical structures. When sRS is not recommended, multi-session radiosurgery (mRS) can be the solution. The best treatment schedule for mRS, however, is not well established. The aim of the present retrospective study is to validate the effectiveness of one approach, 25 Gy delivered in 5 fractions in 5 consecutive days, to treat skull base meningiomas. METHODS: This is a retrospective multicenter study. Patients with an anterior or a medium skull base meningioma that could not be treated by sRS due to large volume or proximity to the anterior optic pathways (AOPs) underwent 5-fraction mRS. Only patients with at least 36 months follow-up were included in the analysis. Local control and visual outcomes were investigated. RESULTS: One-hundred-sixty-seven patients were included in the analysis. One-hundred-one patients underwent RS as a primary indication and 66 were treated after a previous surgery. The median follow-up period was 51 months (range 36-129 months). Progression-free survival at 3, 5 and 8 years were, respectively, 98%, 94% and 90%. Excluding the progressive disease patients, the visual worsening rate was 3.7%. The 42% of the patients with a pre-treatment visual deficit experienced improvement in vision. CONCLUSION: 25 Gy delivered in 5 fractions is an effective modality for meningiomas that are near the AOP or are too large to be treated by sRS. The treatment schedule controlled the tumors while sparing visual function.
PURPOSE: Most recent literature has confirmed the efficacy of single-session radiosurgery (sRS) in the treatment of intracranial meningioma. Unfortunately, sRS is not always applicable due to large tumor volume and the proximity of the tumor to critical structures. When sRS is not recommended, multi-session radiosurgery (mRS) can be the solution. The best treatment schedule for mRS, however, is not well established. The aim of the present retrospective study is to validate the effectiveness of one approach, 25 Gy delivered in 5 fractions in 5 consecutive days, to treat skull base meningiomas. METHODS: This is a retrospective multicenter study. Patients with an anterior or a medium skull base meningioma that could not be treated by sRS due to large volume or proximity to the anterior optic pathways (AOPs) underwent 5-fraction mRS. Only patients with at least 36 months follow-up were included in the analysis. Local control and visual outcomes were investigated. RESULTS: One-hundred-sixty-seven patients were included in the analysis. One-hundred-one patients underwent RS as a primary indication and 66 were treated after a previous surgery. The median follow-up period was 51 months (range 36-129 months). Progression-free survival at 3, 5 and 8 years were, respectively, 98%, 94% and 90%. Excluding the progressive disease patients, the visual worsening rate was 3.7%. The 42% of the patients with a pre-treatment visual deficit experienced improvement in vision. CONCLUSION: 25 Gy delivered in 5 fractions is an effective modality for meningiomas that are near the AOP or are too large to be treated by sRS. The treatment schedule controlled the tumors while sparing visual function.
Authors: Roland Goldbrunner; Pantelis Stavrinou; Michael D Jenkinson; Felix Sahm; Christian Mawrin; Damien C Weber; Matthias Preusser; Giuseppe Minniti; Morten Lund-Johansen; Florence Lefranc; Emanuel Houdart; Kita Sallabanda; Emilie Le Rhun; David Nieuwenhuizen; Ghazaleh Tabatabai; Riccardo Soffietti; Michael Weller Journal: Neuro Oncol Date: 2021-11-02 Impact factor: 13.029