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Bin Sumaida A, Shanbhag NM, Balaraj K. Evaluating the Efficacy and Safety of CyberKnife for Meningiomas: A Systematic Review. Cureus 2024; 16:e56848. [PMID: 38528994 PMCID: PMC10961244 DOI: 10.7759/cureus.56848] [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: 03/08/2024] [Accepted: 03/24/2024] [Indexed: 03/27/2024] Open
Abstract
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.
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Affiliation(s)
| | - Nandan M Shanbhag
- Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE
- Oncology/Radiation Oncology/Palliative Care, Tawam Hospital, Al Ain, ARE
| | - Khalid Balaraj
- Oncology/Radiation Oncology, Tawam Hospital, Al Ain, ARE
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2
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Li X, Lu Y, Liu L, Wang D, Zhao Y, Mei N, Geng D, Ma X, Zheng W, Duan S, Wu PY, Wen H, Tan Y, Sun X, Sun S, Li Z, Yu T, Yin B. Predicting peritumoral edema development after gamma knife radiosurgery of meningiomas using machine learning methods: a multicenter study. Eur Radiol 2023; 33:8912-8924. [PMID: 37498381 DOI: 10.1007/s00330-023-09955-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Edema is a complication of gamma knife radiosurgery (GKS) in meningioma patients that leads to a variety of consequences. The aim of this study is to construct radiomics-based machine learning models to predict post-GKS edema development. METHODS In total, 445 meningioma patients who underwent GKS in our institution were enrolled and partitioned into training and internal validation datasets (8:2). A total of 150 cases from multicenter data were included as the external validation dataset. In each case, 1132 radiomics features were extracted from each pre-treatment MRI sequence (contrast-enhanced T1WI, T2WI, and ADC maps). Nine clinical features and eight semantic features were also generated. Nineteen random survival forest (RSF) and nineteen neural network (DeepSurv) models with different combinations of radiomics, clinical, and semantic features were developed with the training dataset, and evaluated with internal and external validation. A nomogram was derived from the model achieving the highest C-index in external validation. RESULTS All the models were successfully validated on both validation datasets. The RSF model incorporating clinical, semantic, and ADC radiomics features achieved the best performance with a C-index of 0.861 (95% CI: 0.748-0.975) in internal validation, and 0.780 (95% CI: 0.673-0.887) in external validation. It stratifies high-risk and low-risk cases effectively. The nomogram based on the predicted risks provided personalized prediction with a C-index of 0.962 (95%CI: 0.951-0.973) and satisfactory calibration. CONCLUSION This RSF model with a nomogram could represent a non-invasive and cost-effective tool to predict post-GKS edema risk, thus facilitating personalized decision-making in meningioma treatment. CLINICAL RELEVANCE STATEMENT The RSF model with a nomogram built in this study represents a handy, non-invasive, and cost-effective tool for meningioma patients to assist in better counselling on the risks, appropriate individual treatment decisions, and customized follow-up plans. KEY POINTS • Machine learning models were built to predict post-GKS edema in meningioma. The random survival forest model with clinical, semantic, and ADC radiomics features achieved excellent performance. • The nomogram based on the predicted risks provides personalized prediction with a C-index of 0.962 (95%CI: 0.951-0.973) and satisfactory calibration and shows the potential to assist in better counselling, appropriate treatment decisions, and customized follow-up plans. • Given the excellent performance and convenient acquisition of the conventional sequence, we envision that this non-invasive and cost-effective tool will facilitate personalized medicine in meningioma treatment.
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Affiliation(s)
- Xuanxuan Li
- Department of Radiology, Huashan Hospital, Fudan University, 12, Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China
| | - Yiping Lu
- Department of Radiology, Huashan Hospital, Fudan University, 12, Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China
| | - Li Liu
- Department of Radiology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Dongdong Wang
- Department of Radiology, Huashan Hospital, Fudan University, 12, Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China
| | - Yajing Zhao
- Department of Radiology, Huashan Hospital, Fudan University, 12, Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China
| | - Nan Mei
- Department of Radiology, Huashan Hospital, Fudan University, 12, Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, 12, Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China
| | - Xin Ma
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu Province, China
| | - Weiwei Zheng
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | | | | | - Hongkai Wen
- Department of Computer Science, University of Warwick, Coventry, UK
| | - Yongli Tan
- Neurosurgery Gamma Knife Centre, Zibo Wanjie Cancer Hospital, Zibo City, Shandong, China
| | - Xiaogang Sun
- Neurosurgery Gamma Knife Centre, Zibo Wanjie Cancer Hospital, Zibo City, Shandong, China
| | - Shibin Sun
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhiwei Li
- Neurosurgery Department, Wenzhou Central Hospital, Wenzhou, Zhejiang Province, China
| | - Tonggang Yu
- Department of Radiology, Shanghai Gamma Hospital, Huashan Hospital, Fudan University, 518, Middle Wuzhong Rd., Xuhui District, Shanghai, 200235, China.
| | - Bo Yin
- Department of Radiology, Huashan Hospital, Fudan University, 12, Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China.
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3
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Holdaway M, Starner J, Patel RR, Salama J, Langer DJ, Ellis JA, Boockvar JA, D'Amico RS, Wernicke AG. Improvement in visual outcomes of patients with base of skull meningioma as a result of evolution in the treatment techniques in the last three decades: a systematic review. J Neurooncol 2023; 163:485-503. [PMID: 37354356 DOI: 10.1007/s11060-023-04366-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/07/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE We systematically reviewed visual outcomes over the last three decades in patients undergoing treatment for base of skull (BOS) meningiomas and provide recommendations to preserve vision. METHODS In accordance with the PRISMA guidelines for systematic reviews, a search was conducted from 6/1/2022-9/1/2022 using PubMed and Web of Science. Inclusion criteria included (1) patients treated for BOS meningiomas (2) treatment modality specified (3) specifics of surgical techniques and/or dose/fractions of radiotherapy (4) individual patient outcomes of treatment. Each study was assessed for bias based on study design and heterogeneity of results. RESULTS A total of 50 studies were included (N = 2911). When comparing improved vision versus unchanged or worsened vision, studies investigating surgery alone published from 2006 and onward had significantly better visual outcomes compared to pre-2006 studies (p = 0.02). When comparing improved vision versus unchanged or worsened vision, studies investigating combined therapy with surgery and radiation published from 2008 and onward had significantly better visual outcomes compared to pre-2008 studies (p < 0.01). Combined modality therapy was less likely to worsen vision compared to either surgery or radiation monotherapy (p < 0.01). However, surgery and radiation monotherapy were more likely to actually improve outcomes compared to combination therapy (p < 0.01). CONCLUSION For over a decade we have observed improvement in visual outcomes in patients managed for meningioma of BOS, likely attributing the innovation in microsurgical and more targeted and conformal radiation techniques. Combination therapy may be the safest option for preventing worsening of vision, but the highest rates of improving visual function are achieved through monotherapy when indicated.
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Affiliation(s)
| | - John Starner
- Department of Radiation Medicine, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 130 East 77th Street, New York, NY, 10065, USA
| | - Roshal R Patel
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Joshua Salama
- SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - David J Langer
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - Jason A Ellis
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - John A Boockvar
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - Randy S D'Amico
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - A Gabriella Wernicke
- Department of Radiation Medicine, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 130 East 77th Street, New York, NY, 10065, USA.
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA.
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Hypofractionated Radiosurgery for Large or in Critical-Site Intracranial Meningioma: Results of a Phase 2 Prospective Study. Int J Radiat Oncol Biol Phys 2023; 115:153-163. [PMID: 36075299 DOI: 10.1016/j.ijrobp.2022.08.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 08/19/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Radiosurgery is a well-known, safe, and effective technique used in the treatment of intracranial meningiomas. However, single-fraction radiosurgery can lead to high toxicity rates when large-volume or critically located lesions are targeted. Multisession-also called hypofractionated-radiosurgery (hypo-RS) might overcome these limitations. Accordingly, we carried out a prospective phase 2 trial, aiming to establish whether a fractionated RS schedule of 25 Gy in 5 fractions would be safe and effective in treating large (≥ 3 cm) and/or critically located (<3 mm from critical structures) grade 1 intracranial meningiomas. The main aim was to evaluate the safety of hypo-RS in terms of absence of adverse events. The secondary aim was to evaluate tumor response in terms of local control, defined as stability or reduction of lesion volume. METHODS AND MATERIALS We prospectively enrolled patients with diagnoses of grade 1 meningiomas, large size and/or critically located lesions, either histologically diagnosed or imaging defined. Additional inclusion criteria were signed informed consent, an age of ≥18 years, and Karnofsky Performance Status ≥70. RESULTS Between 2011 and 2016, 178 patients were consecutively enrolled. The median follow-up was 53 months (range, 4-101 months). Overall, the toxicity rate was 12.7% (21 of 166 patients). At a 5-year minimum follow-up, the patients' toxicity rates were 11.7 % (9 of 77 patients). Symptom evaluation at both 3-year and last follow-up showed an improvement in most of the patients. Five-year local tumor control was 97% (95% confidence interval, 92%-99%). CONCLUSIONS Hypo-RS schedule of 25 Gy in 5 fractions is a well-tolerated option in the treatment of large-volume and/or critically located benign meningiomas. Early results suggest favorable local control, although longer-term follow-up is needed.
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Unterberger A, Nguyen T, Duong C, Kondajji A, Kulinich D, Yang I. Meta-analysis of adjuvant radiotherapy for intracranial atypical and malignant meningiomas. J Neurooncol 2021; 152:205-216. [PMID: 33635510 DOI: 10.1007/s11060-020-03674-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/05/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Meningiomas comprise 33% of all CNS tumors. The World Health Organization (WHO) describes meningiomas as benign (BM), atypical (AM), and malignant/anaplastic (MM). High-grade meningiomas such as AMs and MMs are more aggressive, recur more frequently, and portend a worse prognosis than BMs. Currently, the standard treatment for high-grade meningiomas, especially AMs, is ill-defined. In particular, the benefit to survival outcomes of adjuvant radiotherapy post-surgical resection remains unclear. In this study, we investigated the effect of adjuvant radiotherapy (ART) post-surgery on survival outcomes compared to surgery alone for high-grade meningiomas. METHODS PRISMA guidelines were a foundation for our literature review. We screened the PubMed database for studies reporting overall survival (OS), progression free survival (PFS), and tumor recurrence for intracranial, primary AM and MMs treated with surgery+ART or surgery alone. Fixed and random effect models compared tumor control rate for AM aforementioned groups. RESULTS Mean 5-year PFS was 76.9% for AM (surgery+ART) and 55.9% for AM (surgery alone) patients. Mean 5-year OS was 81.3% and 74% for AM (surgery+ART) and AM (surgery alone) groups, respectively. Overall, the mean 5-year PFS for aggregated high-grade meningiomas AM+MM (surgery+ART) was 67.6%. Fixed effect models revealed tumor control rate as 76% for AM (surgery+ART) and 69% for AM (surgery alone) groups. ART induced toxicity incidence ranged from 12.0% to 35.5% for AM and MM patients. CONCLUSIONS Our analysis suggests that (surgery+ART) may increase PFS, OS, and tumor control rates in high-grade meningiomas. However, further studies involving surgery+ ART should be conducted to fully evaluate the ideal radiosurgical candidate, modality, and dosage.
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Affiliation(s)
- Ansley Unterberger
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA.,David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Thien Nguyen
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Courtney Duong
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Aditya Kondajji
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA.,David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Daniel Kulinich
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA.,David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Isaac Yang
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA. .,Department of Radiation Oncology, Los Angeles (UCLA), Los Angeles, CA, USA. .,Department of Head and Neck Surgery, Los Angeles (UCLA), Los Angeles, CA, USA. .,Jonsson Comprehensive Cancer Center, Los Angeles (UCLA), Los Angeles, CA, USA. .,Los Angeles Biomedical Research Institute, Los Angeles (UCLA), Los Angeles, CA, USA. .,Harbor-UCLA Medical Center, Los Angeles (UCLA), Los Angeles, CA, USA. .,David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA.
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Wilson TA, Huang L, Ramanathan D, Lopez-Gonzalez M, Pillai P, De Los Reyes K, Kumal M, Boling W. Review of Atypical and Anaplastic Meningiomas: Classification, Molecular Biology, and Management. Front Oncol 2020; 10:565582. [PMID: 33330036 PMCID: PMC7714950 DOI: 10.3389/fonc.2020.565582] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022] Open
Abstract
Although the majority of meningiomas are slow-growing and benign, atypical and anaplastic meningiomas behave aggressively with a penchant for recurrence. Standard of care includes surgical resection followed by adjuvant radiation in anaplastic and partially resected atypical meningiomas; however, the role of adjuvant radiation for incompletely resected atypical meningiomas remains debated. Despite maximum treatment, atypical, and anaplastic meningiomas have a strong proclivity for recurrence. Accumulating mutations over time, recurrent tumors behave more aggressively and often become refractory or no longer amenable to further surgical resection or radiation. Chemotherapy and other medical therapies are available as salvage treatment once standard options are exhausted; however, efficacy of these agents remains limited. This review discusses the risk factors, classification, and molecular biology of meningiomas as well as the current management strategies, novel therapeutic approaches, and future directions for managing atypical and anaplastic meningiomas.
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Affiliation(s)
| | - Lei Huang
- Loma Linda University, Loma Linda, CA, United States
| | | | | | - Promod Pillai
- Loma Linda University, Loma Linda, CA, United States
| | | | | | - Warren Boling
- Loma Linda University, Loma Linda, CA, United States
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Huang SH, Wang CC, Wei KC, Chang CN, Chuang CC, Chen HC, Lin YJ, Chen KT, Pai PC, Hsu PW. Treatment of intracranial meningioma with single-session and fractionated radiosurgery: a propensity score matching study. Sci Rep 2020; 10:18500. [PMID: 33116194 PMCID: PMC7595213 DOI: 10.1038/s41598-020-75559-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 10/14/2020] [Indexed: 11/09/2022] Open
Abstract
Single-session stereotactic radiosurgery (SSRS) is recognized as a safe and efficient treatment for meningioma. We aim to compare the long-term efficacy and safety of fractionated stereotactic radiotherapy (FSRT) with SSRS in the treatment of grade I meningioma. A total of 228 patients with 245 tumors treated with radiosurgery between March 2006 and June 2017were retrospectively evaluated. Of these, 147 (64.5%) patients were treated with SSRS. The remaining 81 patients (35.5%) were treated with a fractionated technique. Protocols to treat meningioma were classified as 12-16 Gy per fraction for SSRS and 7 Gy/fraction/day for three consecutive days to reach a total dose of 21 Gy for FSRT. In univariate and multivariate analyses, tumor volume was found to be associated with local control rate (hazard ratio = 4.98, p = 0.025). The difference in actuarial local control rate (LCR) between the SSRS and FSRT groups after propensity score matching (PSM) was not statistically significant during the 2-year (96.86% versus 100.00%, respectively; p = 0.175), 5-year (94.76% versus 97.56%, respectively; p = 0.373), and 10-year (74.40% versus 91.46%, respectively; p = 0.204) follow-up period. FSRT and SSRS were equally well-tolerated and effective for the treatment of intracranial benign meningioma during the10-year follow-up period.
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Affiliation(s)
- Sheng-Han Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Xing Street, Kwei-shan Dist., Taoyuan, 33305, Taiwan, Republic of China
| | - Chun-Chieh Wang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Kuo-Chen Wei
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Xing Street, Kwei-shan Dist., Taoyuan, 33305, Taiwan, Republic of China
| | - Cheng-Nen Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Xing Street, Kwei-shan Dist., Taoyuan, 33305, Taiwan, Republic of China
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Xing Street, Kwei-shan Dist., Taoyuan, 33305, Taiwan, Republic of China
| | - Hsien-Chih Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Keelung, Chang Gung University, Keelung, Taiwan, Republic of China
| | - Ya-Jui Lin
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Xing Street, Kwei-shan Dist., Taoyuan, 33305, Taiwan, Republic of China
| | - Ko-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Xing Street, Kwei-shan Dist., Taoyuan, 33305, Taiwan, Republic of China
| | - Ping-Ching Pai
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Peng-Wei Hsu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Xing Street, Kwei-shan Dist., Taoyuan, 33305, Taiwan, Republic of China.
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Joshi KC, Raghavan A, Muhsen B, Hsieh J, Borghei-Razavi H, Chao ST, Barnett GH, Suh JH, Neyman G, Kshettry VR, Recinos PF, Mohammadi AM, Angelov L. Fractionated Gamma Knife radiosurgery for skull base meningiomas: a single-institution experience. Neurosurg Focus 2020; 46:E8. [PMID: 31153152 DOI: 10.3171/2019.3.focus1963] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEGamma Knife radiosurgery (GKRS) has been successfully used for the treatment of intracranial meningiomas given its steep dose gradients and high-dose conformality. However, treatment of skull base meningiomas (SBMs) may pose significant risk to adjacent radiation-sensitive structures such as the cranial nerves. Fractionated GKRS (fGKRS) may decrease this risk, but until recently it has not been practical with traditional pin-based systems. This study reports the authors' experience in treating SBMs with fGKRS, using a relocatable, noninvasive immobilization system.METHODSThe authors performed a retrospective review of all patients who underwent fGKRS for SBMs between 2013 and 2018 delivered using the Extend relocatable frame system or the Icon system. Patient demographics, pre- and post-GKRS tumor characteristics, perilesional edema, prior treatment details, and clinical symptoms were evaluated. Volumetric analysis of pre-GKRS, post-GKRS, and subsequent follow-up visits was performed.RESULTSTwenty-five patients met inclusion criteria. Nineteen patients were treated with the Icon system, and 6 patients were treated with the Extend system. The mean pre-fGKRS tumor volume was 7.62 cm3 (range 4.57-13.07 cm3). The median margin dose was 25 Gy delivered in 4 (8%) or 5 (92%) fractions. The median follow-up time was 12.4 months (range 4.7-17.4 months). Two patients (9%) experienced new-onset cranial neuropathy at the first follow-up. The mean postoperative tumor volume reduction was 15.9% with 6 patients (27%) experiencing improvement of cranial neuropathy at the first follow-up. Median first follow-up scans were obtained at 3.4 months (range 2.8-4.3 months). Three patients (12%) developed asymptomatic, mild perilesional edema by the first follow-up, which remained stable subsequently.CONCLUSIONSfGKRS with relocatable, noninvasive immobilization systems is well tolerated in patients with SBMs and demonstrated satisfactory tumor control as well as limited radiation toxicity. Future prospective studies with long-term follow-up and comparison to single-session GKRS or fractionated stereotactic radiotherapy are necessary to validate these findings and determine the efficacy of this approach in the management of SBMs.
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Affiliation(s)
- Krishna C Joshi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | | | - Baha'eddin Muhsen
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Jason Hsieh
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
| | - Hamid Borghei-Razavi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Samuel T Chao
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gene H Barnett
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - John H Suh
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gennady Neyman
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Varun R Kshettry
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Pablo F Recinos
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Alireza M Mohammadi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Lilyana Angelov
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
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9
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Huo M, Foley H, Pinkham M, Shanker M, Bernard A, Jenkins M, Olson S, Hall B, Watkins T, Jones C, Foote M. Stereotactic radiotherapy for large vestibular schwannomas: Volume change following single fraction versus hypofractionated approaches. JOURNAL OF RADIOSURGERY AND SBRT 2020; 7:11-17. [PMID: 32802574 PMCID: PMC7406344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/10/2020] [Indexed: 06/11/2023]
Abstract
Hypofractionated stereotactic radiotherapy is a treatment option for large vestibular schwannomas supported by an increasing evidence. A single institution retrospective review of large (>3.5cc) vestibular schwannomas treated with hypofractionated stereotactic radiotherapy and single-session radiosurgery was conducted. Using serial follow up scans, a volumetric analysis of tumor volume change over time was performed. Vestibular schwannomas treated with hypofractionated stereotactic radiotherapy appeared to reduce in volume significantly faster than those treated with single-session radiosurgery. Cystic lesions reduced in volume faster than solid lesions. There was no significant difference in the rates of radiological and symptomatic oedema, nor subsequent dexamethasone requirement between the two treatment modalities.
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Affiliation(s)
| | - Heath Foley
- Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia
| | - Mark Pinkham
- Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia
- The University of Queensland, St Lucia, Brisbane, QLD, Australia
| | - Mihir Shanker
- Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia
- The University of Queensland, St Lucia, Brisbane, QLD, Australia
| | - Anne Bernard
- Queensland Facility for Advanced Bioinformatics, Brisbane, QLD, Australia
| | - Michael Jenkins
- Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia
| | - Sarah Olson
- Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia
- The University of Queensland, St Lucia, Brisbane, QLD, Australia
| | - Bruce Hall
- Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia
| | - Trevor Watkins
- Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia
- The University of Queensland, St Lucia, Brisbane, QLD, Australia
| | - Catherine Jones
- Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia
| | - Matthew Foote
- Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia
- The University of Queensland, St Lucia, Brisbane, QLD, Australia
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10
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Leroy HA, Tuleasca C, Reyns N, Levivier M. Radiosurgery and fractionated radiotherapy for cavernous sinus meningioma: a systematic review and meta-analysis. Acta Neurochir (Wien) 2018; 160:2367-2378. [PMID: 30393820 DOI: 10.1007/s00701-018-3711-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/16/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Radiosurgery (RS) and fractionated radiotherapy (FRT) are part of the therapeutic armamentarium for the management of cavernous sinus meningiomas. We propose a systematic review of the local tumor control and clinical outcomes after monofractionated radiosurgical treatment, including gamma knife radiosurgery (GKRS) and linear accelerator (Linac RS), or fractionated radiotherapy. MATERIALS AND METHODS The current review and meta-analysis adhered to the PRISMA guidelines. We performed a search in PubMed, Embase, and Medline based on the following mesh terms, used alone or in diverse combinations, in both title and abstract: "cavernous sinus," "meningioma," "radiosurgery," "gamma knife," "linac," "cyberknife," and "radiotherapy". We screened 425 studies. We selected 36 studies, matching all selection criteria: 24 for GK, 5 for Linac, and 7 for FRT. RESULTS Were included 2817 patients (GKRS, n = 2047, LinacRS, n = 350, FRT, n = 420). Half of patients benefited from upfront RS or FRT; the other half benefited from adjuvant RS or FRT (combined approach or tumor recurrence). The mean gross target volume (GTV) was smaller for RS as compared to FRT (p = 0.07). The median marginal doses were 13.9 Gy (range, 11 to 28) for GKRS and 14 Gy (range, 12.8 to 17.7) for LinacRS. For FRT, patients received a mean dose of 51.2 Gy (25.5 fractions, 1.85 Gy each). The mean overall follow-up values were 48 months (range, 15 to 89) for GKRS, 69 months (range, 46 to 87) for Linac, and 59.5 months (range, 33 to 83) for FRT. PFS at 5 years for GKRS, LinacRS, and FRT were respectively 93.6%, 95.6%, and 97.4% (p = 0.32, the Kruskal-Wallis). Monofractionated treatments (GKRS and LinacRS) induced more tumor volume regression than FRT (p = 0.001). Tumor recurrence or progression ranged between 3 and 5.8%, without statistically significant differences between modalities (p > 0.05). Trigeminal symptoms improved in approximately 54%, and III-IV-VI cranial nerves (CN) palsies improved in approximately 45%. After GKRS, visual acuity improved in 21% (not enough data available for other modalities). De novo deficits occurred in 5 to 7.5%. Adverse radiation effects appeared in 4.6 to 9.3% (all techniques pooled). CONCLUSION RS achieved a twice-higher rate of tumor volume regression than FRT. GKRS series reported an improvement in visual acuity in 21% of the cases. GKRS, Linac, and FRT provided similar clinical post therapeutic outcomes for the trigeminal and oculomotor CN.
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Affiliation(s)
- Henri-Arthur Leroy
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
- Department of Neurosurgery and Neuro-oncology, CHU Lille, F-59000, Lille, France.
- Department of Neurosurgery, Lille University Hospital, Rue Emile Laine, 59037, Lille Cedex, France.
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Signal Processing Laboratory (LTS-5), Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Nicolas Reyns
- Department of Neurosurgery and Neuro-oncology, CHU Lille, F-59000, Lille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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11
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Park HR, Lee JM, Park KW, Kim JH, Jeong SS, Kim JW, Chung HT, Kim DG, Paek SH. Fractionated Gamma Knife Radiosurgery as Initial Treatment for Large Skull Base Meningioma. Exp Neurobiol 2018; 27:245-255. [PMID: 30022876 PMCID: PMC6050410 DOI: 10.5607/en.2018.27.3.245] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/02/2018] [Accepted: 05/24/2018] [Indexed: 11/19/2022] Open
Abstract
We present our experience on the hypofractionated Gamma Knife radiosurgery (FGKS) for large skull base meningioma as an initial treatment. We retrospectively reviewed 23 patients with large skull base meningioma ≥10 cm3 who underwent FGKS as the initial treatment option. The mean volume of tumors prior to radiosurgery was 21.2±15.63 cm3 (range, 10.09~71.42). The median total margin dose and marginal dose per fraction were 18 Gy (range, 15~20) and 6 Gy (range, 5~6), respectively. Patients underwent three or four fractionations in consecutive days with the same Leksell® frame. The mean follow-up duration was 38 months (range, 17~78). There was no mortality. At the last follow-up, the tumor volume was stationary in 15 patients (65.2%) and had decreased in 8 patients (34.8%). Six patients who had cranial neuropathy at the time of FGKS showed improvement at the last clinical follow-up. Following FGKS, 4 patients (17%) had new cranial neuropathy. The trigeminal neuropathy was the most common and all were transient. The mean Karnofsky Performance Status score at pre-FGKS and the last clinical follow-up was 97.0±10.4 points (median, 100) and 98.6±6.9 (median, 100) points, respectively. FGKS has showed satisfactory tumor control with functional preservation for large skull base meningiomas. Further prospective studies of large cohorts with long term follow-up are required to clarify the efficacy in the tumor control and functional outcome as well as radiation toxicity.
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Affiliation(s)
- Hye Ran Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Jae Meen Lee
- Department of Neurosurgery, Pusan National University Hospital, Busan 49241, Korea
| | - Kwang-Woo Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Jung Hoon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Sang Soon Jeong
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyun-Tai Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Dong Gyu Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea.,Cancer Research Institute, Seoul National University, Seoul 03080, Korea.,Ischemia Hypoxia Disease Institute, Seoul National University, Seoul 03080, Korea
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12
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Milano MT, Sharma M, Soltys SG, Sahgal A, Usuki KY, Saenz JM, Grimm J, El Naqa I. Radiation-Induced Edema After Single-Fraction or Multifraction Stereotactic Radiosurgery for Meningioma: A Critical Review. Int J Radiat Oncol Biol Phys 2018; 101:344-357. [PMID: 29726362 DOI: 10.1016/j.ijrobp.2018.03.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE Potential dosimetric and clinicopathologic predictors of radiation-induced brain edema after single-fraction or multifraction stereotactic radiosurgery (SRS) for non-base of skull (non-BOS) meningiomas are summarized based on a systematic review of the published literature. METHODS AND MATERIALS Reviewed studies (PubMed indexed from 1998 through 2017) included all or some non-BOS meningioma patients, reported risks of edema after SRS, and correlated dosimetric and/or nondosimetric measures with the magnitude of risk. RESULTS Twenty-six studies reporting risks of edema after SRS for meningioma are reviewed. The treatment techniques as well as distribution of tumor locations, target dosing, and target volume varied across studies. Among 13 studies that included only non-BOS tumors or separately grouped non-BOS tumors, symptomatic edema occurred in 5% to 43% of patients and any edema occurred in 28% to 50%. The reported average time to onset of edema ranged from approximately 3 to 9 months in most studies. Factors reported to significantly correlate with increased risks of edema and/or symptomatic edema after SRS for meningioma include the following: greater tumor margin and/or maximum dose, greater tumor size and/or volume, non-BOS (particularly parasagittal) location, no prior resection for meningioma, and presence of pretreatment edema. Nevertheless, the extent and significance of these factors were inconsistent across studies. Potentially important dosimetric factors, such as volume of brain or tissue receiving single-fraction doses > 10 to 12 Gy, are not well studied. CONCLUSIONS The variability in risks of edema and in factors impacting those risks is likely a result of differences across studies in the clinicopathologic characteristics of the patient populations, as well as differences in treatment modalities and SRS planning and delivery parameters. More studies on pooled populations, grouped by potential prognostic factors such as tumor location and prior therapy, are needed to better understand dosimetric and nondosimetric factors predictive of edema risk after SRS for meningioma.
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Affiliation(s)
- Michael T Milano
- Department of Radiation Oncology, University of Rochester, Rochester, New York.
| | - Manju Sharma
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth Y Usuki
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - Jon-Michael Saenz
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - Jimm Grimm
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan Hospital, Ann Arbor, Michigan
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13
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Wilson HP, Price PM, Ashkan K, Edwards A, Green MM, Cross T, Beaney RP, Davies R, Sibtain A, Plowman NP, Goldsmith C. CyberKnife Radiosurgery of Skull-base Tumors: A UK Center Experience. Cureus 2018; 10:e2380. [PMID: 29805949 PMCID: PMC5969819 DOI: 10.7759/cureus.2380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The study aim was to evaluate patient individualized Cyberknife® treatment for heterogeneous skull-base tumors. Patients treated between 2009 and 2013 at The Harley Street Clinic were studied. In total, 66 patients received 15–30 Gy in 1–5 fractions to a median planning target volume (PTV) of 6.4 cc, including patients with secondary, multiple, residual and recurrent tumors, and those with tumors of uncertain pathological type. Outcome analysis was pragmatically restricted to 35 patients who had single, primary tumors treated with curative intent, and sufficient diagnostic and outcome information. Sixteen vestibular schwannoma patients with median PTV 3.8 cc (range 0.81–19.6) received 18–25 Gy in 3–5 fractions: 81% showed no acute toxicity, 50% reported no late toxicity, 71% of symptoms were stable/improved and local control was 100% at 11.4 months median follow-up. Twelve meningioma patients with median PTV of 5.5 cc (range 0.68–22.3) received 17–30 Gy in 1–5 fractions: 83% experienced no acute toxicity, 33% reported no late toxicity, 88% of symptoms were stable/improved and local control was 100% at 22.1 months median follow-up. Seven patients with other tumor types with median PTV of 24.3 cc (range 7.6–100.5) received 15–28.5 Gy in 1–5 fractions: 57% experienced no acute toxicity, 57% reported no late toxicities, 66% of symptoms were stable and local control was 43% at 14.9 months median follow-up. When tumor types were considered together, smaller tumors (PTV < 6.4 cc) showed reduced acute toxicity (p = 0.01). Overall, smaller benign tumors showed low acute toxicity, excellent local control, and good symptom management: a focus on enhanced neurological preservation may refine outcomes. For other tumor types outcome was encouraging: a focus on optimal dose and fractionation scheduling may reduce toxicity and improve local control. Individual patient experiences are detailed where valuable lessons were gained for optimizing local control and minimizing toxicity.
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Affiliation(s)
- Hannah P Wilson
- Department of Surgery and Cancer, Imperial College London, London, GBR
| | - Patricia M Price
- Department of Radiation Oncology, The Harley Street Clinic, London, GBR
| | - Keyoumars Ashkan
- Department of Radiation Oncology, The Harley Street Clinic, London, GBR
| | - Andrew Edwards
- Department of Radiation Oncology, The Harley Street Clinic, London, GBR
| | - Melanie M Green
- Department of Radiation Oncology, The Harley Street Clinic, London, GBR
| | - Timothy Cross
- Department of Radiation Oncology, The Harley Street Clinic, London, GBR
| | - Ronald P Beaney
- Department of Radiation Oncology, The Harley Street Clinic, London, GBR
| | - Rhiannon Davies
- Department of Neuro Oncology, Guy's and St. Thomas' Hospital, London, GBR
| | - Amen Sibtain
- Department of Radiation Oncology, The Harley Street Clinic, London, GBR
| | - Nick P Plowman
- Department of Radiation Oncology, The Harley Street Clinic, London, GBR
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14
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Prasad RN, Breneman JC, Struve T, Warnick RE, Pater LE. Linac-based fractionated stereotactic radiosurgery for high-risk meningioma. JOURNAL OF RADIOSURGERY AND SBRT 2018; 5:269-276. [PMID: 30538887 PMCID: PMC6255720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 07/30/2018] [Indexed: 06/09/2023]
Abstract
PURPOSE Single-fraction stereotactic radiosurgery(SRS) for meningioma has high rates of symptomatic perilesional edema in some settings. Fractionated stereotactic radiosurgery(fSRS) could decrease edema rates while maintaining tumor control. METHODS AND MATERIALS Patients at an institution were retrospectively reviewed(2013-2017). Adults receiving definitive, linear accelerator(linac)-based fSRS (25-30Gy/5 fractions) were included. fSRS was recommended for tumors at high risk for perilesional edema with SRS due to large size, prior irradiation, or proximity to organs at risk. Endpoints included rates of symptomatic, radiographically-defined perilesional edema and local control(LC). RESULTS 12 Patients with 13 meningiomas met criteria. 24-month actuarial LC and overall survival were 87% and 100%. Symptomatic, post-treatment edema was identified on follow-up MRI in 31% of cases. No variables predicted edema, but affected lesions were larger(6.82 v. 2.46cc). CONCLUSION Linac-based fSRS for meningioma has high local control and modest toxicity rates similar to SRS in the literature. Prospective studies comparing fSRS/SRS are warranted.
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Affiliation(s)
- Rahul N Prasad
- Department of Radiation Oncology at the University of Cincinnati Barrett Cancer Center, 234 Goodman Street, Cincinnati, OH 45219, USA
| | - John C Breneman
- Department of Radiation Oncology at the University of Cincinnati Barrett Cancer Center, 234 Goodman Street, Cincinnati, OH 45219, USA
| | - Timothy Struve
- Department of Radiation Oncology at the University of Cincinnati Barrett Cancer Center, 234 Goodman Street, Cincinnati, OH 45219, USA
| | - Ronald E Warnick
- Mayfield Clinic, 3825 Edwards Road, Suite 300, Cincinnati, OH 45209, USA
| | - Luke E. Pater
- Department of Radiation Oncology at the University of Cincinnati Barrett Cancer Center, 234 Goodman Street, Cincinnati, OH 45219, USA
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15
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Fossati P, Vavassori A, Deantonio L, Ferrara E, Krengli M, Orecchia R. Review of photon and proton radiotherapy for skull base tumours. Rep Pract Oncol Radiother 2016; 21:336-55. [PMID: 27330419 DOI: 10.1016/j.rpor.2016.03.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 03/01/2016] [Accepted: 03/30/2016] [Indexed: 11/18/2022] Open
Abstract
An extremely large variety of benign and malignant tumours occur at skull base; these tumour lesions are in the proximity to structures deputed to relevant physiologic functions, limiting extensive surgical approaches to this body district. Most recent progresses of surgery and radiotherapy have allowed to improve local control with acceptable rates of side effects. Various photon radiotherapy techniques are employed, including 3-dimensional conformal radiotherapy, intensity modulated radiotherapy (IMRT), stereotactic radiotherapy (SRT) and brachytherapy that is manly limited to the treatment of primary or recurrent nasopharyngeal carcinoma. Proton beam radiotherapy is also extensively used thanks to its physical characteristics. Our review, focusing in particular on meningioma, chordoma, and chondrosarcoma, suggests that proton therapy plays a major role in the treatment of malignant tumours whereas photon therapy still plays a relevant role in the treatment of benign tumour lesions.
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Affiliation(s)
- Piero Fossati
- Radiotherapy Division, IEO, Milan, Italy; Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | | | - Letizia Deantonio
- Radiotherapy Division, University Hospital "Maggiore della Carità", Novara, Italy; Department of Translational Medicine, University of "Piemonte Orientale", Novara, Italy
| | - Eleonora Ferrara
- Radiotherapy Division, University Hospital "Maggiore della Carità", Novara, Italy
| | - Marco Krengli
- Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy; Radiotherapy Division, University Hospital "Maggiore della Carità", Novara, Italy; Department of Translational Medicine, University of "Piemonte Orientale", Novara, Italy
| | - Roberto Orecchia
- Radiotherapy Division, IEO, Milan, Italy; Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
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16
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Galkin M, Golanov AV, Antipina N, Gorlachev G. Successful CyberKnife Irradiation of 1000 cc Hemicranial Meningioma: 6-year Follow-up. Cureus 2015; 7:e384. [PMID: 26719827 PMCID: PMC4689568 DOI: 10.7759/cureus.384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Meningiomas are common benign tumors with accepted treatment approaches and usually don't challenge healthcare specialists. We present a case of a huge unresectable hemicranial meningioma, which was successfully treated with hypofractionated irradiation. A male patient, sixty-two years of age, suffered for over 12 years from headaches, facial deformity, right eye displacement, right eye movement restriction, right-sided ptosis, and facial hypoesthesia. MRI and CT studies revealed an extended hemicranial meningioma. Prior to irradiation, the patient underwent four operations. Eventually, the tumor was irradiated with the CyberKnife in August 2009. Tumor volume composed 1085 cc. The mean dose of 35.3 Gy was delivered in 7 fractions (31.5 Gy at 72% isodose line comprising 95% of tumor volume). The patient was followed during six years and experienced only mild (Grade 1-2 CTCAE) acute skin and mucosa reactions. During the follow-up period, we observed target volume shrinkage for 17% (for 26% after excluding hyperostosis) and regression of intracranial hypertension signs. Due to the extreme volume and complex shape of the tumor, spreading along the surface of the hemisphere as well as an optic nerve involvement, the case presented would not be generally considered suitable for irradiation, especially for hypofractionation. We regard this clinical situation not as a treatment recommendation, but as a demonstration of the underestimated possibilities of hypofractionation regimen and CyberKnife system, both of which are limited with our habit of conventional treatments.
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Affiliation(s)
- Mikhail Galkin
- Department of Radiation Oncology, Burdenko Neurosurgical Institute
| | - Andrey V Golanov
- Department of Radiation Oncology, Burdenko Neurosurgical Institute
| | - Natalia Antipina
- Department of Radiation Oncology, Burdenko Neurosurgical Institute
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17
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Sheehan JP, Cohen-Inbar O, Ruangkanchanasetr R, Bulent Omay S, Hess J, Chiang V, Iorio-Morin C, Alonso-Basanta M, Mathieu D, Grills IS, Lee JYK, Lee CC, Dade Lunsford L. Post-radiosurgical edema associated with parasagittal and parafalcine meningiomas: a multicenter study. J Neurooncol 2015; 125:317-24. [PMID: 26329323 DOI: 10.1007/s11060-015-1911-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 08/29/2015] [Indexed: 11/29/2022]
Abstract
Stereotactic radiosurgery (SRS) offers a high degree of tumor control for benign meningiomas. However, radiosurgery can occasionally incite edema or exacerbate pre-existing peri-tumoral edema. The current study investigates the incidence, timing, and extent of edema around parasagittal or parafalcine meningiomas following SRS. A retrospective multicenter review was undertaken through participating centers in the International Gamma Knife Research Foundation (previously the North American Gamma Knife Consortium or NAGKC). All included patients had a parafalcine or parasagittal meningioma and a minimum of 6 months follow up. The median follow up was 19.6 months (6-158 months). Extent of new or worsening edema was quantitatively analyzed using volumetric analysis; edema indices were longitudinally computed following radiosurgery. Analysis was performed to identify prognostic factors for new or worsening edema. A cohort of 212 patients comprised of 51.9 % (n = 110) females, 40.1 % upfront SRS and 59.9 % underwent adjuvant SRS for post-surgical residual tumor. The median tumor volume at SRS was 5.2 ml. Venous sinus compression or invasion was demonstrated in 25 % (n = 53). The median marginal dose was 14 Gy (8-20 Gy). Tumor volume control was determined in 77.4 % (n = 164 out of 212 patients). Tumor edema progressed and then regressed in 33 % (n = 70), was stable or regressed in 52.8 % (n = 112), and progressively worsened in 5.2 % (n = 11). Tumor location, tumor volume, venous sinus invasion, margin, and maximal dose were found to be significantly related to post-SRS edema in multivariate analysis. SRS affords a high degree of tumor control for patients with parasagittal or parafalcine meningiomas. Nevertheless, SRS can lead to worsening peritumoral edema in a subset of patients such as those with larger tumors (>10 cc) and venous sinus invasion/compression. Long-term follow up is required to detect and appropriately manage post-SRS edema.
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Affiliation(s)
- Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, 22908, USA.
| | - Or Cohen-Inbar
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, 22908, USA
| | | | | | | | | | | | | | - David Mathieu
- Université de Sherbrooke and Centre de recherche du CHUS, Sherbrooke, Canada
| | | | | | - Cheng-Chia Lee
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, 22908, USA
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18
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Five-fraction Gamma Knife radiosurgery using the Extend relocatable system for benign neoplasms close to optic pathways. Pract Radiat Oncol 2015; 5:e119-e125. [DOI: 10.1016/j.prro.2014.08.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 08/23/2014] [Accepted: 08/26/2014] [Indexed: 11/20/2022]
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19
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Hadelsberg U, Nissim U, Cohen ZR, Spiegelmann R. LINAC Radiosurgery in the Management of Parasagittal Meningiomas. Stereotact Funct Neurosurg 2014; 93:10-6. [DOI: 10.1159/000368440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 09/18/2014] [Indexed: 11/19/2022]
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20
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Kuhn EN, Taksler GB, Dayton O, Loganathan A, Bourland D, Tatter SB, Laxton AW, Chan MD. Is There a Tumor Volume Threshold for Postradiosurgical Symptoms? A Single-Institution Analysis. Neurosurgery 2014; 75:536-45; discussion 544-5; quiz 545. [DOI: 10.1227/neu.0000000000000519] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Single-fraction radiosurgery may carry a higher risk of symptomatic peritumoral edema than conventionally fractionated radiotherapy, with a reported incidence of 2.5% to 37%. Previous research has shown that larger tumor volume and margin dose >14 Gy are associated with increased risk of toxicity. Parasagittal location has been associated with toxicity in some studies, but not in others.
OBJECTIVE:
To determine risk factors for and patterns of postradiosurgical symptoms (PRS).
METHODS:
This single-institution retrospective chart review included 282 stereotactic radiosurgery procedures for an intracranial meningioma from January 1999 to March 2011. PRS were assessed by using the Common Terminology Criteria for Adverse Events (Version 4.0). Statistical analyses were conducted by using the 194 procedures for which treatment plans were available.
RESULTS:
PRS were observed after 65 procedures (23%); 35 (12%) were grade 2 or higher. Posttreatment edema occurred in 21% of grade I PRS, 68% of grade II PRS, and 71% of grade III PRS. Tumor volume ≥7.1 cc (adjusted hazards ratio = 4.9, P = .02), prior external beam radiotherapy (adjusted hazards ratio = 2.6, P = .03), and histological grade (P = .005) predicted PRS. On multivariate analysis, parasagittal location was not predictive of PRS, although skull base location predicted a lower risk of symptomatic posttreatment edema (adjusted hazards ratio = 0.133, P = .02).
CONCLUSION:
In our series, prior external beam radiotherapy, tumor volume, and tumor grade are risk factors for PRS, while pretreatment edema approached statistical significance. Peritumoral edema is the predominant mechanism of significant PRS, and skull base tumors have a lower risk of posttreatment edema.
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Affiliation(s)
- Elizabeth N. Kuhn
- Department of Neurosurgery, University of Alabama at Birmingham Medical Center, Birmingham, Alabama
- Department of Neurosurgery, Wake Forest School of Medicine, Winston–Salem, North Carolina
| | | | - Orrin Dayton
- Department of Neurosurgery, University of Florida Health, Gainesville, Florida; and Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Amritraj Loganathan
- Department of Neurosurgery, Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Daniel Bourland
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Stephen B. Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Adrian W. Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Michael D. Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston–Salem, North Carolina
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