Michael A Mooney1,2, Wenya Linda Bi3, Jonathan M Cantalino4, Kyle C Wu3, Thomas C Harris4, Lucas L Possatti3, Parikshit Juvekar3, Liangge Hsu5, Ian F Dunn3, Ossama Al-Mefty3, Phillip M Devlin4. 1. Department of Neurosurgery, Barrow Neurological Institute, 350 W. Thomas Rd, Phoenix, AZ, USA. michael.mooney@bnaneuro.net. 2. Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA. michael.mooney@bnaneuro.net. 3. Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA. 4. Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA. 5. Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
Abstract
PURPOSE: To evaluate surgical resection with brachytherapy placement as a salvage treatment in patients with recurrent high-grade meningioma who exhausted prior external beam treatment options. METHODS: Single-center retrospective review of our institutional experience of brachytherapy implantation from 2012 to 2018. The primary outcome of the study was progression free survival (PFS). Secondary outcomes included overall survival (OS) and complications. A matched cohort of patients not treated with brachytherapy over the same time period was evaluated as a control group. All patients had received prior radiation treatment and underwent planned gross total resection (GTR) surgery. RESULTS: A total of 27 cases were evaluated. Compared with prior treatment, brachytherapy implantation demonstrated a statistically significant improvement in tumor control [HR 0.316 (0.101 - 0.991), p = 0.034]. PFS-6 and PFS-12 were 92.3% and 84.6%, respectively. Compared with the matched control cohort, brachytherapy treatment demonstrated improved PFS [HR 0.310 (0.103 - 0.933), p = 0.030]. Overall survival was not statistically significantly different between groups [HR 0.381 (0.073 - 1.982), p = 0.227]. Overall postoperative complications were comparable between groups, although there was a higher incidence of radiation necrosis in the brachytherapy cohort. CONCLUSION: Brachytherapy with planned GTR improved PFS in recurrent high-grade meningioma patients who exhausted prior external beam radiation treatment options. Future improvement of brachytherapy dose delivery methods and techniques may continue to prolong control rates and improve outcomes for this challenging group of patients.
PURPOSE: To evaluate surgical resection with brachytherapy placement as a salvage treatment in patients with recurrent high-grade meningioma who exhausted prior external beam treatment options. METHODS: Single-center retrospective review of our institutional experience of brachytherapy implantation from 2012 to 2018. The primary outcome of the study was progression free survival (PFS). Secondary outcomes included overall survival (OS) and complications. A matched cohort of patients not treated with brachytherapy over the same time period was evaluated as a control group. All patients had received prior radiation treatment and underwent planned gross total resection (GTR) surgery. RESULTS: A total of 27 cases were evaluated. Compared with prior treatment, brachytherapy implantation demonstrated a statistically significant improvement in tumor control [HR 0.316 (0.101 - 0.991), p = 0.034]. PFS-6 and PFS-12 were 92.3% and 84.6%, respectively. Compared with the matched control cohort, brachytherapy treatment demonstrated improved PFS [HR 0.310 (0.103 - 0.933), p = 0.030]. Overall survival was not statistically significantly different between groups [HR 0.381 (0.073 - 1.982), p = 0.227]. Overall postoperative complications were comparable between groups, although there was a higher incidence of radiation necrosis in the brachytherapy cohort. CONCLUSION: Brachytherapy with planned GTR improved PFS in recurrent high-grade meningiomapatients who exhausted prior external beam radiation treatment options. Future improvement of brachytherapy dose delivery methods and techniques may continue to prolong control rates and improve outcomes for this challenging group of patients.
Authors: Anthony Pham; Menachem Z Yondorf; Bhupesh Parashar; Ronald J Scheff; Susan C Pannullo; Rohan Ramakrishna; Philip E Stieg; Theodore H Schwartz; A Gabriella Wernicke Journal: J Neurooncol Date: 2015-12-09 Impact factor: 4.130
Authors: Philipp Kickingereder; Christina Hamisch; Bogdana Suchorska; Norbert Galldiks; Veerle Visser-Vandewalle; Roland Goldbrunner; Martin Kocher; Harald Treuer; Juergen Voges; Maximilian I Ruge Journal: J Neurooncol Date: 2014-08-24 Impact factor: 4.130
Authors: Matthew J Koch; Pankaj K Agarwalla; Trevor J Royce; Helen A Shih; Kevin Oh; Andrezj Niemierko; Thomas C Mauceri; William T Curry; Frederick G Barker; Jay S Loeffler Journal: Neurosurgery Date: 2019-11-01 Impact factor: 4.654
Authors: A Gabriella Wernicke; Cole B Hirschfeld; Andrew W Smith; Shoshana Taube; Menachem Z Yondorf; Bhupesh Parashar; Lucy Nedialkova; Fridon Kulidzhanov; Samuel Trichter; Albert Sabbas; Rohan Ramakrishna; Susan Pannullo; Theodore H Schwartz Journal: Int J Radiat Oncol Biol Phys Date: 2017-06-10 Impact factor: 7.038
Authors: Hussam Abou Al-Shaar; Kaith K Almefty; Mohammad Abolfotoh; Nils D Arvold; Phillip M Devlin; David A Reardon; Jay S Loeffler; Ossama Al-Mefty Journal: J Neurooncol Date: 2015-08-08 Impact factor: 4.130
Authors: A Gabriella Wernicke; Andrew W Smith; Shoshana Taube; Menachem Z Yondorf; Bhupesh Parashar; Samuel Trichter; Lucy Nedialkova; Albert Sabbas; Paul Christos; Rohan Ramakrishna; Susan C Pannullo; Philip E Stieg; Theodore H Schwartz Journal: J Neurosurg Date: 2016-06-03 Impact factor: 5.115