The role of stereotactic radiosurgery in the management of petroclival meningioma: a systematic review

Efficacy and safety of stereotactic radiosurgery for petroclival meningiomas: A systematic review and Meta-Analysis

BACKGROUND

Managing petroclival meningiomas (PCMs) is challenging due to their deep-seated location and proximity to critical anatomical structures. Resection aimed at achieving gross total resection (GTR) has been the primary therapeutic approach for PCMs; however, GTR is associated with considerable complications. Stereotactic radiosurgery (SRS) has emerged as an effective and safe minimally invasive option for managing petroclival meningiomas. This study evaluated the role of primary or adjuvant SRS in the treatment of petroclival meningiomas.

METHODS

Following a comprehensive literature search, studies evaluating the role of primary or adjuvant SRS in petroclival meningiomas were included. The meta-analysis calculated the pooled estimates for local tumor control (LTC), progression-free survival (PFS), and adverse radiation effect (ARE).

RESULTS

A total of 10 studies involving 605 patients were included. The meta-analysis revealed a pooled LTC rate of 94% (95% CI: 88-98%), a 5-year PFS rate of 94% (95% CI: 81-100%), and a 10-year PFS rate of 87% (95% CI: 69-98%). The meta-analysis for the SRS indication demonstrated that both primary and adjuvant SRS were associated with substantial LTC rates, and the difference was not significant (Primary: 95% [95% CI: 83-100%] vs. Adjuvant: 92% [95% CI: 69-100%], P = 0.65). The meta-analysis for the ARE indicated a pooled rate of 5% (95% CI: 0-12%).

CONCLUSION

Our findings suggest that primary and adjuvant SRS are associated with significant LTC and PFS rates, along with minimal complications. Primary SRS may be considered for individuals with small or asymptomatic lesions, while adjuvant SRS is advised for larger or recurrent lesions.

Radiosurgery for Intracranial Meningiomas: A Review of Anatomical Challenges and an Update on the Evidence

Radiation has been used to treat meningiomas since the mid-1970s. Traditionally, radiation was reserved for patients unfit for major surgery or those with surgically inaccessible tumors. With an increased quantity and quality of imaging, and an aging population, there has been a rise in incidentally diagnosed meningiomas with smaller tumors at diagnosis time. Deciding if, how, and when to intervene must be determined on a case-by-case basis. Anatomical location and adjacent vital structures are crucial for decision-making. Prior review articles have detailed outcomes of radiosurgery in broad anatomical regions such as the skull base, but a recent deluge of research on increasingly specific anatomical subregions deserves attention. This narrative review synthesizes information regarding specific anatomical subregions, including anatomical challenges, radiosurgical outcomes, and unique considerations. Via MEDLINE and ascendancy search, we utilized evidence available for each anatomical region and herein discuss details of published research and explore future directions. Meningioma management remains individualized based on patient comorbidities, tumor location/characteristics, symptomatic burden, and patient age. In addition to stereotactic radiosurgery's established role for surgically inaccessible, recurrent, and high-grade meningiomas, its use as upfront management for small asymptomatic meningiomas is increasingly investigated. For all subregions reported, radiosurgical intervention resulted in high tumor control rates and acceptably low adverse radiation events.

Evaluating the Efficacy and Safety of CyberKnife for Meningiomas: A Systematic Review

This systematic review aims to evaluate CyberKnife (Accuray, Madison, WI, USA) radiosurgery's efficacy, safety, and outcomes in treating meningiomas, focusing on tumour control rates, symptom relief, survival rates, quality of life, and adverse events. A comprehensive literature search was conducted across PubMed, EMBASE, Web of Science, Google Scholar, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), covering studies published in the last 20 years and available in English. The inclusion criteria targeted studies involving patients with meningioma treated with CyberKnife radiosurgery, reporting on specific outcomes of interest. Quality assessment was performed using the Newcastle-Ottawa Scale for observational studies, and a narrative synthesis approach was adopted for data analysis. Twenty-one studies met the inclusion criteria, encompassing various design types and patient demographics. The review highlights CyberKnife's effectiveness in managing benign and atypical meningiomas and specific challenging cases like perioptic lesions and large cranial base tumours. Key findings include high tumour control rates, preservation or improvement of visual functions in perioptic lesions, and promising results in benign spinal tumours and supratentorial meningiomas. Comparative analyses suggest better radiographic tumour control and a lower incidence of post-treatment complications with stereotactic radiotherapy over stereotactic radiosurgery. Long-term outcomes and safety profiles underline the viability of CyberKnife as a treatment option, with minimal permanent side effects reported. CyberKnife radiosurgery is a highly effective and safe treatment modality for meningiomas. It offers significant benefits in tumour control, symptom relief, and maintaining the quality of life with minimal adverse effects. The precision and adaptability of CyberKnife technology make it a valuable addition to the treatment arsenal for meningiomas. It necessitates further research and adoption in clinical practice, especially in regions like the United Arab Emirates, where its use is emerging.

Hypofractionated proton therapy for benign tumors of the central nervous system: A systematic review of the literature

AIMS

Aim of the present analysis was to report results of a systematic review of the literature in the setting of patients treated with hypoF PT for benign lesions of the central nervous system (CNS).

METHODS

The methodology complied with the PRISMA recommendations. PubMed, EMBASE and Scopus databases were interrogated in September 2022.

RESULTS

Twelve papers have been selected including patients treated for base of the skull meningiomas (6 papers), vestibular schwannoma (3 papers) and pituitary adenomas (3 papers). Clinical outcomes were evaluated with both radiologic images and clinical parameters. Long-term toxicity was reported in all but one series with an incidence ranging from 2 % to 7 % in patients treated for base of skull meningioma and 1-9 % for schwannoma.

CONCLUSIONS

HypoF PT is a safe and effective treatment in selected benign tumors of the CNS. Further dosimetric and clinical comparisons are required to better refine the patients' selection criteria.