TY - JOUR
T1 - Cyberknife stereotactic radiosurgery for treatment of atypical (Who Grade II) cranial meningiomas
AU - Choi, Clara Y.H.
AU - Soltys, Scott G.
AU - Gibbs, Iris C.
AU - Harsh, Griffith R.
AU - Jackson, Paul S.
AU - Lieberson, Robert E.
AU - Chang, Steven D.
AU - Adler, John R.
PY - 2010/11
Y1 - 2010/11
N2 - Background: The optimal management of subtotally resected atypical meningiomas is unknown. Objective: To perform a retrospective review of patients with residual or recurrent atypical meningiomas treated with stereotactic radiosurgery (SRS). Methods: Twenty-five patients were treated, either immediately after surgery (n = 15) or at the time of radiographic progression or treatment failure (n = 10). SRS was delivered to with a median marginal dose of 22 Gy (range, 16-30) in 1 to 4 fractions (median, 1), targeting a median tumor volume of 5.3 cm (range, 0.3-26.0). Results: With a median follow-up time of 28 months (range, 3-67), the 12-, 24-, and 36-month actuarial local and regional control rates for all patients were 94%, 94%, 74%, and 90%, 90%, 62%, respectively. There were 2 cases of radiation toxicity. On univariate analysis, the number of recurrences before SRS (P = .046), late SRS (ie, waiting until tumor progression to initiate treatment) (P = .03), and age at treatment 60 years (P = .01) were significant predictors of recurrence. Of the 20 radiation-naïve patients, 2 patients failed with the targeted lesion and 3 elsewhere in the resection bed, resulting in 12-, 24- and 36-month actuarial local and regional control rates of 100%, 100%, 73% and 93%, 93%, 75%, respectively. The overall locoregional control rates at 12, 24, and 36 months were 93%, 93%, and 54%, respectively. Conclusion: Irradiation of the entire postoperative tumor bed may not be necessary for the majority of patients with subtotally resected atypical meningiomas. Patients in this series achieved outcomes comparable to that of historical control rates for larger volume, conventionally fractionated radiotherapy.
AB - Background: The optimal management of subtotally resected atypical meningiomas is unknown. Objective: To perform a retrospective review of patients with residual or recurrent atypical meningiomas treated with stereotactic radiosurgery (SRS). Methods: Twenty-five patients were treated, either immediately after surgery (n = 15) or at the time of radiographic progression or treatment failure (n = 10). SRS was delivered to with a median marginal dose of 22 Gy (range, 16-30) in 1 to 4 fractions (median, 1), targeting a median tumor volume of 5.3 cm (range, 0.3-26.0). Results: With a median follow-up time of 28 months (range, 3-67), the 12-, 24-, and 36-month actuarial local and regional control rates for all patients were 94%, 94%, 74%, and 90%, 90%, 62%, respectively. There were 2 cases of radiation toxicity. On univariate analysis, the number of recurrences before SRS (P = .046), late SRS (ie, waiting until tumor progression to initiate treatment) (P = .03), and age at treatment 60 years (P = .01) were significant predictors of recurrence. Of the 20 radiation-naïve patients, 2 patients failed with the targeted lesion and 3 elsewhere in the resection bed, resulting in 12-, 24- and 36-month actuarial local and regional control rates of 100%, 100%, 73% and 93%, 93%, 75%, respectively. The overall locoregional control rates at 12, 24, and 36 months were 93%, 93%, and 54%, respectively. Conclusion: Irradiation of the entire postoperative tumor bed may not be necessary for the majority of patients with subtotally resected atypical meningiomas. Patients in this series achieved outcomes comparable to that of historical control rates for larger volume, conventionally fractionated radiotherapy.
KW - Atypical meningioma
KW - CyberKnife
KW - Radiation
KW - Stereotactic radiosurgery
KW - WHO Grade II meningioma
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U2 - 10.1227/NEU.0b013e3181f2f427
DO - 10.1227/NEU.0b013e3181f2f427
M3 - Review article
C2 - 20871435
AN - SCOPUS:77958473044
VL - 67
SP - 1180
EP - 1188
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 5
ER -