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Toader C, Covache-Busuioc RA, Bratu BG, Glavan LA, Popa AA, Ciurea AV. Successful Surgical Treatment of a Giant Intraventricular Meningioma: A Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:560. [PMID: 38674205 PMCID: PMC11052000 DOI: 10.3390/medicina60040560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
In our study, we document the case of a 48-year-old patient who presented at our clinic with various neurological disturbances. Magnetic Resonance Imaging revealed the presence of an intraventricular meningioma located in the body of the left lateral ventricle measuring 60 mm in diameter. This tumor was classified as a giant meningioma, accompanied by a significant amount of digitiform-type edema. A surgical procedure was conducted, resulting in a gross total resection of the tumor. Histopathological analysis identified the tumor as a fibrous meningioma. Postoperative assessments, as well as follow-ups conducted at 3 months and 1 year post-surgery, indicated considerable neurological improvement. The patient exhibited a remission of hemiparesis and gait disturbances along with a marginal improvement in the status of expressive aphasia. This case report underscores the significance of achieving total and safe resection of the tumor and includes an analysis of various cases from the literature, particularly focusing on those that describe minimally invasive surgical approaches and highlight the benefits of radiosurgery in the treatment of giant intraventricular meningiomas.
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Affiliation(s)
- Corneliu Toader
- Department of Neurosurgery “Carol Davila”, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (B.-G.B.); (L.A.G.); (A.A.P.); (A.V.C.)
- Department of Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery “Carol Davila”, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (B.-G.B.); (L.A.G.); (A.A.P.); (A.V.C.)
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery “Carol Davila”, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (B.-G.B.); (L.A.G.); (A.A.P.); (A.V.C.)
| | - Luca Andrei Glavan
- Department of Neurosurgery “Carol Davila”, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (B.-G.B.); (L.A.G.); (A.A.P.); (A.V.C.)
| | - Andrei Adrian Popa
- Department of Neurosurgery “Carol Davila”, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (B.-G.B.); (L.A.G.); (A.A.P.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery “Carol Davila”, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (B.-G.B.); (L.A.G.); (A.A.P.); (A.V.C.)
- Department of Neurosurgery, Sanador Clinical Hospital, 010991 Bucharest, Romania
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Schwartz C, Rautalin I, Grauvogel J, Bissolo M, Masalha W, Steiert C, Schnell O, Beck J, Ebel F, Bervini D, Raabe A, Eibl T, Steiner HH, Shlobin NA, Nandoliya KR, Youngblood MW, Chandler JP, Magill ST, Romagna A, Lehmberg J, Fuetsch M, Spears J, Rezai A, Ladisich B, Demetz M, Griessenauer CJ, Niemelä M, Korja M. Surgical Outcome of Patients With Supratentorial Meningiomas Aged 80 Years or Older-Retrospective International Multicenter Study. Neurosurgery 2024; 94:399-412. [PMID: 37847034 DOI: 10.1227/neu.0000000000002673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/13/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Demographic changes will lead to an increase in old patients, a population with significant risk of postoperative morbidity and mortality, requiring neurosurgery for meningiomas. This multicenter study aims to report neurofunctional status after resection of patients with supratentorial meningioma aged 80 years or older, to identify factors associated with outcome, and to validate a previously proposed decision support tool. METHODS Neurofunctional status was assessed by the Karnofsky Performance Scale (KPS). Patients were categorized in poor (KPS ≤40), intermediate (KPS 50-70), and good (KPS ≥80) preoperative subgroups. Volumetric analyses of tumor and peritumoral brain edema (PTBE) were performed; volumes were scored as small (<10 cm 3 ), medium (10-50 cm 3 ), and large (>50 cm 3 ). RESULTS The study population consisted of 262 patients, and the median age at surgery was 83.0 years. The median preoperative KPS was 70; 117 (44.7%) patients were allotted to the good, 113 (43.1%) to the intermediate, and 32 (12.2%) to the poor subgroup. The median tumor and PTBE volumes were 30.2 cm 3 and 27.3 cm 3 ; large PTBE volume correlated with poor preoperative KPS status ( P = .008). The 90-day and 1-year mortality rates were 9.0% and 13.2%, respectively. Within the first postoperative year, 101 (38.5%) patients improved, 87 (33.2%) were unchanged, and 74 (28.2%) were functionally worse (including deaths). Each year increase of age associated with 44% (23%-70%) increased risk of 90-day and 1-year mortality. In total, 111 (42.4%) patients suffered from surgery-associated complications. Maximum tumor diameter ≥5 cm (odds ratio 1.87 [1.12-3.13]) and large tumor volume (odds ratio 2.35 [1.01-5.50]) associated with increased risk of complications. Among patients with poor preoperative status and large PTBE, most (58.3%) benefited from surgery. CONCLUSION Patients with poor preoperative neurofunctional status and large PTBE most often showed postoperative improvements. The decision support tool may be of help in identifying cases that most likely benefit from surgery.
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Affiliation(s)
- Christoph Schwartz
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland
- Current Affiliations: Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
| | - Ilari Rautalin
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland
- The National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland , New Zealand
| | - Jürgen Grauvogel
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Marco Bissolo
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Waseem Masalha
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Christine Steiert
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Florian Ebel
- Department of Neurosurgery, Inselspital, Bern University-Hospital, Bern , Switzerland
- Department of Neurosurgery, University of Basel, Basel , Switzerland
| | - David Bervini
- Department of Neurosurgery, Inselspital, Bern University-Hospital, Bern , Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University-Hospital, Bern , Switzerland
| | - Thomas Eibl
- Department of Neurosurgery, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg , Germany
| | - Hans-Herbert Steiner
- Department of Neurosurgery, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg , Germany
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
- Feinberg School of Medicine, Northwestern University, Chicago , Illinois , USA
| | - Khizar R Nandoliya
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
- Feinberg School of Medicine, Northwestern University, Chicago , Illinois , USA
| | - Mark W Youngblood
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
| | - James P Chandler
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
| | - Alexander Romagna
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
- Department of Neurosurgery, München Klinik Bogenhausen, Munich , Germany
| | - Jens Lehmberg
- Department of Neurosurgery, München Klinik Bogenhausen, Munich , Germany
| | - Manuel Fuetsch
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto , ON , Canada
- Department of Spine and Scoliosis Surgery, Artemed Klinikum München Süd, Munich , Germany
| | - Julian Spears
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto , ON , Canada
| | - Arwin Rezai
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
| | - Barbara Ladisich
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
- Department of Neurosurgery, University Hospital St. Pölten, St. Pölten , Austria
| | - Matthias Demetz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck , Austria
| | - Christoph J Griessenauer
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland
| | - Miikka Korja
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland
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Früh A, Bodnar B, Nachbar M, Gradhand J, Kalinauskaite G, Rubarth K, Truckenmueller P, Kaul D, Zips D, Vajkoczy P, Senger C, Acker G. Robotic stereotactic radiosurgery for intracranial meningiomas in elderly patients: assessment of treatment efficacy and safety. Front Oncol 2024; 14:1329696. [PMID: 38347835 PMCID: PMC10860398 DOI: 10.3389/fonc.2024.1329696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024] Open
Abstract
Purpose Stereotactic radiosurgery (SRS) has been increasingly used to treat intracranial pathologies in elderly patients. The treatment efficiency of SRS has been demonstrated in meningiomas, with excellent local control. We aimed to analyze the safety of robotic SRS in elderly patients with meningiomas. Methods We searched for patients with suspected WHO °I meningioma ≥ 60 years old, who underwent CyberKnife (CK) SRS from January 2011 to December 2021. Tumor localization was categorized using the "CLASS" algorithmic scale. Tumor response was evaluated using the Response Assessment in Neuro-Oncology (RANO) criteria for meningiomas. Adverse effects were graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 and a cox regression was performed to investigate possible predictors. Results We identified 82 patients with 102 CK-treated lesions that matched the criteria for the first SRS. The median age was 70 [IQR 64-75] years, and 24.3% of the patients were aged > 75 years. Multiple lesions (up to six) were treated in 14.1% of the SRS-sessions. A previous surgery was performed in 57.3% of lesions, with a median time interval of 41 [IQR 10 - 58] months between the initial surgical procedure and the SRS treatment. In 47.9% of cases, CLASS 3 meningiomas at high-risk locations were irradiated. Single fraction radiosurgery was applied to 62.5% of the lesions, while in the remaining cases multi-session SRS with three to five fractions was used. During the median follow-up period of 15.9 months, lesion size progression was observed in 3 cases. Karnofsky Performance Status (KPS) declined by ≥ 20 points in four patients. Adverse effects occurred in 13 patients, while only four patients had CTCAE ≥2 toxicities. Hereby only one of these toxicities was persistent. The occurrence of complications was independent of age, planned target volume (PTV), high-risk localization, and surgery before SRS. Conclusion The data indicates that SRS is a safe, efficient, and convenient treatment modality for elderly patients with meningioma, even at high-risk locations.
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Affiliation(s)
- Anton Früh
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health Charité Junior Digital Clinician Scientist Program, Berlin Institute of Health Biomedical Innovation Academy, Berlin, Germany
| | - Bohdan Bodnar
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marcel Nachbar
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Julia Gradhand
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Goda Kalinauskaite
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kerstin Rubarth
- Insitute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Insitute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Truckenmueller
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Carolin Senger
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Güliz Acker
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
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Christ SM, Farhadi DS, Junzhao S, Mahadevan A, Thormann M, Lam FC, Yu X, Kasper EM. Efficacy and Safety of Primary Stereotactic Radiosurgery in Patients With Intraventricular Meningiomas. Adv Radiat Oncol 2023; 8:101098. [PMID: 36407683 PMCID: PMC9666502 DOI: 10.1016/j.adro.2022.101098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Primary stereotactic radiosurgery for intraventricular meningiomas remains controversial owing to the potential for life-threatening peritumoral edema and lack of long-term follow-up data. We review the literature and present the largest series to assess efficacy and safety of primary stereotactic radiosurgery. Methods and Materials A systematic review of the literature for primary stereotactic radiosurgery for intraventricular meningiomas was conducted. The retrospective series presented here comprised 33 patients who received primary stereotactic radiosurgery between 1999 and 2015 for a radiologically detected intraventricular meningioma. Demographic, diagnostic, and therapeutic data were extracted from medical records, imaging, and treatment-planning systems. Both standalone and pooled analysis were performed. Results The mean patient age was 53 years, and 24 patients (73%) were female. The median Karnofsky performance status pretreatment was 80 (range, 60-100). The majority of lesions were located in the lateral ventricles (n = 32; 97%). The mean tumor volume was 8.7 cm3 (range, 0.6-44.55 cm3). The mean delivered dose was 1390.9 cGy. Complete imaging follow-up data were available for 21 patients (64%). Of those, 14 (67%) showed partial or marginal response, 7 (33%) had stable disease, and no patient progressed per Response Assessment in Neuro-Oncology criteria. On last follow-up, 32 patients (97%) had significant improvement in performance status and a decrease in pretreatment symptoms. No high-grade Common Terminology Criteria for Adverse Events (version 5.0) toxicity was observed with the dose range employed. Conclusions Primary stereotactic radiosurgery for intraventricular meningiomas shows excellent treatment efficacy and low toxicity in patients with a long follow-up period. The best therapeutic algorithm remains to be established leveraging further clinical investigation.
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Abstract
Meningiomas are benign tumors that arise from the meningo-epithelial cells of the arachnoid dura and account for approximately one-third of all adult intracranial tumors. With the evolution of diagnostic imaging and the average life span increasing, meningiomas are being detected more frequently in an older population. In the elderly population, defined by patients aged 60 years or older, meningiomas are the most incidentally detected benign primary brain tumor. As a patient ages, the rate of growth of the meningioma decreases, while comorbidities increase, making the elderly population a unique group when it comes to decision-making for treatment. Treatment options for intracranial meningiomas in the elderly include surgery, radiosurgery, or observation. Although age may have some part in treatment considerations, comorbidities, overall state of health, and tumor characteristics play a more significant role in patient outcome. This chapter will investigate the incidence, evaluation, treatment, and outcomes of intracranial meningiomas in the elderly population.
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Dohm A, Diaz R, Nanda RH. The Role of Radiation Therapy in the Older Patient. Curr Oncol Rep 2021; 23:11. [PMID: 33387104 DOI: 10.1007/s11912-020-01000-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Older patients represent a unique subgroup of the cancer patient population for which the role of radiation therapy (RT) requires special consideration. This review will discuss many of these considerations as well as various radiation treatment techniques in the context of a variety of disease sites. RECENT FINDINGS Several recent studies give insight into the management of older cancer patients considering their age, performance status, comorbid conditions, quality of life, genetics, cost, and individual goals. RT plays an evolving and pivotal role in providing optimal care for this population. Recent advances in RT technique allow for more precise treatment delivery and reduced toxicity. Studies evaluating the use of radiation therapy in breast, brain, lung, prostate, rectal, pancreatic, esophageal, and oligometastatic cancer are summarized and discussed in the context of treating the older patient population. Individual age, performance and functional status, comorbid conditions, and patients' objectives and goals should all be considered when presenting treatment options for older patients and age alone should not disqualify patients from curative intent treatments. When possible, hypofractionated courses should be utilized as outcomes are often equivalent and toxicities are reduced. In many cases, RT may be preferable to other treatment options due to decreased toxicity profile and acceptable disease control.
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Affiliation(s)
- Ammoren Dohm
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Dr., Tampa, FL, 33612, USA
| | - Roberto Diaz
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Dr., Tampa, FL, 33612, USA
| | - Ronica H Nanda
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Dr., Tampa, FL, 33612, USA.
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Rueß D, Weyer V, Tutunji J, Grau S, Kocher M, Hoevels M, Treuer H, Baues C, Ruge MI. Stereotactic radiosurgery of benign brain tumors in elderly patients: evaluation of outcome and toxicity. Radiat Oncol 2020; 15:274. [PMID: 33298109 PMCID: PMC7724716 DOI: 10.1186/s13014-020-01714-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is widely accepted as a therapeutic option for meningiomas (M) and vestibular schwannomas (VS). However, data on outcome and toxicity in the elderly population have rarely been reported in detail. METHODS All patients aged ≥ 65 years with M or VS who underwent single fraction SRS were included. Patient data were analyzed in terms of clinical tumor control and incidence of early and late treatment related complications, which were graded according to the Common Terminology Criteria for Adverse Events (CTCAE), RESULTS: We identified 245 patients with benign brain tumors (129 M and 116 VS, median tumor volume 2.9 ml, range 0.1-28). The median age was 71 years (range 65-86) and the mean follow-up times were 42 months (range 2-181). Tumors were irradiated with a median dose of 12.4 Gy. Actuarial clinical and radiological tumor control rates at 2, 5, and 10 years after SRS were 98%, 93%, and 88%, respectively. Recurrent tumors after previous treatment had a higher probability of post-radiosurgical progression (p < 0.001). Permanent toxicity (CTCAE I/II) were noted in 5.7%. No severe adverse events were observed during early and late follow up, although patients > 70 years had a slightly higher risk for toxicity (p = 0.027). The presence and extent of co-morbidities had no significant influence on local tumor control or toxicity. CONCLUSION SRS provides favorable tumor control with low risk for treatment-related severe complications. Thus, SRS should always be considered as treatment option for benign intracranial tumors (meningiomas, schwannomas), especially in the group of elderly patients.
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Affiliation(s)
- Daniel Rueß
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Vera Weyer
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Juman Tutunji
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Stefan Grau
- Department of Neurosurgery, Centre of Neurosurgery, Faculty of Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Martin Kocher
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Mauritius Hoevels
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Harald Treuer
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Christian Baues
- Institute of Radiation Oncology, Faculty of Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Maximilian I Ruge
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Shimanskiy VN, Karnaukhov VV, Galkin MV, Tanyashin SV, Golanov AV, Poshataev VK, Shevchenko KV. [Treatment of petroclival meningiomas: current state of the problem]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 83:78-89. [PMID: 32031171 DOI: 10.17116/neiro20198306178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Petroclival meningiomas (PCMs) are benign, slowly growing tumors. Surgery still remains the main treatment option for them. The desire for total resection of large extended PCMs often leads to the development or worsening of persistent neurological deficits. This paper presents a review of the world literature devoted to petroclival meningiomas. We discuss the issues of PCM classification, biology, diagnosis, and selection of the optimal algorithm for their treatment.
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Affiliation(s)
| | | | - M V Galkin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - A V Golanov
- Burdenko Neurosurgical Center, Moscow, Russia
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Hasegawa H, Hanakita S, Shin M, Koga T, Takahashi W, Nomoto AK, Sakuramachi M, Saito N. Single-Fractionated Stereotactic Radiosurgery for Intracranial Meningioma in Elderly Patients: 25-Year Experience at a Single Institution. Oper Neurosurg (Hagerstown) 2019; 14:341-350. [PMID: 29554374 DOI: 10.1093/ons/opx109] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 04/07/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) has been accepted as a therapeutic option for intracranial meningiomas; however, the detailed data on outcomes in elderly patients remain unclear. OBJECTIVE To delineate the efficacy of SRS for meningiomas in elderly patients. METHODS The outcomes of 67 patients aged ≥65 yr who underwent SRS for benign intracranial meningioma (World Health Organization grade I) between 1990 and 2014 at our institution were retrospectively analyzed. The median age was 71 yr (range, 65-83 yr), and the mean and median follow-up were 62 and 52 mo (range, 7-195 mo), respectively. Tumor margins were irradiated with a median dose of 16 Gy, and the median tumor volume was 4.9 cm3 (range, 0.7-22.9 cm3). RESULTS Actuarial local tumor control rates at 3, 5, and 10 yr after SRS were 92%, 86%, and 72%, respectively. Previous surgery and parasagittal/falcine location were statistically significant predictive factors for failed tumor control. Mild or moderate adverse events were noted in 9 patients. No severe adverse event was observed. A higher margin dose was significantly associated with adverse events by univariate analysis. CONCLUSION SRS is one of the standard therapies for meningiomas in elderly patients, providing both favorable tumor control and a low risk of adverse events under minimum invasiveness.
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Affiliation(s)
- Hirotaka Hasegawa
- Department of Neurosurgery, The Uni-versity of Tokyo Hospital, Tokyo, Japan
| | - Shunya Hanakita
- Department of Neurosurgery, The Uni-versity of Tokyo Hospital, Tokyo, Japan
| | - Masahiro Shin
- Department of Neurosurgery, The Uni-versity of Tokyo Hospital, Tokyo, Japan
| | - Tomoyuki Koga
- Department of Neurosurgery, The Uni-versity of Tokyo Hospital, Tokyo, Japan
| | - Wataru Takahashi
- Department of Radiation Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Akihiro K Nomoto
- Department of Radiation Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Madoka Sakuramachi
- Department of Radiation Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The Uni-versity of Tokyo Hospital, Tokyo, Japan
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10
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Cohen-Inbar O. Geriatric brain tumor management part I: Meningioma. J Clin Neurosci 2019; 67:5-9. [DOI: 10.1016/j.jocn.2019.05.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/27/2019] [Indexed: 12/26/2022]
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Garcia CR, Slone SA, Chau M, Neltner JH, Pittman T, Villano JL. Initial management of meningiomas: Analysis of the National Cancer Database. Cancer Epidemiol 2019; 60:16-22. [PMID: 30878798 DOI: 10.1016/j.canep.2019.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Meningiomas are the most common central nervous system tumor. We describe current trends in treatment and survival using the largest cancer dataset in the United States. METHODS We analyzed the National Cancer Database from 2004 to 2014, for all patients with diagnosis of meningioma. RESULTS 201,765 cases were analyzed. Patients were most commonly White (81.9%) females (73.2%) with a median age of 64 years. Fifty percent of patients were diagnosed by imaging. Patients were reported as grade I (24.9%), grade II (5.0%), grade III (0.7%), or unknown WHO grade (69.4%). Patients diagnosed by imaging were older, received treatment in community facilities, had higher Charlson-Deyo score, and a lower rate of private insurance. Watchful waiting was the most common treatment modality (46.7%), followed by surgery only (40%). Grade II and III patients were more likely to receive therapy. Watchful waiting increased from 35.2% in 2004 to 51.4% in 2014. Younger age, male gender, private insurance, and treatment in academic facilities were determinants for receipt of surgery and/or radiation. Median survival was 12.6 years, higher in histologically confirmed cases (13.1 years). Older patients, Blacks, males, those that received radiation plus surgery, and were treated in community facilities had an increased risk of mortality. CONCLUSIONS Over half of patients were diagnosed by imaging, suggesting a higher role of clinical determinants over histological confirmation in treatment decisions. Watchful waiting as initial management is increasing. Our survival analysis favored histological confirmation. Patients receiving radiation and surgery had an increased risk of mortality.
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Affiliation(s)
- Catherine R Garcia
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Stacey A Slone
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Monica Chau
- Department of Neurology, University of Kentucky, Lexington, KY, United States
| | - Janna H Neltner
- Departments of Pathology, Division of Neuropathology, University of Kentucky, Lexington, KY, United States
| | - Thomas Pittman
- Departments of Neurosurgery, University of Kentucky, Lexington, KY, United States
| | - John L Villano
- Department of Medicine, University of Kentucky, Lexington, KY, United States; Department of Neurology, University of Kentucky, Lexington, KY, United States; Departments of Neurosurgery, University of Kentucky, Lexington, KY, United States; Markey Cancer Center, University of Kentucky, Lexington, KY, United States.
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Proton therapy for treatment of intracranial benign tumors in adults: A systematic review. Cancer Treat Rev 2018; 72:56-64. [PMID: 30530009 DOI: 10.1016/j.ctrv.2018.11.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The depth-dose distribution of a proton beam, materialized by the Bragg peak makes it an attractive radiation modality as it reduces exposure of healthy tissues to radiations, compared with photon therapy Prominent indications, based on a long-standing experience are: intraocular melanomas, low-grade skull-base and spinal canal malignancies. However, many others potential indications are under investigations such as the benign morbid conditions that are compatible with an extended life-expectancy: low grade meningiomas, paragangliomas, pituitary adenomas, neurinomas craniopharyngioma or recurrent pleomorphic adenomas. MATERIALS Given the radiation-induced risk of secondary cancer and the potential neurocognitive and functional alteration with photonic radiotherapy, we systematically analyzed the existing clinical literature about the use of proton therapy as an irradiation modality for cervical or intracranial benign tumors. The aim of this review was to report clinical outcomes of adult patients with benign intracranial or cervical tumors treated with proton therapy and to discuss about potential advantages of proton therapy over intensity modulated radiotherapy or radiosurgery. RESULTS Twenty-four studies were included. There was no randomized studies. Most studies dealt with low grade meningiomas (n = 9). Studies concerning neurinoma (n = 4), pituitary adenoma (n = 5), paraganglioma (n = 5), or craniopharyngioma (n = 1) were fewer. Whatever the indication, long term local control was systematically higher than 90% and equivalent to series with conventional radiotherapy. CONCLUSION Proton-therapy for treatment of adult benign intracranial and cervical tumors is safe. Randomized or prospective cohorts with long term cognitive evaluations are needed to assess the real place of proton-therapy in the treatment of adults benign head and neck tumors.
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Clinical outcome after high-precision radiotherapy for skull base meningiomas: Pooled data from three large German centers for radiation oncology. Radiother Oncol 2018; 127:274-279. [DOI: 10.1016/j.radonc.2018.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/02/2018] [Accepted: 03/12/2018] [Indexed: 01/18/2023]
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Jones SH, Iannone AF, Patel KS, Anchouche K, Raza SM, Anand VK, Schwartz TH. The Impact of Age on Long-Term Quality of Life After Endonasal Endoscopic Resection of Skull Base Meningiomas. Neurosurgery 2017; 79:736-745. [PMID: 27465844 DOI: 10.1227/neu.0000000000001360] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Midline ventral skull base meningiomas may be amenable to an endonasal endoscopic approach, which has theoretical advantages and may help preserve quality of life (QOL) when compared with transcranial approaches. OBJECTIVE To investigate the effect of age on QOL following endonasal endoscopic surgery, given the documented impact of age on QOL outcomes following transcranial resection of midline ventral skull base meningiomas. METHODS We reviewed a prospectively acquired database of endonasal endoscopic surgery for meningiomas. Inclusion criteria included patients who had completed long-term postoperative (≥6 months follow-up) QOL questionnaires (Anterior Skull Base Questionnaire [ASBQ] and Sino-Nasal Outcome Test [SNOT-22]). Postoperative QOL scores were also compared with preoperative QOL in a patient subset. RESULTS Long-term QOL data were available in 34 patients. Average postoperative ASBQ and SNOT-22 scores were 3.39 and 23.0, respectively. Better QOL was statistically associated with age <55 (P = .02). In a subset of patients, preoperative and postoperative ASBQ and SNOT-22 scores were compared. Only SNOT-22 scores significantly increased from 15.9 + 20.8 to 25.9 + 19.5 (P = .04). CONCLUSION We report the first study specifically evaluating long-term QOL after endonasal endoscopic resection of skull base meningiomas. QOL was decreased postoperatively in patients aged ≥55. ABBREVIATIONS ASBQ, Anterior Skull Base QuestionnaireGTR, gross total resectionQOL, quality of lifeSNOT-22, 22-item Sino-Nasal Outcome Test.
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Affiliation(s)
- Samuel H Jones
- Departments of *Neurological Surgery,‡Otolaryngology, and§Neuroscience, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
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Abstract
The incidence of brain tumors in the elderly population has increased over the last few decades. Current treatment includes surgery, radiotherapy and chemotherapy, but the optimal management of older patients with brain tumors remains a matter of debate, since aggressive radiation treatments in this population may be associated with high risks of neurological toxicity and deterioration of quality of life. For such patients, a careful clinical status assessment is mandatory both for clinical decision making and for designing randomized trials to adequately evaluate the optimal combination of radiotherapy and chemotherapy. Several randomized studies have demonstrated the efficacy and safety of chemotherapy for patients with glioblastoma or lymphoma; however, the use of radiotherapy given in association with chemotherapy or as salvage therapy remains an effective treatment option associated with survival benefit. Stereotactic techniques are increasingly used for the treatment of patients with brain metastases and benign tumors, including pituitary adenomas, meningiomas and acoustic neuromas. Although no randomized trials have proven the superiority of SRS over other radiation techniques in older patients with brain metastases or benign brain tumors, data extracted from recent randomized studies and large retrospective series suggest that SRS is an effective approach in such patients associated with survival advantages and toxicity profile similar to those observed in young adults. Future trials need to investigate the optimal radiation techniques and dose/fractionation schedules in older patients with brain tumors with regard to clinical outcomes, neurocognitive function, and quality of life.
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Affiliation(s)
- Giuseppe Minniti
- Department of Neurological Sciences, IRCCS Neuromed, Via Atinense, Pozzilli, (IS), Italy. .,UPMC San Pietro FBF, Radiotherapy Center, Rome, Italy.
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Pinzi V, Biagioli E, Roberto A, Galli F, Rizzi M, Chiappa F, Brenna G, Fariselli L, Floriani I. Radiosurgery for intracranial meningiomas: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2017; 113:122-134. [DOI: 10.1016/j.critrevonc.2017.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 01/30/2017] [Accepted: 03/08/2017] [Indexed: 10/20/2022] Open
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Abstract
OPINION STATEMENT Proton therapy is characterized by certain physical properties leading to a reduction in integral dose. As proton therapy becomes more widely available, the ongoing discussion on the real indications for proton therapy becomes more important. In the present article, data on proton therapy for tumors of the central nervous system (CNS) is summarized and discussed in view of modern photon treatments. Still today, no randomized controlled trials are available confirming any clinical benefit of protons in CNS tumors. For certain skull base lesions, such as chordomas and chondrosarcomas, dose escalation is possible with protons thus patients should be referred to a proton center if readily available. For vestibular schwannoma, at present, proton data are inferior to advanced photons. For glioma patients, early data is present for low-grade gliomas, presenting comparable results to photons; dose escalation studies for high-grade gliomas have led to significant side effects, thus strategies of dose-escalation need to rethought. For skull base meningiomas, data from stereotactic series and IMRT present excellent local control with minimal side effects, thus any improvement with protons might only be marginal. The largest benefit is considered in pediatric CNS tumors, due to the intricate radiation sensitivity of children's normal tissue, as well as the potential of long-term survivorship. Long-term data is still lacking, and even recent analyses do not all lead to a clear reduction in side effects with improvement of outcome; furthermore, clinical data seem to be comparable. However, based on the preclinical evidence, proton therapy should be evaluated in every pediatric patient. Protons most likely have a benefit in terms of reduction of long-term side effects, such as neurocognitive sequelae or secondary malignancies; moreover, dose escalation can be performed in radio-resistant histologies. Clinical data with long-term follow-up is still warranted to prove any superiority to advanced photons in CNS tumors. If available, protons should be evaluated for chordoma or chondrosarcoma of the skull base and pediatric tumors. However, many factors are important for excellent oncology care, and no time delay or inferior oncological care should be accepted for the sake of protons only.
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Affiliation(s)
- Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany. .,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.
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Spasic M, Pelargos PE, Barnette N, Bhatt NS, Lee SJ, Ung N, Gopen Q, Yang I. Incidental Meningiomas: Management in the Neuroimaging Era. Neurosurg Clin N Am 2016; 27:229-38. [PMID: 27012387 DOI: 10.1016/j.nec.2015.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The number of patient imaging studies has increased because of precautious physicians ordering scans when a vague symptom is presented; subsequently, the number of incidental meningiomas detected has increased as well. These brain tumors do not present with related symptoms and are usually small. MRI and computed tomographic scans most frequently capture incidental meningiomas. Incidental meningiomas are managed with observation, radiation, and surgical resection. Ultimately, a conservative approach is recommended, such as observing an incidental meningioma and then only radiating if the tumor displays growth, whereas a surgical approach is to be used only when proven necessary.
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Affiliation(s)
- Marko Spasic
- Department of Neurological Surgery, University of California Los Angeles, Box 956901, Los Angeles, CA 90095-6901, USA
| | - Panayiotis E Pelargos
- Department of Neurological Surgery, University of California Los Angeles, Box 956901, Los Angeles, CA 90095-6901, USA
| | - Natalie Barnette
- Department of Neurological Surgery, University of California Los Angeles, Box 956901, Los Angeles, CA 90095-6901, USA
| | - Nikhilesh S Bhatt
- Department of Neurological Surgery, University of California Los Angeles, Box 956901, Los Angeles, CA 90095-6901, USA
| | - Seung James Lee
- Department of Neurological Surgery, University of California Los Angeles, Box 956901, Los Angeles, CA 90095-6901, USA
| | - Nolan Ung
- Department of Neurological Surgery, University of California Los Angeles, Box 956901, Los Angeles, CA 90095-6901, USA
| | - Quinton Gopen
- Department of Otolaryngology - Head and Neck Surgery, University of California Los Angeles, 10833 Le Conte Ave., CHS 62-132, Los Angeles, CA 90095, USA
| | - Isaac Yang
- Department of Neurological Surgery, University of California Los Angeles, Box 956901, Los Angeles, CA 90095-6901, USA.
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Demiral S, Dincoglan F, Sager O, Gamsiz H, Uysal B, Gundem E, Elcim Y, Dirican B, Beyzadeoglu M. Hypofractionated stereotactic radiotherapy (HFSRT) for who grade I anterior clinoid meningiomas (ACM). Jpn J Radiol 2016; 34:730-737. [PMID: 27659448 DOI: 10.1007/s11604-016-0581-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/05/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE While microsurgical resection plays a central role in the management of ACMs, extensive surgery may be associated with substantial morbidity particularly for tumors in intimate association with critical structures. In this study, we evaluated the use of HFSRT in the management of ACM. MATERIALS AND METHODS A total of 22 patients with ACM were treated using HFSRT. Frameless image guided volumetric modulated arc therapy (VMAT) was performed with a 6 MV linear accelerator (LINAC). The total dose was 25 Gy delivered in five fractions over five consecutive treatment days. Local control (LC) and progression free survival (PFS) rates were calculated using the Kaplan-Meier method. Common Terminology Criteria for Adverse Events, version 4.0 was used in toxicity grading. RESULTS Out of the total 22 patients, outcomes of 19 patients with at least 36 months of periodic follow-up were assessed. Median patient age was 40 years old (range 24-77 years old). Median follow-up time was 53 months (range 36-63 months). LC and PFS rates were 100 and 89.4 % at 1 and 3 years, respectively. Only two patients (10.5 %) experienced clinical deterioration during the follow-up period. CONCLUSION LINAC-based HFSRT offers high rates of LC and PFS for patients with ACMs.
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Affiliation(s)
- Selcuk Demiral
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey.
| | - Ferrat Dincoglan
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey
| | - Omer Sager
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey
| | - Hakan Gamsiz
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey
| | - Bora Uysal
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey
| | - Esin Gundem
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey
| | - Yelda Elcim
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey
| | - Bahar Dirican
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey
| | - Murat Beyzadeoglu
- Department of Radiation Oncology, Gulhane Medical School, Ankara, Turkey
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Outcome of Elderly Patients with Meningioma after Image-Guided Stereotactic Radiotherapy: A Study of 100 Cases. BIOMED RESEARCH INTERNATIONAL 2015; 2015:868401. [PMID: 26101778 PMCID: PMC4460196 DOI: 10.1155/2015/868401] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/22/2014] [Indexed: 12/20/2022]
Abstract
Introduction. Incidence of meningioma increases with age. Surgery has been the mainstay treatment. Elderly patients, however, are at risk of severe morbidity. Therefore, we conducted this study to analyze long-term outcomes of linac-based fractionated stereotactic radiotherapy (FSRT) for older adults (aged ≥65 years) with meningioma and determine prognostic factors. Materials and Methods. Between October 1998 and March 2009, 100 patients (≥65, median age, 71 years) were treated with FSRT for meningioma. Two patients were lost to follow-up. Eight patients each had grade I and grade II meningiomas, and five patients had grade III meningiomas. The histology was unknown in 77 cases (grade 0). Results. The median follow-up was 37 months, and 3-year, 5-year, and 10-year progression-free survival (PFS) rates were 93.7%, 91.1%, and 82%. Patients with grade 0/I meningioma showed 3- and 5-year PFS rates of 98.4% and 95.6%. Patients with grade II or III meningiomas showed 3-year PFS rates of 36%. 93.8% of patients showed local tumor control. Multivariate analysis did not indicate any significant prognostic factors. Conclusion. FSRT may play an important role as a noninvasive and safe method in the clinical management of older patients with meningioma.
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Matched-pair comparisons of stereotactic body radiotherapy (SBRT) versus surgery for the treatment of early stage non-small cell lung cancer: A systematic review and meta-analysis. Radiother Oncol 2014; 112:250-5. [DOI: 10.1016/j.radonc.2014.08.031] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/10/2014] [Accepted: 08/12/2014] [Indexed: 01/04/2023]
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