Linac-based stereotactic radiotherapy and radiosurgery in patients with meningioma

Radiation Oncology

Harun Badakhshi³  Piet Habbel¹  Lukas Graaf³  Arne Gruen³  Reinhard Wurm²  Volker Budach³  David Kaul³ 

[1] Department of Oncology and Hematology, Charité School of Medicine and University Hospital, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany;Department of Radiation Oncology, Hospital Frankfurt/Oder, Müllroser Chaussee 7, 15236 Frankfurt, Germany;Department of Radiation Oncology, Charité School of Medicine and University Hospital, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany

关键词: Image-guided radiotherapy;    Stereotactic fractionated radiotherapy;    Local control;    Meningioma;   

Others  :  1228551
DOI  :  10.1186/1748-717X-9-78

 received in 2013-12-09, accepted in 2014-03-16,  发布年份 2014

【 摘 要 】

Background

It was our purpose to analyze long-term clinical outcome and to identify prognostic factors after Linac-based fractionated stereotactic radiotherapy (Linac-based FSRT) and stereotactic radiosurgery (SRS) in patients with intracranial meningiomas.

Materials and methods

Between 10/1995 and 03/2009, 297 patients with a median age of 59 years were treated with FSRT for intracranial meningioma. 50 patients had a Grade I meningioma, 20 patients had a Grade II meningioma, 12 patients suffered from a Grade III tumor, and in 215 cases no histology was obtained (Grade 0). Of the 297 patients, 144 underwent FSRT as their primary treatment and 158 underwent postoperative FSRT. 179 patients received normofractionated radiotherapy (nFSRT), 92 patients received hypofractionated FSRT (hFSRT) and 26 patients underwent SRS. Patients with nFSRT received a mean total dose of 57.31 ± 5.82 Gy, patients with hFSRT received a mean total dose of 37.6 ± 4.4 Gy and patients who underwent SRS received a mean total dose of 17.31 ± 2.58 Gy.

Results

Median follow-up was 35 months. Overall progression free survival (PFS) was 92.3% at 3 years, 87% at 5 years and 84.1% at 10 years. Patients with adjuvant radiotherapy showed significantly better PFS-rates than patients who had been treated with primary radiotherapy. There was no significant difference between PFS-rates of nFSRT, hFSRT and SRS patients. PFS-rates were independent of tumor size. Patients who had received nFSRT showed less acute toxicity than those who had received hFSRT. In the Grade 0/I group the rate of radiologic focal reactions was significantly lower than in the atypical/malignant histology group.

Conclusion

This large study showed that FSRT is an effective and safe treatment modality with high PFS-rates for intracranial meningioma. We identified “pathological grading” and and “prior surgery” as significant prognostic factors.

【 授权许可】

   
2014 Kaul et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]van Alkemade H, de Leau M, Dieleman EM, Kardaun JW, van Os R, Vandertop WP, van Furth WR, Stalpers LJ: Impaired survival and long-term neurological problems in benign meningioma. Neuro Oncol 2012, 14:658-666.
• [2]Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL: Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 1985, 62:18-24.
• [3]Milker-Zabel S, Zabel-du Bois A, Huber P, Schlegel W, Debus J: Fractionated stereotactic radiation therapy in the management of benign cavernous sinus meningiomas : long-term experience and review of the literature. Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft 2006, 182:635-640.
• [4]Glaholm J, Bloom HJ, Crow JH: The role of radiotherapy in the management of intracranial meningiomas: the Royal Marsden Hospital experience with 186 patients. Int J Radiat Oncol Biol Phys 1990, 18:755-761.
• [5]Thilmann C, Schulz-Ertner D, Unterberg A, Wannenmacher M, Debus J: Stereotaktische strahlenbehandlung schädelbasisnaher meningeome und schwannome. Dtsch Arztebl 2004, Heft 15:1022-1026.
• [6]Claus EB, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M, Black PM: Epidemiology of intracranial meningioma. Neurosurgery 2005, 57:1088-1095. discussion 1088–1095
• [7]Gondi V, Tome WA, Mehta MP: Fractionated radiotherapy for intracranial meningiomas. J Neuro-Oncol 2010, 99:349-356.
• [8]Engenhart-Cabillic R, Farhoud A, Sure U, Heinze S, Henzel M, Mennel HD, Bertalanffy H: Clinicopathologic features of aggressive meningioma emphasizing the role of radiotherapy in treatment. Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft 2006, 182:641-646.
• [9]DeVries A, Munzenrider JE, Hedley-Whyte T, Hug EB: [The role of radiotherapy in the treatment of malignant meningiomas]. Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft 1999, 175:62-67.
• [10]Lee JH, Sade B: The novel “CLASS” algorithmic scale for patient selection in meningioma surgery. In Meningiomas. Edited by Lee JH. London: Springer London; 2009:217-221.
• [11]Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, Shank B, Solin LJ, Wesson M: Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991, 21:109-122.
• [12]Milker-Zabel S, Zabel A, Schulz-Ertner D, Schlegel W, Wannenmacher M, Debus J: Fractionated stereotactic radiotherapy in patients with benign or atypical intracranial meningioma: long-term experience and prognostic factors. Int J Radiat Oncol Biol Phys 2005, 61:809-816.
• [13]Maire JP, Vendrely V, Dautheribes M, Bonichon N, Darrouzet V: [Fractionated radiotherapy of intracranial meningiomas and neurinomas]. Cancer Radiotherapie: journal de la Societe francaise de radiotherapie oncologique 2000, 4 Suppl 1:84s-94s.
• [14]Nakaya K, Chernov M, Kasuya H, Izawa M, Hayashi M, Kato K, Kubo O, Muragaki Y, Iseki H, Hori T: Risk factors for regrowth of intracranial meningiomas after gamma knife radiosurgery: importance of the histopathological grade and MIB-1 index. Minim Invasive Neurosurg 2009, 52:216-221.
• [15]Compter I, Zaugg K, Houben RM, Dings JT, Bosmans G, Buescher C, Anten MM, Baumert BG: High symptom improvement and local tumor control using stereotactic radiotherapy when given early after diagnosis of meningioma. A multicentre study. Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft 2012, 188:887-893.
• [16]Debus J, Wuendrich M, Pirzkall A, Hoess A, Schlegel W, Zuna I, Engenhart-Cabillic R, Wannenmacher M: High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results. J Clin Oncol: J Am Soc Clin Oncol 2001, 19:3547-3553.
• [17]Kreil W, Luggin J, Fuchs I, Weigl V, Eustacchio S, Papaefthymiou G: Long term experience of gamma knife radiosurgery for benign skull base meningiomas. J Neurol Neurosurg Psychiatry 2005, 76:1425-1430.
• [18]Stessin AM, Schwartz A, Judanin G, Pannullo SC, Boockvar JA, Schwartz TH, Stieg PE, Wernicke AG: Does adjuvant external-beam radiotherapy improve outcomes for nonbenign meningiomas? a surveillance, epidemiology, and end results (SEER)-based analysis. J Neurosurg 2012, 117:669-675.
• [19]Nutting C, Brada M, Brazil L, Sibtain A, Saran F, Westbury C, Moore A, Thomas DG, Traish D, Ashley S: Radiotherapy in the treatment of benign meningioma of the skull base. J Neurosurg 1999, 90:823-827.
• [20]Goldsmith BJ, Wara WM, Wilson CB, Larson DA: Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 1994, 80:195-201.
• [21]Engenhart R, Kimmig BN, Hover KH, Wowra B, Sturm V, van Kaick G, Wannenmacher M: Stereotactic single high dose radiation therapy of benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 1990, 19:1021-1026.
• [22]Jalali R, Loughrey C, Baumert B, Perks J, Warrington AP, Traish D, Ashley S, Brada M: High precision focused irradiation in the form of fractionated stereotactic conformal radiotherapy (SCRT) for benign meningiomas predominantly in the skull base location. Clin Oncol (R Coll Radiol) 2002, 14:103-109.
• [23]Chang JH, Chang JW, Choi JY, Park YG, Chung SS: Complications after gamma knife radiosurgery for benign meningiomas. J Neurol Neurosurg Psychiatry 2003, 74:226-230.