1
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Bin-Alamer O, Abou-Al-Shaar H, Singh R, Mallela AN, Legarreta A, Bowden G, Mathieu D, Perlow HK, Palmer JD, Elhamdani S, Shepard M, Liang Y, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad Eldin R, Elazzazi AH, Warnick RE, Gozal YM, Daly M, McShane B, Addis-Jackson M, Karthikeyan G, Smith S, Picozzi P, Franzini A, Kaisman-Elbaz T, Yang HC, Hess J, Templeton K, Zhang X, Wei Z, Pikis S, Mantziaris G, Simonova G, Liscak R, Peker S, Samanci Y, Chiang V, Kersh CR, Lee CC, Trifiletti DM, Niranjan A, Hadjipanayis CG, Lunsford LD, Sheehan JP. Local control and survival after stereotactic radiosurgery for colorectal cancer brain metastases: an international multicenter analysis. J Neurosurg 2024; 140:1233-1242. [PMID: 37948682 DOI: 10.3171/2023.8.jns231231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/18/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The goal of this study was to characterize local tumor control (LC), overall survival (OS), and safety of stereotactic radiosurgery for colorectal brain metastasis (CRBM). METHODS Ten international institutions participating in the International Radiosurgery Research Foundation provided data for this retrospective case series. This study included 187 patients with CRBM (281 tumors), with a median age of 62 years and 56.7% being male. Most patients (53.5%) had solitary tumors, although 10.7% had > 5 tumors. The median tumor volume was 2.7 cm3 (IQR 0.22-8.1 cm3), and the median margin dose was 20 Gy (IQR 18-22 Gy). RESULTS The 3-year LC and OS rates were 72% and 20%, respectively. Symptomatic adverse radiation effects occurred in 1.6% of patients. In the multivariate analysis, age > 65 years and tumor volume > 4.0 cm3 were significant predictors of tumor progression (hazard ratio [HR] 2.6, 95% CI 1.4-4.9; p = 0.003 and HR 3.4, 95% CI 1.7-6.9; p < 0.001, respectively). Better performance status (Karnofsky Performance Scale score > 80) was associated with a reduced risk of tumor progression (HR 0.38, 95% CI 0.19-0.73; p = 0.004). Patient age > 62 years (HR 1.6, 95% CI 1.1-2.3; p = 0.03) and the presence of active extracranial disease (HR 1.7, 95% CI 1.1-2.4; p = 0.009) were significantly associated with worse OS. CONCLUSIONS Stereotactic radiosurgery offers a high LC rate and a low rate of symptomatic adverse radiation effects for the majority of CRBMs. The OS and LC favored younger patients with high functional performance scores and inactive extracranial disease.
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Affiliation(s)
- Othman Bin-Alamer
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hussam Abou-Al-Shaar
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Raj Singh
- 2Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Arka N Mallela
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew Legarreta
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Greg Bowden
- 3Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - David Mathieu
- 4Department of Neurosurgery, Université de Sherbrooke, Quebec, Canada
| | | | - Joshua D Palmer
- Departments of5Radiation Oncology and
- 6Neurosurgery, The James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | | | - Yun Liang
- 8Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Ahmed M Nabeel
- 9Gamma Knife Center, Nasser Institute Hospital, Cairo, Egypt
- 10Department of Neurosurgery, Benha University, Benha, Egypt
| | - Wael A Reda
- 9Gamma Knife Center, Nasser Institute Hospital, Cairo, Egypt
- Departments of11Neurosurgery and
| | - Sameh R Tawadros
- 9Gamma Knife Center, Nasser Institute Hospital, Cairo, Egypt
- Departments of11Neurosurgery and
| | - Khaled Abdelkarim
- 9Gamma Knife Center, Nasser Institute Hospital, Cairo, Egypt
- 12Clinical Oncology, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- 9Gamma Knife Center, Nasser Institute Hospital, Cairo, Egypt
- Departments of11Neurosurgery and
| | - Reem Emad Eldin
- 9Gamma Knife Center, Nasser Institute Hospital, Cairo, Egypt
- 13Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Ronald E Warnick
- 15Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio
| | - Yair M Gozal
- 15Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio
| | - Megan Daly
- 16Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brendan McShane
- 16Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marcel Addis-Jackson
- 16Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gokul Karthikeyan
- 16Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sian Smith
- 16Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Piero Picozzi
- 17Department of Neurosurgery, Humanitas Research Hospital-IRCCS, Milan, Italy
| | - Andrea Franzini
- 17Department of Neurosurgery, Humanitas Research Hospital-IRCCS, Milan, Italy
| | - Tehila Kaisman-Elbaz
- 18Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Huai-Che Yang
- 19Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 20National Yang Ming Chiao Tung University School of Medicine, Hsinchu, Taiwan
| | - Judith Hess
- 21Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Kelsey Templeton
- 21Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Xiaoran Zhang
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Zhishuo Wei
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | - Gabriela Simonova
- 23Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- 23Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Selcuk Peker
- 24Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey; and
| | - Yavuz Samanci
- 24Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey; and
| | - Veronica Chiang
- 21Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Charles R Kersh
- 25Radiation Oncology, University of Virginia, Charlottesville, Virginia
| | - Cheng-Chia Lee
- 19Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 20National Yang Ming Chiao Tung University School of Medicine, Hsinchu, Taiwan
| | - Daniel M Trifiletti
- 26Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida
| | - Ajay Niranjan
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - L Dade Lunsford
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jason P Sheehan
- 21Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
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Dumot C, Mantziaris G, Dayawansa S, Peker S, Samanci Y, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Abdelsalam AR, Liscak R, May J, Mashiach E, De Nigris Vasconcellos F, Bernstein K, Kondziolka D, Speckter H, Mota R, Brito A, Bindal SK, Niranjan A, Lunsford DL, Benjamin CG, Abrantes de Lacerda Almeida T, Mao J, Mathieu D, Tourigny JN, Tripathi M, Palmer JD, Matsui J, Crooks J, Wegner RE, Shepard MJ, Vance ML, Sheehan JP. Stereotactic radiosurgery for nonfunctioning pituitary tumor: A multicenter study of new pituitary hormone deficiency. Neuro Oncol 2024; 26:715-723. [PMID: 38095431 PMCID: PMC10995514 DOI: 10.1093/neuonc/noad215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is used to treat recurrent or residual nonfunctioning pituitary neuroendocrine tumors (NFPA). The objective of the study was to assess imaging and development of new pituitary hormone deficiency. METHODS Patients treated with single-session SRS for a NFPA were included in this retrospective, multicenter study. Tumor control and new pituitary dysfunction were evaluated using Cox analysis and Kaplan-Meier curves. RESULTS A total of 869 patients (male 476 [54.8%], median age at SRS 52.5 years [Interquartile range (IQR): 18.9]) were treated using a median margin dose of 14Gy (IQR: 4) for a median tumor volume of 3.4 cc (IQR: 4.3). With a median radiological follow-up of 3.7 years (IQR: 4.8), volumetric tumor reduction occurred in 451 patients (51.9%), stability in 364 (41.9%) and 54 patients (6.2%) showed tumor progression.The probability of tumor control was 95.5% (95% Confidence Interval [CI]: 93.8-97.3) and 88.8% (95%CI: 85.2-92.5) at 5 and 10 years, respectively. A margin dose >14 Gy was associated with tumor control (Hazard Ratio [HR]:0.33, 95% CI: 0.18-0.60, P < 0.001). The probability of new hypopituitarism was 9.9% (95% CI: 7.3-12.5) and 15.3% (95% CI: 11-19.4) at 5 and 10 years, respectively. A maximum point dose >10 Gy in the pituitary stalk was associated with new pituitary hormone deficiency (HR: 3.47, 95% CI: 1.95-6.19). The cumulative probability of new cortisol, thyroid, gonadotroph, and growth hormone deficiency was 8% (95% CI: 3.9-11.9), 8.3% (95% CI: 3.9-12.5), 3.5% (95% CI: 1.7-5.2), and 4.7% (95% CI: 1.9-7.4), respectively at 10 years. CONCLUSIONS SRS provides long-term tumor control with a 15.3% risk of hypopituitarism at 10 years.
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Affiliation(s)
- Chloe Dumot
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurological Surgery, Hospices civils de Lyon, Lyon, France
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Sam Dayawansa
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Departments of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Departments of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Departments of Clinical Oncology, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Departments of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir May
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Neurosurgery, University of Miami, Miami, Florida, USA
- Department of Radiation Oncology, James Cancer Hospital at The Ohio State University, Columbus, Ohio, USA
| | - Elad Mashiach
- Department of Neurosurgery, NYU Langone, New York City, New York, USA
| | | | - Kenneth Bernstein
- Department of Radiation Oncology, NYU Langone, New York City, New York, USA
| | | | - Herwin Speckter
- Departments of Neurosurgery, Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Ruben Mota
- Departments of Neurosurgery, Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Anderson Brito
- Departments of Neurosurgery, Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Shray Kumar Bindal
- Departments of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ajay Niranjan
- Departments of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Dade L Lunsford
- Departments of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | | | - Jennifer Mao
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Neurosurgery, University of Miami, Miami, Florida, USA
- Department of Radiation Oncology, James Cancer Hospital at The Ohio State University, Columbus, Ohio, USA
| | - David Mathieu
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Jean-Nicolas Tourigny
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Manjul Tripathi
- Departments of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Joshua David Palmer
- Department of Radiation Oncology, James Cancer Hospital at The Ohio State University, Columbus, Ohio, USA
| | - Jennifer Matsui
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Neurosurgery, University of Miami, Miami, Florida, USA
- Department of Radiation Oncology, James Cancer Hospital at The Ohio State University, Columbus, Ohio, USA
| | - Joe Crooks
- College of Medecine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Rodney E Wegner
- Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Matthew J Shepard
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Mary Lee Vance
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
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3
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Mantziaris G, Dumot C, Pikis S, Peker S, Samanci Y, Ardor GD, Nabeel AM, Reda WA, Tawadros SR, Abdel Karim K, El-Shehaby AMN, Emad Eldin RM, Elazzazi AH, Sheehan D, Sheehan K, Martínez Moreno N, Martínez Álvarez R, Liscak R, May J, Tripathi M, Rajput A, Kumar N, Kaur R, Alzate JD, Kondziolka D, Dayawansa S, Sheehan JP. Pediatric cerebral cavernous malformations and stereotactic radiosurgery: an analysis of 50 cases from a multicentric study. J Neurosurg Pediatr 2024; 33:315-322. [PMID: 38181511 DOI: 10.3171/2023.11.peds23402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/16/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Cerebral cavernous malformations (CCMs) are the second most common vascular anomaly affecting the CNS in children. Although stereotactic radiosurgery (SRS) has been proposed as an alternative to microsurgery in the management of selected cases in adults, there is a paucity of studies focusing on pediatric patients. The aim of this study was to present the outcomes and associated risks of SRS in this subgroup of patients. METHODS This retrospective multicenter study included pediatric patients treated with single-session SRS for CCMs. The annual hemorrhage rate (AHR) was calculated before and after SRS in hemorrhagic lesions. The Engel classification was used to describe post-SRS epileptic control. Adverse radiation effects (AREs) and the occurrence of new neurological deficits were recorded. RESULTS The study included 50 patients (median age 15.1 [IQR 5.6] years) harboring 62 CCMs. Forty-two (84%) and 22 (44%) patients had a history of hemorrhage or epilepsy prior to SRS, respectively. The AHR from diagnosis to SRS excluding the first hemorrhage was 7.19 per 100 CCM-years, dropping to 3.15 per 100 CCM-years after treatment. The cumulative risk of first hemorrhage after SRS was 7.4% (95% CI 0%-14.3%) at 5 years and 23.6% (95% CI 0%-42.2%) at 10 years. Eight hemorrhagic events involving 6 CCMs in 6 patients were recorded in the post-SRS follow-up period; 4 patients presented with transient symptoms and 4 with permanent symptoms. Of the 22 patients with pre-SRS seizures, 11 were seizure free at the last follow-up (Engel class I), 6 experienced improvement (Engel class II or III), 5 had no improvement (Engel class IVA or IVB), and 1 experienced worsening (Engel class IVC). Radiographic AREs were documented in 14.5% (9/62) of CCMs, with 4 being symptomatic. CONCLUSIONS Single-session SRS reduces the CCM hemorrhage rate in the pediatric population and provides adequate seizure control.
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Affiliation(s)
- Georgios Mantziaris
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Chloe Dumot
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
- 2Department of Neurological Surgery, Hospices Civils de Lyon, France
| | - Stylianos Pikis
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Selcuk Peker
- 3Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- 3Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Gokce D Ardor
- 3Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Ahmed M Nabeel
- 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 5Neurosurgery Department, Faculty of Medicine, Benha University, Qalubya, Egypt
| | - Wael A Reda
- 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Departments of6Neurosurgery and
| | - Sameh R Tawadros
- 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Departments of6Neurosurgery and
| | - Khaled Abdel Karim
- 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 7Clinical Oncology, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Departments of6Neurosurgery and
| | - Reem M Emad Eldin
- 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 8Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed H Elazzazi
- 9Extended Modular Program, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Darrah Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Kimball Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | | | | | - Roman Liscak
- 11Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir May
- 11Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | | | | | - Narendra Kumar
- 13Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India; and
| | | | | | | | - Sam Dayawansa
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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4
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Garcia G, Mantziaris G, Pikis S, Dumot C, Lunsford LD, Niranjan A, Wei Z, Srinivasan P, Tang LW, Liscak R, May J, Lee CC, Yang HC, Peker S, Samanci Y, Nabeel AM, Reda WA, Tawadros SR, Abdel Karim K, El-Shehaby AMN, Emad Eldin R, Elazzazi AH, Martínez Moreno N, Martínez Álvarez R, Padmanaban V, Jareczek FJ, McInerney J, Cockroft KM, Alzate JD, Kondziolka D, Tripathi M, Sheehan JP. Repeat stereotactic radiosurgery for persistent cerebral arteriovenous malformations in pediatric patients. J Neurosurg Pediatr 2024; 33:307-314. [PMID: 38277659 DOI: 10.3171/2023.12.peds23465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/05/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE The purpose of this study was to describe the long-term outcomes and associated risks related to repeat stereotactic radiosurgery (SRS) for persistent arteriovenous malformations (AVMs) in pediatric patients. METHODS Under the auspices of the International Radiosurgery Research Foundation, this retrospective multicenter study analyzed pediatric patients who underwent repeat, single-session SRS between 1987 and 2022. The primary outcome variable was a favorable outcome, defined as nidus obliteration without hemorrhage or neurological deterioration. Secondary outcomes included rates and probabilities of hemorrhage, radiation-induced changes (RICs), and cyst or tumor formation. RESULTS The cohort included 83 pediatric patients. The median patient age was 11 years at initial SRS and 15 years at repeat SRS. Fifty-seven children (68.7%) were managed exclusively using SRS, and 42 (50.6%) experienced hemorrhage prior to SRS. Median AVM diameter and volume were substantially different between the first (25 mm and 4.5 cm3, respectively) and second (16.5 mm and 1.6 cm3, respectively) SRS, while prescription dose and isodose line remained similar. At the 5-year follow-up evaluation from the second SRS, nidus obliteration was achieved in 42 patients (50.6%), with favorable outcome in 37 (44.6%). The median time to nidus obliteration and hemorrhage was 35.5 and 38.5 months, respectively. The yearly cumulative probability of favorable outcome increased from 2.5% (95% CI 0.5%-7.8%) at 1 year to 44% (95% CI 32%-55%) at 5 years. The probability of achieving obliteration followed a similar pattern and reached 51% (95% CI 38%-62%) at 5 years. The 5-year risk of hemorrhage during the latency period after the second SRS reached 8% (95% CI 3.2%-16%). Radiographically, 25 children (30.1%) had RICs, but only 5 (6%) were symptomatic. Delayed cyst formation occurred in 7.2% of patients, with a median onset of 47 months. No radiation-induced neoplasia was observed. CONCLUSIONS The study results showed nidus obliteration in most pediatric patients who underwent repeat SRS for persistent AVMs. The risks of symptomatic RICs and latency period hemorrhage were quite low. These findings suggest that repeat radiosurgery should be considered when treating pediatric patients with residual AVM after prior SRS. Further study is needed to define the role of repeat SRS more fully in this population.
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Affiliation(s)
- Gracie Garcia
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Georgios Mantziaris
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Stylianos Pikis
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Chloe Dumot
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - L Dade Lunsford
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania
| | - Ajay Niranjan
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania
| | - Zhishuo Wei
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania
| | - Priyanka Srinivasan
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania
| | - Lilly W Tang
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania
| | - Roman Liscak
- 3Department of Stereotactic and Radiation Neurosurgery, Nemocnice Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir May
- 3Department of Stereotactic and Radiation Neurosurgery, Nemocnice Na Homolce Hospital, Prague, Czech Republic
| | - Cheng-Chia Lee
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 5School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Huai-Che Yang
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 5School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Selcuk Peker
- 6Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- 6Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Ahmed M Nabeel
- 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 8Neurosurgery Department, Benha University, Qalubiya, Egypt
| | - Wael A Reda
- 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 8Neurosurgery Department, Benha University, Qalubiya, Egypt
| | - Sameh R Tawadros
- 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 9Neurosurgery and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Khaled Abdel Karim
- 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 9Neurosurgery and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 9Neurosurgery and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Reem Emad Eldin
- 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 10Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | | | | | - Varun Padmanaban
- 12Department of Neurosurgery, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Francis J Jareczek
- 12Department of Neurosurgery, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - James McInerney
- 12Department of Neurosurgery, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Kevin M Cockroft
- 12Department of Neurosurgery, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | | | - Manjul Tripathi
- 14Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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5
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Shaaban A, Dumot C, Mantziaris G, Dayawansa S, Peker S, Samanci Y, Nabeel AM, Reda WA, Tawadros SR, Abdel Karim K, El-Shehaby AMN, Emad Eldin RM, Ragab Abdelsalam A, Liscak R, May J, Mashiach E, De Nigris Vasconcellos F, Bernstein K, Kondziolka D, Speckter H, Mota R, Brito A, Bindal SK, Niranjan A, Lunsford LD, Benjamin CG, Almeida T, Mao JZ, Mathieu D, Tourigny JN, Tripathi M, Palmer JD, Matsui J, Crooks J, Wegner RE, Shepard MJ, Sheehan JP. Long-term radiographic and endocrinological outcomes of stereotactic radiosurgery for recurrent or residual nonfunctioning pituitary adenomas. J Neurosurg 2024:1-8. [PMID: 38518285 DOI: 10.3171/2024.1.jns232285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/12/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) is used for the treatment of residual/recurrent nonfunctional pituitary adenoma (NFPA). The aim of this study was to evaluate the factors related to long-term tumor control and delayed endocrinopathies following SRS. METHODS This retrospective, multicenter study included patients with recurrent/residual NFPA treated with single-fraction SRS; they were then divided into two arms. The first arm included patients with at least 5 years of radiographic follow-up and all patients with local tumor progression. The second arm included patients with at least 5 years of endocrinological follow-up and all patients who developed endocrinopathy. Study endpoints were tumor control and new or worsening hypopituitarism after SRS and were analyzed using Cox regression and Kaplan-Meier methodology. RESULTS There were 360 patients in the tumor control arm (median age 52.7 [IQR 42.9-61] years, 193 [53.6%] males) and 351 patients in the hypopituitarism arm (median age 52.5 [IQR 43-61] years, 186 [53.0%] males). The median follow-up in the tumor control evaluation group was 7.95 (IQR 5.7-10.5) years. Tumor control rates at 5, 8, 10, and 15 years were 93% (95% CI 90%-95%), 87% (95% CI 83%-91%), 86% (95% CI 82%-90%), and 69% (95% CI 59%-81%), respectively. The median follow-up in the endocrinopathy evaluation group was 8 (IQR 5.9-10.7) years. Pituitary function preservation rates at 5, 8, 10, and 15 years were 83% (95% CI 80%-87%), 81% (95% CI 77%-85%), 78% (95% CI 74%-83%), and 71% (95% CI 63%-79%), respectively. A margin dose > 15 Gy (HR 0.8, 95% CI 0.7-0.9; p < 0.001) and a delay from last resection to SRS > 1 year (HR 0.9, 95% CI 0.7-0.9; p = 0.04) were significant factors related to tumor control in multivariable analysis. A maximum dose to the pituitary stalk ≤ 10 Gy (HR 1.1, 95% CI 1.09-1.2; p < 0.001) was associated with pituitary function preservation. New visual deficits after SRS occurred in 7 (1.94%) patients in the tumor control group and 8 (2.3%) patients in the endocrinopathy group. Other new cranial nerve deficits post-SRS occurred in 4 of 160 patients with data in the tumor control group and 3 of 140 patients with data in the endocrinopathy group. CONCLUSIONS SRS affords favorable and durable tumor control for the vast majority of NFPAs. Post-SRS hypopituitarism occurs in a minority of patients, but this risk increases with time and warrants long-term follow-up.
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Affiliation(s)
- Ahmed Shaaban
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Chloé Dumot
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
- 2Department of Neurological Surgery, Hospices Civils de Lyon, France
| | - Georgios Mantziaris
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Sam Dayawansa
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Selcuk Peker
- 3Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- 3Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Ahmed M Nabeel
- 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 5Neurosurgery Department, Faculty of Medecine, Benha University, Qalubya, Egypt
| | - Wael A Reda
- 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Departments of6Neurosurgery and
| | - Sameh R Tawadros
- 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Departments of6Neurosurgery and
| | - Khaled Abdel Karim
- 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 7Clinical Oncology, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Departments of6Neurosurgery and
| | - Reem M Emad Eldin
- 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 8Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Roman Liscak
- 10Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir May
- 10Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | | | | | | | | | - Herwin Speckter
- 13Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Ruben Mota
- 13Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Anderson Brito
- 13Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Shray K Bindal
- 14University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ajay Niranjan
- 14University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- 14University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | | | - David Mathieu
- 17Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Québec, Canada
| | - Jean-Nicolas Tourigny
- 17Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Québec, Canada
| | - Manjul Tripathi
- 18Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Joshua David Palmer
- 19Department of Radiation Oncology, The James Cancer Hospital at The Ohio State University, Columbus, Ohio
| | - Jennifer Matsui
- 19Department of Radiation Oncology, The James Cancer Hospital at The Ohio State University, Columbus, Ohio
| | - Joseph Crooks
- 20Drexel University College of Medicine, Philadelphia, Pennsylvania; and
| | - Rodney E Wegner
- 21Allegheny Health Network Cancer and Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Matthew J Shepard
- 21Allegheny Health Network Cancer and Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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Bin-Alamer O, Abou-Al-Shaar H, Mallela AN, Kallos JA, Deng H, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Peker S, Samanci Y, Lee CC, Yang HC, Mathieu D, Tripathi M, Mantziaris G, Mullapudi A, Urgosik D, Liscak R, Bowden GN, Zaki P, Wegner RE, Shepard MJ, Sheehan JP, Niranjan A, Hadjipanayis CG, Lunsford LD. Intratumoral Hemorrhage in Vestibular Schwannomas After Stereotactic Radiosurgery: Multi-Institutional Study. Neurosurgery 2024; 94:289-296. [PMID: 37581440 DOI: 10.1227/neu.0000000000002627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/01/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Intratumoral hemorrhage (ITH) in vestibular schwannoma (VS) after stereotactic radiosurgery (SRS) is exceedingly rare. The aim of this study was to define its incidence and describe its management and outcomes in this subset of patients. METHODS A retrospective multi-institutional study was conducted, screening 9565 patients with VS managed with SRS at 10 centers affiliated with the International Radiosurgery Research Foundation. RESULTS A total of 25 patients developed ITH (cumulative incidence of 0.26%) after SRS management, with a median ITH size of 1.2 cm 3 . Most of the patients had Koos grade II-IV VS, and the median age was 62 years. After ITH development, 21 patients were observed, 2 had urgent surgical intervention, and 2 were initially observed and had late resection because of delayed hemorrhagic expansion and/or clinical deterioration. The histopathology of the resected tumors showed typical, benign VS histology without sclerosis, along with chronic inflammatory cells and multiple fragments of hemorrhage. At the last follow-up, 17 patients improved and 8 remained clinically stable. CONCLUSION ITH after SRS for VS is extremely rare but has various clinical manifestations and severity. The management paradigm should be individualized based on patient-specific factors, rapidity of clinical and/or radiographic progression, ITH expansion, and overall patient condition.
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Affiliation(s)
- Othman Bin-Alamer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Arka N Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Justiss A Kallos
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Hansen Deng
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Neurosurgery Department, Benha University, Qalubya , Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Neurosurgery Department, Ain Shams University, Cairo , Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Neurosurgery Department, Ain Shams University, Cairo , Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Clinical Oncology Department, Ain Shams University, Cairo , Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Neurosurgery Department, Ain Shams University, Cairo , Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo , Egypt
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei , Taiwan
- School of Medicine, National Yang-Ming University, Taipei , Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei , Taiwan
- School of Medicine, National Yang-Ming University, Taipei , Taiwan
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Quebec , Canada
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh , India
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Abhishek Mullapudi
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Dusan Urgosik
- Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - Roman Liscak
- Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - Greg N Bowden
- Department of Neurosurgery, University of Alberta, Edmonton , Canada
| | - Peter Zaki
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh , Pennsylvania , USA
| | - Rodney E Wegner
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh , Pennsylvania , USA
| | - Matthew J Shepard
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh , Pennsylvania , USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Constantinos G Hadjipanayis
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
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7
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El-Shehaby AMN, Reda WA, Abdel Karim KM, Nabeel AM, Emad Eldin RM, Tawadros SR. Gamma Knife Radiosurgery for Third Ventricular Colloid Cysts: A Retrospective Study. Stereotact Funct Neurosurg 2024; 102:33-39. [PMID: 38185106 DOI: 10.1159/000535423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/17/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Colloid cysts often occur in the third ventricle, and they are considered benign, slowly growing lesions. They commonly present with symptoms of intracranial hypertension and rarely sudden death due to acute hydrocephalus. The management options include cerebrospinal fluid diversion procedure by shunt, endoscopic or transcranial surgical excision, and stereotactic aspiration. Complications associated with excisional procedures make them undesirable to some patients. Stereotactic radiosurgery has emerged as a noninvasive less risky treatment option. To date, there is no clinical series in the literature reporting on this treatment modality. The aim of the study was to determine the efficacy and safety of gamma knife (GK) radiosurgery in the treatment of third ventricular colloid cysts. METHODS This is a retrospective study involving 13 patients with third ventricular colloid cysts who underwent GK radiosurgery. GK radiosurgery was used as a primary treatment in all the patients. The median prescription dose was 12 Gy (11-12 Gy). The cyst volumes ranged from 0.2 to 10 cc (median 1.6 cc). RESULTS The median follow-up was 50 months (18-108 months). Cyst control was achieved in 100% of the patients. Complete or partial response was observed in 12 patients (92%). Eight patients (62%) had hydrocephalus on imaging at the initial diagnosis. Seven of these patients had VP shunt insertion before GK. One patient required shunt insertion after GK. CONCLUSION GK for third ventricular colloid cysts is a promising treatment, regarding its efficacy and safety, to be added to other treatment options. A longer follow-up is required to confirm long-term control.
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Affiliation(s)
- Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute For Research and Treatment, Cairo, Egypt
- Faculty of Medicine, Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute For Research and Treatment, Cairo, Egypt
- Faculty of Medicine, Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Khaled M Abdel Karim
- Gamma Knife Center Cairo, Nasser Institute For Research and Treatment, Cairo, Egypt
- Faculty of Medicine, Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute For Research and Treatment, Cairo, Egypt
- Neurosurgery Department, Faculty of Medicine, Benha University, Qalubya, Egypt
| | - Reem M Emad Eldin
- Gamma Knife Center Cairo, Nasser Institute For Research and Treatment, Cairo, Egypt
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute For Research and Treatment, Cairo, Egypt
- Faculty of Medicine, Neurosurgery Department, Ain Shams University, Cairo, Egypt
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8
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Niranjan A, Faramand A, Raju SS, Lee CC, Yang HC, Nabeel AM, Tawadros SR, El-Shehaby AMN, Abdelkarim K, Emad RM, Reda WA, Álvarez RM, Moreno NEM, Liscak R, May J, Mathieu D, Langlois AM, Snyder MH, Shepard MJ, Sheehan J, Muhsen BA, Borghei-Razavi H, Barnett G, Kondziolka D, Golfinos JG, Attuati L, Picozzi P, McInerney J, Daggubati LC, Warnick RE, Feliciano CE, Carro E, McCarthy D, Starke RM, Landy HJ, Cifarelli CP, Vargo JA, Flickinger J, Lunsford LD. Clinical and Imaging Outcomes After Trigeminal Schwannoma Radiosurgery: Results From a Multicenter, International Cohort Study. Neurosurgery 2024; 94:165-173. [PMID: 37523519 DOI: 10.1227/neu.0000000000002623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/19/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES An international, multicenter, retrospective study was conducted to evaluate the long-term clinical outcomes and tumor control rates after stereotactic radiosurgery (SRS) for trigeminal schwannoma. METHODS Patient data (N = 309) were collected from 14 international radiosurgery centers. The median patient age was 50 years (range 11-87 years). Sixty patients (19%) had prior resections. Abnormal facial sensation was the commonest complaint (49%). The anatomic locations were root (N = 40), ganglion (N = 141), or dumbbell type (N = 128). The median tumor volume was 4 cc (range, 0.2-30.1 cc), and median margin dose was 13 Gy (range, 10-20 Gy). Factors associated with tumor control, symptom improvement, and adverse radiation events were assessed. RESULTS The median and mean time to last follow-up was 49 and 65 months (range 6-242 months). Greater than 5-year follow-up was available for 139 patients (45%), and 50 patients (16%) had longer than 10-year follow-up. The overall tumor control rate was 94.5%. Tumors regressed in 146 patients (47.2%), remained unchanged in 128 patients (41.4%), and stabilized after initial expansion in 20 patients (6.5%). Progression-free survival rates at 3 years, 5 years, and 10 years were 91%, 86%, and 80 %. Smaller tumor volume (less than 8 cc) was associated with significantly better progression-free survival ( P = .02). Seventeen patients with sustained growth underwent further intervention at a median of 27 months (3-144 months). Symptom improvement was noted in 140 patients (45%) at a median of 7 months. In multivariate analysis primary, SRS ( P = .003) and smaller tumor volume ( P = .01) were associated with better symptom improvement. Adverse radiation events were documented in 29 patients (9%). CONCLUSION SRS was associated with long-term freedom (10 year) from additional management in 80% of patients. SRS proved to be a valuable salvage option after resection. When used as a primary management for smaller volume tumors, both clinical improvement and prevention of new deficits were optimized.
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Affiliation(s)
- Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Andrew Faramand
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Sudesh S Raju
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei , Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei , Taiwan
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Cairo , Egypt
- Neurosurgery Department, Faculty of Medicine, Benha University, Qalubya , Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Cairo , Egypt
- Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Cairo , Egypt
- Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Cairo , Egypt
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Cairo , Egypt
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo , Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Cairo , Egypt
- Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt
| | | | | | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - Jaromir May
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Québec , Canada
| | - Anne-Marie Langlois
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Québec , Canada
| | - M Harrison Snyder
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville , Virginia , USA
| | - Matthew J Shepard
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh , Pennsylvania , USA
| | - Jason Sheehan
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville , Virginia , USA
| | - Baha'eddin A Muhsen
- Department of Neurologic Surgery, Cleveland Clinic Foundation, Cleveland , Ohio , USA
| | - Hamid Borghei-Razavi
- Department of Neurologic Surgery, Cleveland Clinic Foundation, Cleveland , Ohio , USA
| | - Gene Barnett
- Department of Neurologic Surgery, Cleveland Clinic Foundation, Cleveland , Ohio , USA
| | - Douglas Kondziolka
- Departments of Neurosurgery and Medical Physics, NYU Langone Health System, New York , New York , USA
| | - John G Golfinos
- Departments of Neurosurgery and Medical Physics, NYU Langone Health System, New York , New York , USA
| | - Luca Attuati
- Department of Neurosurgery, Gamma Knife Humanitas Research Hospital, Milan , Italy
| | - Piero Picozzi
- Department of Neurosurgery, Gamma Knife Humanitas Research Hospital, Milan , Italy
| | - James McInerney
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey , Pennsylvania , USA
| | - Lekhaj Chand Daggubati
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey , Pennsylvania , USA
| | - Ronald E Warnick
- Department of Neurosurgery, Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati , Ohio , USA
| | - Caleb E Feliciano
- Department of Neurosurgery, Gamma Knife Center of Puerto Rico, San Juan , Puerto Rico
| | - Eric Carro
- Department of Neurosurgery, Gamma Knife Center of Puerto Rico, San Juan , Puerto Rico
| | - David McCarthy
- Department of Neurologic Surgery, University of Miami, Coral Gables , Florida , USA
| | - Robert M Starke
- Department of Neurologic Surgery, University of Miami, Coral Gables , Florida , USA
| | - Howard J Landy
- Department of Neurologic Surgery, University of Miami, Coral Gables , Florida , USA
| | - Christopher P Cifarelli
- Department of Neurologic Surgery, West Virginia University, Morgantown , West Virginia , USA
| | - John A Vargo
- Department of Neurologic Surgery, West Virginia University, Morgantown , West Virginia , USA
| | - John Flickinger
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
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9
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Mantziaris G, Pikis S, Dumot C, Dayawansa S, Liscak R, May J, Lee CC, Yang HC, Martínez Moreno N, Martinez Álvarez R, Lunsford LD, Niranjan A, Wei Z, Srinivasan P, Tang LW, Nabeel AM, Reda WA, Tawadros SR, Abdel Karim K, El-Shehaby AMN, Emad Eldin RM, Elazzazi AH, Peker S, Samanci Y, Padmanaban V, Jareczek FJ, McInerney J, Cockroft KM, Mathieu D, Aldakhil S, Alzate JD, Kondziolka D, Tripathi M, Palmer JD, Upadhyay R, Lin M, Zada G, Yu C, Cifarelli CP, Cifarelli DT, Shaaban A, Xu Z, Sheehan JP. Effect of cerebral arteriovenous malformation location on outcomes of repeat, single-fraction stereotactic radiosurgery: a matched-cohort analysis. J Neurosurg 2023:1-9. [PMID: 38134430 DOI: 10.3171/2023.10.jns231957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/17/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Patients with deep-seated arteriovenous malformations (AVMs) have a higher rate of unfavorable outcome and lower rate of nidus obliteration after primary stereotactic radiosurgery (SRS). The aim of this study was to evaluate and quantify the effect of AVM location on repeat SRS outcomes. METHODS This retrospective, multicenter study involved 505 AVM patients managed with repeat, single-session SRS. The endpoints were nidus obliteration, hemorrhage in the latency period, radiation-induced changes (RICs), and favorable outcome. Patients were split on the basis of AVM location into the deep (brainstem, basal ganglia, thalamus, deep cerebellum, and corpus callosum) and superficial cohorts. The cohorts were matched 1:1 on the basis of the covariate balancing score for volume, eloquence of location, and prescription dose. RESULTS After matching, 149 patients remained in each cohort. The 5-year cumulative probability rates for favorable outcome (probability difference -18%, 95% CI -30.9 to -5.8%, p = 0.004) and AVM obliteration (probability difference -18%, 95% CI -30.1% to -6.4%, p = 0.007) were significantly lower in the deep AVM cohort. No significant differences were observed in the 5-year cumulative probability rates for hemorrhage (probability difference 3%, 95% CI -2.4% to 8.5%, p = 0.28) or RICs (probability difference 1%, 95% CI -10.6% to 11.7%, p = 0.92). The median time to delayed cyst formation was longer with deep-seated AVMs (deep 62 months vs superficial 12 months, p = 0.047). CONCLUSIONS AVMs located in deep regions had significantly lower favorable outcomes and obliteration rates compared with superficial lesions after repeat SRS. Although the rates of hemorrhage in the latency period and RICs in the two cohorts were comparable, delayed cyst formation occurred later in patients with deep-seated AVMs.
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Affiliation(s)
- Georgios Mantziaris
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Stylianos Pikis
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Chloe Dumot
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
- 2Department of Neurological Surgery, Hospices Civils de Lyon, France
| | - Sam Dayawansa
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Roman Liscak
- 3Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir May
- 3Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Cheng-Chia Lee
- 4Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- 5School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Huai-Che Yang
- 4Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- 5School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | | | - L Dade Lunsford
- 7Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Ajay Niranjan
- 7Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Zhishuo Wei
- 7Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | | | - Lilly W Tang
- 7Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Ahmed M Nabeel
- 8Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 9Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Wael A Reda
- 8Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 9Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Sameh R Tawadros
- 8Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 10Neurosurgery Department and
| | - Khaled Abdel Karim
- 8Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 21Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- 8Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 10Neurosurgery Department and
| | - Reem M Emad Eldin
- 8Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 11Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Selcuk Peker
- 12Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- 12Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Varun Padmanaban
- 13Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Francis J Jareczek
- 13Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - James McInerney
- 13Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Kevin M Cockroft
- 13Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - David Mathieu
- 14Department of Neurosurgery, University of Sherbrooke, CHUS Research Center, Sherbrooke, Canada
| | - Salman Aldakhil
- 14Department of Neurosurgery, University of Sherbrooke, CHUS Research Center, Sherbrooke, Canada
| | | | | | - Manjul Tripathi
- 16Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Joshua D Palmer
- 17Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, Ohio
| | - Rituraj Upadhyay
- 17Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, Ohio
| | - Michelle Lin
- 18Department of Neurosurgery, University of Southern California, Los Angeles, California; and
| | - Gabriel Zada
- 18Department of Neurosurgery, University of Southern California, Los Angeles, California; and
| | - Cheng Yu
- 18Department of Neurosurgery, University of Southern California, Los Angeles, California; and
| | | | - Daniel T Cifarelli
- 20Radiation Oncology, West Virginia University, Morgantown, West Virginia
| | - Ahmed Shaaban
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Zhiyuan Xu
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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10
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Pikis S, Mantziaris G, Dumot C, Shaaban A, Protopapa M, Xu Z, Niranjan A, Wei Z, Srinivasan P, Tang LW, Liscak R, May J, Martinez Moreno N, Martinez Álvarez R, Peker S, Samanci Y, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Elazzazi AH, Padmanaban V, Jareczek FJ, McInerney J, Cockroft KM, Lunsford D, Sheehan JP. Third Stereotactic Radiosurgery for Residual Arteriovenous Malformations: A Retrospective Multicenter Study. Neurosurgery 2023:00006123-990000000-01004. [PMID: 38108313 DOI: 10.1227/neu.0000000000002805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There are no studies evaluating the efficacy and safety of more than 2 stereotactic radiosurgery (SRS) procedures for cerebral arteriovenous malformations (AVM). The aim of this study was to provide evidence on the role of third single-session SRS for AVM residual. METHODS This multicenter, retrospective study included patients managed with a third single-session SRS procedure for an AVM residual. The primary study outcome was defined as AVM nidus obliteration without AVM bleeding or symptomatic radiation-induced changes (RIC). Secondary outcomes evaluated were AVM obliteration, AVM hemorrhage, asymptomatic, and symptomatic RIC. RESULTS Thirty-eight patients (20/38 [52.6%] females, median age at third SRS 34.5 [IQR 20] years) were included. The median clinical follow-up was 46 (IQR 14.8) months, and 17/38 (44.7%) patients achieved favorable outcome. The 3-year and 5-year cumulative probability rates of favorable outcome were 23% (95% CI = 10%-38%) and 53% (95% CI = 29%-73%), respectively. The cumulative probability of AVM obliteration at 3 and 5 years after the third SRS was 23% (95% CI = 10%-37%) and 54% (95% CI = 29%-74%), respectively. AVM bleeding occurred in 2 patients, and 1 of them underwent subsequent resection. The cumulative probability rate of post-SRS AVM hemorrhage remained constant at 5.3% (95% CI = 1%-16%) during the first 5 years of follow-up. Transient symptomatic RIC managed conservatively occurred in 5/38 patients (13.2%) at a median time of 12.5 (IQR 22.5) months from third SRS. Radiation-induced cyst formation was noted in 1 patient (4.2%) 19 months post-SRS. No mortality, radiation-associated malignancy, or permanent symptomatic RIC was noted during follow-up. CONCLUSION A third single-session SRS to treat a residual intracranial AVM offers obliteration in most patients. The risk of RIC was low, and these effects were transient. While not often required, a third SRS can be performed in patients with persistent residual AVMs.
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Affiliation(s)
- Stylianos Pikis
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
- Department of Radiotherapy and Stereotactic Radiosurgery, Mediterraneo Hospital, Glyfada, Greece
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Chloe Dumot
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
- Department of Neurological Surgery, Hospices Civils de Lyon, Lyon, France
| | - Ahmed Shaaban
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Maria Protopapa
- Department of Radiotherapy and Stereotactic Radiosurgery, Mediterraneo Hospital, Glyfada, Greece
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zhishuo Wei
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Priyanka Srinivasan
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lilly W Tang
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir May
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | | | | | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Hesham Elazzazi
- Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Varun Padmanaban
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Francis J Jareczek
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - James McInerney
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Kevin M Cockroft
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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11
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Samanci Y, Askeroglu MO, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Legarreta A, Fernandes Cabral D, Anand S, Niranjan A, Lunsford LD, Tripathi M, Kumar N, Liščák R, May J, Lee CC, Yang HC, Martínez Moreno N, Martínez Álvarez R, Douri K, Mathieu D, Pikis S, Mantziaris G, Sheehan JP, Bernstein K, Kondziolka D, Peker S. Stereotactic Radiosurgery for Meningiomas in Children and Adolescents: An International Multi-Institutional Study. Neurosurgery 2023; 93:1066-1074. [PMID: 37235980 DOI: 10.1227/neu.0000000000002543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/05/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Meningiomas in children are uncommon, with distinct characteristics that set them apart from their adult counterparts. The existing evidence for stereotactic radiosurgery (SRS) in this patient population is limited to only case series. The objective of this study was to evaluate the safety and efficacy of SRS in managing pediatric meningiomas. METHODS Children and adolescents who had been treated for meningioma with single-fraction SRS were included in this retrospective, multicenter study. The assessment included local tumor control, any complications related to the tumor or SRS, and the emergence of new neurological deficits after SRS. RESULTS The cohort included 57 patients (male-to-female ratio 1.6:1) with a mean age of 14.4 years who were managed with single-fraction SRS for 78 meningiomas. The median radiological and clinical follow-up periods were 69 months (range, 6-268) and 71 months (range, 6-268), respectively. At the last follow-up, tumor control (tumor stability and regression) was achieved in 69 (85.9%) tumors. Post-SRS, new neurological deficits occurred in 2 (3.5%) patients. Adverse radiation effects occurred in 5 (8.8%) patients. A de novo aneurysm was observed in a patient 69 months after SRS. CONCLUSION SRS seems to be a safe and effective up-front or adjuvant treatment option for surgically inaccessible, recurrent, or residual pediatric meningiomas.
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Affiliation(s)
- Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
| | - M Orbay Askeroglu
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Benha University, Qalubya , Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Clinical Oncology, Ain Shams University, Cairo , Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo , Egypt
| | - Andrew Legarreta
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - David Fernandes Cabral
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Sharath Anand
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh , India
| | - Narendra Kumar
- Department of Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh , India
| | - Roman Liščák
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - Jaromir May
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - Cheng-Chia Lee
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
- National Yang Ming Chiao Tung University School of Medicine, Hsinchu , Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery Neurological Institute, Taipei Veteran General Hospital, Taipei , Taiwan
- National Yang Ming Chiao Tung University School of Medicine, Hsinchu , Taiwan
| | | | | | - Keiss Douri
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Quebec , Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Quebec , Canada
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Kenneth Bernstein
- Department of Radiation Oncology, New York University Langone, New York , USA
| | | | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
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12
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Bin-Alamer O, Pikis S, Mantziaris G, Abdulbaki A, Mallela AN, Lu VM, Peker S, Samanci Y, Nabeel AM, Reda WA, Tawadros SR, El-Shehaby AMN, Abdelkarim K, Emad Eldin RM, Sheehan D, Sheehan K, Liscak R, Chytka T, Tripathi M, Madan R, Speckter H, Hernández W, Barnett GH, Hori YS, Dabhi N, Aldakhil S, Mathieu D, Kondziolka D, Bernstein K, Wei Z, Niranjan A, Kersh CR, Lunsford LD, Sheehan JP, Abou-Al-Shaar H. Adjuvant Stereotactic Radiosurgery With or Without Postresection Fractionated Radiation Therapy for the Management of Clival Chordomas in Adults: An International Multicenter Case Series. Neurosurgery 2023; 93:892-900. [PMID: 37052386 DOI: 10.1227/neu.0000000000002488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/13/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Clival chordomas are challenging because of their proximity to critical neurovascular structures. Stereotactic radiosurgery (SRS) has been proven effective with minimal adverse effects. OBJECTIVE To compare the outcomes of histologically confirmed primary clival chordomas in adults who underwent SRS alone (SRS group) vs SRS after fractionated radiotherapy (FRT+SRS group). METHODS We collected patient data from 10 institutions affiliated with the International Radiosurgery Research Foundation. We evaluated overall survival, tumor control, and freedom from additional treatment (FFAT). RESULTS Fifty-seven (77%) patients were included in the SRS group and 17 (23%) in the FRT+SRS group. The median radiological follow-up was 48 months (IQR, 24-85) in the SRS group and 36 months (IQR, 25-41) in the FRT+SRS group. During the follow-up, 8 SRS and 2 FRT+SRS patients died ( P = .80). The groups had comparable 10-year overall survival (SRS: 76% vs FRT+SRS: 80%; logrank test, P = .75) and tumor control rates (SRS: 34% vs FRT+SRS: 45%; logrank test, P = .29). The SRS group had a superior 10-year FFAT rate (40%) compared with FRT+SRS (23%; logrank test, P = .02). This finding persisted in the multivariate analysis of the Cox proportional hazards illustrating a 2.40-fold increase in the relative risk of requiring additional treatment among the FRT+SRS group ( P = .04). CONCLUSION Adjuvant FRT with subsequent boost SRS did not provide superior overall survival or tumor control compared with patients who underwent adjuvant SRS alone. Further studies are required to refine management guidelines among adults with clival chordomas.
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Affiliation(s)
- Othman Bin-Alamer
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh , Pennsylvania , USA
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Arif Abdulbaki
- Department of Neurosurgery, Hannover Medical School, Hannover , Germany
| | - Arka N Mallela
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh , Pennsylvania , USA
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami School of Medicine, Miami , Florida , USA
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Benha University, Benha , Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
| | - Reem M Emad Eldin
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo , Egypt
| | - Darrah Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Kimball Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Roman Liscak
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - Tomas Chytka
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - Manjul Tripathi
- Department of Neurosurgery and Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh , India
| | - Renu Madan
- Department of Neurosurgery and Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh , India
| | - Herwin Speckter
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo , Dominican Republic
| | - Wenceslao Hernández
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo , Dominican Republic
| | - Gene H Barnett
- Department of Neurosurgery, Cleveland Clinic, Cleveland , Ohio , USA
| | - Yusuke S Hori
- Department of Neurosurgery, Cleveland Clinic, Cleveland , Ohio , USA
| | - Nisha Dabhi
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Salman Aldakhil
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Quebec , Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Quebec , Canada
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone, New York , New York , USA
| | - Kenneth Bernstein
- Department of Radiation Oncology, New York University Langone, New York , New York , USA
| | - Zhishuo Wei
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh , Pennsylvania , USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh , Pennsylvania , USA
| | - Charles R Kersh
- Department of Radiation Oncology, University of Virginia, Charlottesville , Virginia , USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh , Pennsylvania , USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh , Pennsylvania , USA
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13
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Dumot C, Mantziaris G, Pikis S, Dayawansa S, Xu Z, Samanci Y, Ardor GD, Peker S, Nabeel AM, Reda WA, Tawadros SR, Abdel Karim K, El-Shehaby AMN, Eldin RME, Elazzazi AH, Moreno NM, Álvarez RM, Liscak R, May J, Mathieu D, Tourigny JN, Tripathi M, Rajput A, Kumar N, Kaur R, Picozzi P, Franzini A, Speckter H, Hernandez W, Brito A, Warnick RE, Alzate J, Kondziolka D, Bowden GN, Patel S, Sheehan JP. Epilepsy associated with cerebral cavernous malformations managed with stereotactic radiosurgery: an international, multicenter study. J Neurol 2023; 270:5048-5056. [PMID: 37405688 DOI: 10.1007/s00415-023-11836-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) has been proposed as an alternative to resection for epilepsy control in patients with cerebral cavernous malformations (CCM) located in critical areas. METHODS This multicentric, retrospective study evaluated seizure control in patients with a solitary CCM and a history of at least one seizure prior to SRS. RESULTS 109 patients (median age at diagnosis 28.9 years, interquartile range (IQR) 16.4 years] were included. Prior to SRS, 2 (1.8%) were seizure-free without medication, 35 (32.1%) were seizure-free with antiseizure medications (ASM), 17 (15.6%) experienced an improvement of at least 50% in seizure frequency/intensity with ASM, and 55 (50.5%) experienced an improvement of less than 50% in seizure frequency/intensity with ASM. At a median follow-up of 3.5 years post-SRS (IQR: 4.9), 52 (47.7%) patients were Engel class I, 13 (11.9%) class II, 17 (15.6%) class III, 22 (20.2%) class IVA or IVB and 5 (4.6%) class IVC. For the 72 patients who had seizures despite medication prior to SRS, a delay > 1.5 years between epilepsy presentation and SRS decreased the probability to become seizure-free, HR 0.25 (95% CI 0.09-0.66), p = 0.006. The probability of achieving Engel I at the last follow-up was 23.6 (95% CI 12.7-33.1) and 31.3% (95% CI 19.3-50.8) at 2 and 5 years respectively. 27 patients were considered as having drug-resistant epilepsy. At a median follow-up of 3.1 years (IQR: 4.7), 6 (22.2%) of them were Engel I, 3 (11.1%) Engel II, 7 (25.9%) Engel III, 8 (29.6%) Engel IVA or IVB and 3 (11.1%) Engel IVC. INTERPRETATION 47.7% of patients managed with SRS for solitary CCM presenting with seizures achieved Engel class I at the last follow-up.
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Affiliation(s)
- Chloe Dumot
- Department of Neurological Surgery, University of Virginia, 1215 Lee St, Charlottesville, VA, 22908, USA
- Department of Neurological Surgery, Hospices Civils de Lyon, Lyon, France
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, 1215 Lee St, Charlottesville, VA, 22908, USA
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia, 1215 Lee St, Charlottesville, VA, 22908, USA
- Mediterraneo Hospital, Neurosurgery, Athens, Greece
| | - Sam Dayawansa
- Department of Neurological Surgery, University of Virginia, 1215 Lee St, Charlottesville, VA, 22908, USA
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia, 1215 Lee St, Charlottesville, VA, 22908, USA
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Gokce D Ardor
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department, Faculty of Medecine, Benha University, Qalubiya, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Departments of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Departments of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Khaled Abdel Karim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Departments of Clinical Oncology, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Departments of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Reem M Emad Eldin
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed H Elazzazi
- Extended Modular Program-Faculty of Medecine, Ain Shams University, Cairo, Egypt
| | | | | | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir May
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - David Mathieu
- Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Jean-Nicolas Tourigny
- Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Manjul Tripathi
- Departments of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay Rajput
- Departments of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narendra Kumar
- Departments of Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupinder Kaur
- Departments of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Piero Picozzi
- Department of Neurosurgery, Scientific Institute for Research, Hospitalization and Healthcare-IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrea Franzini
- Department of Neurosurgery, Scientific Institute for Research, Hospitalization and Healthcare-IRCCS Humanitas Research Hospital, Milan, Italy
| | - Herwin Speckter
- Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Wenceslao Hernandez
- Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Anderson Brito
- Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Ronald E Warnick
- Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, OH, USA
| | - Juan Alzate
- Department of Neurosurgery, NYU Langone, New York City, NY, USA
| | | | - Greg N Bowden
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Samir Patel
- Division of RadiationOncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, 1215 Lee St, Charlottesville, VA, 22908, USA.
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14
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El-Shehaby AMN, Reda WA, Abdel Karim KM, Nabeel AM, Emad Eldin RM, Tawadros SR. Single-session stereotactic radiosurgery for large perioptic meningiomas. J Neurosurg 2023; 139:780-789. [PMID: 36807115 DOI: 10.3171/2023.1.jns221951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/09/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Meningiomas close to the optic pathway are commonly candidates for microsurgical decompression, more so if they are large perioptic meningiomas. However, microsurgery itself imposes risk to vision, and the larger the tumor, the more the risk and the lower the possibility of postoperative visual recovery. Fractionated stereotactic radiotherapy is usually reserved for such cases. The purpose of this study was to assess the long-term efficacy and safety of single-session stereotactic radiosurgery (SRS) for large (≥ 10 cm3) perioptic intracranial benign meningiomas. METHODS This retrospective study included 175 patients with large perioptic benign meningiomas (≥ 10 cm3) who were treated by single-session SRS. Perioptic meningiomas were defined as meningiomas touching, compressing, or within 3 mm of the optic pathway. The median tumor volume was 15 cm3 (range 10-57.3 cm3, IQR 8.4 cm3). The median prescription dose was 12 Gy (range 9-14 Gy, IQR 1 Gy). RESULTS The median follow-up period was 72 months (range 13-217 months, IQR 65 months). The tumor control rate was 92%. The progression-free survival rates at 5 and 10 years were 97% and 80%, respectively. Favorable (better/stable) visual outcome was reported in 169 patients (97%) and unfavorable (worse) outcome in 6 patients (3%). Temporary adverse radiation effects were observed in 21 patients (12%), but only 7 patients (4%) were symptomatic. Sixty-three patients had a blind/nonuseful eye according to the pretreatment visual field examination. Visual improvement was observed in the blind/nonuseful eye in 17 patients (27%), while vision remained unchanged in 46 patients (73%). Ocular nerve palsy improved in 36 patients (61%). Tumor shrinkage was not a prerequisite for cranial nerve improvement. CONCLUSIONS SRS provides an effective and safe treatment option for large perioptic meningiomas.
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Affiliation(s)
- Amr M N El-Shehaby
- 1Gamma Knife Center Cairo
- 2Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo
| | - Wael A Reda
- 1Gamma Knife Center Cairo
- 2Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo
| | - Khaled M Abdel Karim
- 1Gamma Knife Center Cairo
- 3Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo
| | - Ahmed M Nabeel
- 1Gamma Knife Center Cairo
- 5Neurosurgery Department, Faculty of Medicine, Benha University, Qalubya, Egypt
| | - Reem M Emad Eldin
- 1Gamma Knife Center Cairo
- 4Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo; and
| | - Sameh R Tawadros
- 1Gamma Knife Center Cairo
- 2Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo
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15
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Singh R, Bowden G, Mathieu D, Perlow HK, Palmer JD, Elhamdani S, Shepard M, Liang Y, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Elazzazi AH, Warnick RE, Gozal YM, Daly M, McShane B, Addis-Jackson M, Karthikeyan G, Smith S, Picozzi P, Franzini A, Kaisman-Elbaz T, Yang HC, Wei Z, Legarreta A, Hess J, Templeton K, Pikis S, Mantziaris G, Simonova G, Liscak R, Peker S, Samanci Y, Chiang V, Niranjan A, Kersh CR, Lee CC, Trifiletti DM, Lunsford LD, Sheehan JP. Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries: An International Multicenter Analysis. Neurosurgery 2023; 93:592-598. [PMID: 36942965 DOI: 10.1227/neu.0000000000002456] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/17/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND There are limited data regarding outcomes for patients with gastrointestinal (GI) primaries and brain metastases treated with stereotactic radiosurgery (SRS). OBJECTIVE To examine clinical outcomes after SRS for patients with brain metastases from GI primaries and evaluate potential prognostic factors. METHODS The International Radiosurgery Research Foundation centers were queried for patients with brain metastases from GI primaries managed with SRS. Primary outcomes were local control (LC) and overall survival (OS). Kaplan-Meier analysis was used for univariate analysis (UVA) of prognostic factors. Factors significant on UVA were evaluated with a Cox multivariate analysis proportional hazards model. Logistic regressions were used to examine correlations with RN. RESULTS We identified 263 eligible patients with 543 brain metastases. Common primary sites were rectal (31.2%), colon (31.2%), and esophagus (25.5%) with a median age of 61.6 years (range: 37-91.4 years) and a median Karnofsky performance status (KPS) of 90% (range: 40%-100%). One-year and 2-year LC rates were 83.5% (95% CI: 78.9%-87.1%) and 73.0% (95% CI: 66.4%-78.5%), respectively. On UVA, age >65 years ( P = .001), dose <20 Gy ( P = .006) for single-fraction plans, KPS <90% ( P < .001), and planning target volume ≥2cc ( P = .007) were associated with inferior LC. All factors other than dose were significant on multivariate analysis ( P ≤ .002). One-year and 2-year OS rates were 68.0% (95% CI: 61.5%-73.6%) and 31.2% (95% CI: 24.6%-37.9%), respectively. Age > 65 years ( P = .006), KPS <90% ( P = .005), and extracranial metastases ( P = .05) were associated with inferior OS. CONCLUSION SRS resulted in comparable LC with common primaries. Age and KPS were associated with both LC and OS with planning target volume and extracranial metastases correlating with LC and OS, respectively. These factors should be considered in GI cancer patient selection for SRS.
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Affiliation(s)
- Raj Singh
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Greg Bowden
- Department of Neurosurgery, University of Alberta, Edmonton, Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Sherbrooke, Canada
| | - Haley K Perlow
- Departments of Radiation Oncology and Neurosurgery, The James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Joshua D Palmer
- Departments of Radiation Oncology and Neurosurgery, The James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Shahed Elhamdani
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Matthew Shepard
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Yun Liang
- Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Ahmed M Nabeel
- Department of Neurosurgery, Gamma Knife Center, Nasser Institute Hospital, Cairo, Egypt
- Department of Neurosurgery, Benha University, Banha, Egypt
| | - Wael A Reda
- Department of Neurosurgery, Gamma Knife Center, Nasser Institute Hospital, Cairo, Egypt
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Department of Neurosurgery, Gamma Knife Center, Nasser Institute Hospital, Cairo, Egypt
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Department of Neurosurgery, Gamma Knife Center, Nasser Institute Hospital, Cairo, Egypt
- Department of Clinical Oncology, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Department of Neurosurgery, Gamma Knife Center, Nasser Institute Hospital, Cairo, Egypt
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Reem M Emad
- Department of Neurosurgery, Gamma Knife Center, Nasser Institute Hospital, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Giza City, Egypt
| | | | - Ronald E Warnick
- Department of Neurosurgery, Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio, USA
| | - Yair M Gozal
- Department of Neurosurgery, Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio, USA
| | - Megan Daly
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brendan McShane
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marcel Addis-Jackson
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gokul Karthikeyan
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sian Smith
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Piero Picozzi
- Department of Neurosurgery, Humanitas Research Hospital - IRCCS, Rozzano, Italy
| | - Andrea Franzini
- Department of Neurosurgery, Humanitas Research Hospital - IRCCS, Rozzano, Italy
| | - Tehila Kaisman-Elbaz
- Department of Neurosurgery, Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, China
- Department of Neurosurgery, National Yang Ming Chiao Tung University School of Medicine, Taipei, China
| | - Zhishuo Wei
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Andrew Legarreta
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Judith Hess
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Kelsey Templeton
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Gabriela Simonova
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czechia
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czechia
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Veronica Chiang
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Charles R Kersh
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, China
- Department of Neurosurgery, National Yang Ming Chiao Tung University School of Medicine, Taipei, China
| | - Daniel M Trifiletti
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
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16
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Dumot C, Mantziaris G, Dayawansa S, Xu Z, Pikis S, Peker S, Samanci Y, Ardor GD, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad Eldin RM, Elazzazi AH, Moreno NM, Martínez Álvarez R, Liscak R, May J, Mathieu D, Tourigny JN, Tripathi M, Rajput A, Kumar N, Kaur R, Picozzi P, Franzini A, Speckter H, Hernandez W, Brito A, Warnick RE, Alzate J, Kondziolka D, Bowden GN, Patel S, Sheehan J. Stereotactic radiosurgery for haemorrhagic cerebral cavernous malformation: a multi-institutional, retrospective study. Stroke Vasc Neurol 2023:svn-2023-002380. [PMID: 37586775 DOI: 10.1136/svn-2023-002380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/02/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Cerebral cavernous malformations (CCMs) frequently manifest with haemorrhages. Stereotactic radiosurgery (SRS) has been employed for CCM not suitable for resection. Its effect on reducing haemorrhage risk is still controversial. The aim of this study was to expand on the safety and efficacy of SRS for haemorrhagic CCM. METHODS This retrospective multicentric study included CCM with at least one haemorrhage treated with single-session SRS. The annual haemorrhagic rate (AHR) was calculated before and after SRS. Recurrent event analysis and Cox regression were used to evaluate factors associated with haemorrhage. Adverse radiation effects (AREs) and occurrence of new neurological deficits were recorded. RESULTS The study included 381 patients (median age: 37.5 years (Q1-Q3: 25.8-51.9) with 414 CCMs. The AHR from diagnosis to SRS excluding the first haemorrhage was 11.08 per 100 CCM-years and was reduced to 2.7 per 100 CCM-years after treatment. In recurrent event analysis, SRS, HR 0.27 (95% CI 0.17 to 0.44), p<0.0001 was associated with a decreased risk of haemorrhage, and the presence of developmental venous anomaly (DVA) with an increased risk, HR 1.60 (95% CI 1.07 to 2.40), p=0.022. The cumulative risk of first haemorrhage after SRS was 9.4% (95% CI 6% to 12.6%) at 5 years and 15.6% (95% CI% 9 to 21.8%) at 10 years. Margin doses> 13 Gy, HR 2.27 (95% CI 1.20 to 4.32), p=0.012 and the presence of DVA, HR 2.08 (95% CI 1.00 to 4.31), p=0.049 were factors associated with higher probability of post-SRS haemorrhage. Post-SRS haemorrhage was symptomatic in 22 out of 381 (5.8%) patients, presenting with transient (15/381) or permanent (7/381) neurological deficit. ARE occurred in 11.1% (46/414) CCM and was responsible for transient neurological deficit in 3.9% (15/381) of the patients and permanent deficit in 1.1% (4/381) of the patients. Margin doses >13 Gy and CCM volume >0.7 cc were associated with increased risk of ARE. CONCLUSION Single-session SRS for haemorrhagic CCM is associated with a decrease in haemorrhage rate. Margin doses ≤13 Gy seem advisable.
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Affiliation(s)
- Chloe Dumot
- Department of Neurological Surgery, Hospices Civils de Lyon, Lyon, France
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Sam Dayawansa
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Gokce D Ardor
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Ahmed M Nabeel
- Gamma-knife Center, Nasser institute Hospital, Cairo, Egypt
- Neurosurgery Department, Benha University, Benha, Egypt
| | - Wael A Reda
- Gamma-knife Center, Nasser institute Hospital, Cairo, Egypt
- Departments of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma-knife Center, Nasser institute Hospital, Cairo, Egypt
- Departments of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma-knife Center, Nasser institute Hospital, Cairo, Egypt
- Department of Clinical Oncology, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma-knife Center, Nasser institute Hospital, Cairo, Egypt
- Departments of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Reem M Emad Eldin
- Gamma-knife Center, Nasser institute Hospital, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Giza, Egypt
| | - Ahmed H Elazzazi
- Faculty of Medicine, Extended Modular Program, Ain Shams University, Cairo, Egypt
| | | | | | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir May
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - David Mathieu
- Neurosurgery, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jean-Nicolas Tourigny
- Neurosurgery, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | | | - Narendra Kumar
- Radiation Therapy, PGIMER, Chandigarh, Chandigarh, India
| | | | - Piero Picozzi
- Neurosurgery, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Andrea Franzini
- Neurosurgery, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Herwin Speckter
- Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Wenceslao Hernandez
- Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Anderson Brito
- Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Ronald E Warnick
- Gamma Knife Center, Mayfield Clinic, The Jewish Hospital - Mercy Health, Cincinnati, Ohio, USA
| | - Juan Alzate
- Neurosurgery, NYU Langone Health, New York, New York, USA
| | | | - Greg N Bowden
- Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Samir Patel
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
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17
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Mantziaris G, Pikis S, Dumot C, Dayawansa S, Liščák R, May J, Lee CC, Yang HC, Martinez Moreno N, Martinez Álvarez R, Lunsford LD, Niranjan A, Wei Z, Srinivasan P, Tang LW, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Hesham Elazzazi A, Peker S, Samanci Y, Padmanaban V, Jareczek FJ, McInerney J, Cockroft KM, Mathieu D, Aldakhil S, Alzate JD, Kondziolka D, Tripathi M, Palmer JD, Upadhyay R, Lin M, Zada G, Yu C, Cifarelli CP, Cifarelli DT, Xu Z, Sheehan JP. Outcome Evaluation of Repeat Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations. Stroke 2023. [PMID: 37350270 DOI: 10.1161/strokeaha.123.042515] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Repeat stereotactic radiosurgery (SRS) for persistent cerebral arteriovenous malformation (AVM) has generally favorable patient outcomes. However, reporting studies are limited by small patient numbers and single-institution biases. The purpose of this study was to provide the combined experience of multiple centers, in an effort to fully define the role of repeat SRS for patients with arteriovenous malformation. METHODS This multicenter, retrospective cohort study included patients treated with repeat, single-fraction SRS between 1987 and 2022. Follow-up began at repeat SRS. The primary outcome was a favorable patient outcome, defined as a composite of nidus obliteration in the absence of hemorrhage or radiation-induced neurological deterioration. Secondary outcomes were obliteration, hemorrhage risk, and symptomatic radiation-induced changes. Competing risk analysis was performed to compute yearly rates and identify predictors for each outcome. RESULTS The cohort comprised 505 patients (254 [50.3%] males; median [interquartile range] age, 34 [15] years) from 14 centers. The median clinical and magnetic resonance imaging follow-up was 52 (interquartile range, 61) and 47 (interquartile range, 52) months, respectively. At last follow-up, favorable outcome was achieved by 268 (53.1%) patients (5-year probability, 50% [95% CI, 45%-55%]) and obliteration by 300 (59.4%) patients (5-year probability, 56% [95% CI, 51%-61%]). Twenty-eight patients (5.6%) experienced post-SRS hemorrhage with an annual incidence rate of 1.38 per 100 patient-years. Symptomatic radiation-induced changes were evident in 28 (5.6%) patients, with most occurring in the first 3 years. Larger nidus volumes (between 2 and 4 cm3, subdistribution hazard, 0.61 [95% CI, 0.44-0.86]; P=0.005; >4 cm3, subdistribution hazard, 0.47 [95% CI, 0.32-0.7]; P<0.001) and brainstem/basal ganglia involvement (subdistribution hazard, 0.6 [95% CI, 0.45-0.81]; P<0.001) were associated with reduced probability of favorable outcome. CONCLUSIONS Repeat SRS confers reasonable obliteration rates with a low complication risk. With most complications occurring in the first 3 years, extending the latency period to 5 years generally increases the rate of favorable patient outcomes and reduces the necessity of a third intervention.
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Affiliation(s)
- Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, Charlottesville (G.M., S. Pikis, C.D., S.D., Z.X., J.P.S.)
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia, Charlottesville (G.M., S. Pikis, C.D., S.D., Z.X., J.P.S.)
| | - Chloe Dumot
- Department of Neurological Surgery, University of Virginia, Charlottesville (G.M., S. Pikis, C.D., S.D., Z.X., J.P.S.)
| | - Samantha Dayawansa
- Department of Neurological Surgery, University of Virginia, Charlottesville (G.M., S. Pikis, C.D., S.D., Z.X., J.P.S.)
| | - Roman Liščák
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic (R.L., J.M.)
| | - Jaromir May
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic (R.L., J.M.)
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taiwan (C.-c.L., H.-c.Y.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-c.L., H.-c.Y.)
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taiwan (C.-c.L., H.-c.Y.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-c.L., H.-c.Y.)
| | | | | | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, PA (R.D.L., A.N., Z.W., P.S., L.W.T.)
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh, PA (R.D.L., A.N., Z.W., P.S., L.W.T.)
| | - Zhishuo Wei
- Department of Neurological Surgery, University of Pittsburgh, PA (R.D.L., A.N., Z.W., P.S., L.W.T.)
| | - Priyanka Srinivasan
- Department of Neurological Surgery, University of Pittsburgh, PA (R.D.L., A.N., Z.W., P.S., L.W.T.)
| | - Lilly W Tang
- Department of Neurological Surgery, University of Pittsburgh, PA (R.D.L., A.N., Z.W., P.S., L.W.T.)
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.)
- Neurosurgery Department, Benha University, Qalubya, Egypt (A.M.N., W.A.R.)
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.)
- Neurosurgery Department, Benha University, Qalubya, Egypt (A.M.N., W.A.R.)
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.)
- Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt (S.R.T., K.A., A.M.N.E.-S., A.H.E.)
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.)
- Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt (S.R.T., K.A., A.M.N.E.-S., A.H.E.)
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.)
- Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt (S.R.T., K.A., A.M.N.E.-S., A.H.E.)
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.)
- Radiation Oncology Department, National Cancer Institute, Cairo University, Egypt (R.M.E.)
| | - Ahmed Hesham Elazzazi
- Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt (S.R.T., K.A., A.M.N.E.-S., A.H.E.)
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey (S. Peker, Y.S.)
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey (S. Peker, Y.S.)
| | - Varun Padmanaban
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA (V.P., F.J.J., J.M., K.M.C.)
| | - Francis J Jareczek
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA (V.P., F.J.J., J.M., K.M.C.)
| | - James McInerney
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA (V.P., F.J.J., J.M., K.M.C.)
| | - Kevin M Cockroft
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA (V.P., F.J.J., J.M., K.M.C.)
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada (D.M., S.A.)
| | - Salman Aldakhil
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada (D.M., S.A.)
| | | | | | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India (M.T.)
| | - Joshua D Palmer
- Department of Radiation Oncology, The James Comprehensive Cancer Center Ohio State University, Columbus (J.D.P., R.U.)
| | - Rituraj Upadhyay
- Department of Radiation Oncology, The James Comprehensive Cancer Center Ohio State University, Columbus (J.D.P., R.U.)
| | - Michelle Lin
- Department of Neurosurgery, University of Southern California (M.L., G.Z., C.Y.)
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California (M.L., G.Z., C.Y.)
| | - Cheng Yu
- Department of Neurosurgery, University of Southern California (M.L., G.Z., C.Y.)
| | - Christopher P Cifarelli
- Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown (C.P.C., D.T.C.)
| | - Daniel T Cifarelli
- Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown (C.P.C., D.T.C.)
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia, Charlottesville (G.M., S. Pikis, C.D., S.D., Z.X., J.P.S.)
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville (G.M., S. Pikis, C.D., S.D., Z.X., J.P.S.)
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18
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Bin-Alamer O, Faramand A, Alarifi NA, Wei Z, Mallela AN, Lu VM, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AM, Emad RM, Peker S, Samanci Y, Lee CC, Yang HC, Delabar V, Mathieu D, Tripathi M, Kearns KN, Bunevicius A, Sheehan JP, Chytka T, Liscak R, Moreno NM, Álvarez RM, Grills IS, Parzen JS, Cifarelli CP, Rehman AA, Speckter H, Niranjan A, Lunsford LD, Abou-Al-Shaar H. Stereotactic Radiosurgery for Vestibular Schwannoma in Neurofibromatosis Type 2: An International Multicenter Case Series of Response and Malignant Transformation Risk. Neurosurgery 2023; 92:934-944. [PMID: 36861994 PMCID: PMC10079356 DOI: 10.1227/neu.0000000000002436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/09/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Vestibular schwannomas (VSs) related to neurofibromatosis type 2 (NF2) are challenging tumors. The increasing use of stereotactic radiosurgery (SRS) necessitates further investigations of its role and safety. OBJECTIVE To evaluate tumor control, freedom from additional treatment (FFAT), serviceable hearing preservation, and radiation-related risks of patients with NF2 after SRS for VS. METHODS We performed a retrospective study of 267 patients with NF2 (328 VSs) who underwent single-session SRS at 12 centers participating in the International Radiosurgery Research Foundation. The median patient age was 31 years (IQR, 21-45 years), and 52% were male. RESULTS A total of 328 tumors underwent SRS during a median follow-up time of 59 months (IQR, 23-112 months). At 10 and 15 years, the tumor control rates were 77% (95% CI: 69%-84%) and 52% (95% CI: 40%-64%), respectively, and the FFAT rate were 85% (95% CI: 79%-90%) and 75% (95% CI: 65%-86%), respectively. At 5 and 10 years, the serviceable hearing preservation rates were 64% (95% CI: 55%-75%) and 35% (95% CI: 25%-54%), respectively. In the multivariate analysis, age (hazards ratio: 1.03 [95% CI: 1.01-1.05]; P = .02) and bilateral VSs (hazards ratio: 4.56 [95% CI: 1.05-19.78]; P = .04) were predictors for serviceable hearing loss. Neither radiation-induced tumors nor malignant transformation were encountered in this cohort. CONCLUSION Although the absolute volumetric tumor progression rate was 48% at 15 years, the rate of FFAT related to VS was 75% at 15 years after SRS. None of the patients with NF2-related VS developed a new radiation-related neoplasm or malignant transformation after SRS.
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Affiliation(s)
- Othman Bin-Alamer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andrew Faramand
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Norah A. Alarifi
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Neurosurgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Zhishuo Wei
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arka N. Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Victor M. Lu
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Ahmed M. Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Wael A. Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Sameh R. Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Amr M.N. El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Reem M. Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Cheng-chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huai-che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Violaine Delabar
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kathryn Nicole Kearns
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Adomas Bunevicius
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Jason P. Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Tomas Chytka
- Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | | | | | - Inga S. Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan, USA
| | - Jacob S. Parzen
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan, USA
| | | | - Azeem A. Rehman
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | - Herwin Speckter
- Department of Radiology, Centro Gamma Knife Dominicano and Radiology Department, Cedimat, Santo Domingo, Dominican Republic
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - L. Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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19
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Pikis S, Mantziaris G, Kormath Anand R, Nabeel AM, Sheehan D, Sheehan K, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad Eldin R, Peker S, Samanci Y, Kaisman-Elbaz T, Speckter H, Hernández W, Isidor J, Tripathi M, Madan R, Zacharia BE, Daggubati LC, Martínez Moreno N, Martínez Álvarez R, Langlois AM, Mathieu D, Deibert CP, Sudhakar VR, Cifarelli CP, Arteaga Icaza D, Cifarelli DT, Wei Z, Niranjan A, Barnett GH, Lunsford LD, Bowden GN, Sheehan JP. Stereotactic radiosurgery for Koos grade IV vestibular schwannoma: a multi-institutional study. J Neurosurg 2023; 138:405-412. [PMID: 36303474 DOI: 10.3171/2022.4.jns22203] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/13/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Though stereotactic radiosurgery (SRS) is an established safe treatment for small- and medium-sized vestibular schwannomas (VSs), its role in the management of Koos grade IV VS is still unclear. In this retrospective multicenter study, the authors evaluated tumor control and the patient outcomes of primary, single-session SRS treatment for Koos grade IV VS. METHODS This study included patients treated with primary, single-session SRS for Koos grade IV VS at 10 participating centers. Only those patients presenting with non-life-threatening or incapacitating symptoms and at least 12 months of clinical and neuroimaging follow-up were eligible for inclusion. Relevant data were collected, and the Kaplan-Meier method was used to perform time-dependent analysis for post-SRS tumor control, hearing preservation, and facial nerve function preservation. Univariate and multivariate analyses were performed for outcome measures using Cox regression analysis. RESULTS Six hundred twenty-seven patients (344 females, median patient age 54 [IQR 22] years) treated with primary SRS were included in this study. The median tumor volume was 8.7 (IQR 5) cm3. Before SRS, serviceable hearing, facial nerve weakness (House-Brackmann grade > I), and trigeminal neuropathy were present in 205 (33%), 48 (7.7%), and 203 (32.4%) patients, respectively. The median prescription dose was 12 (IQR 1) Gy. At a median radiological follow-up of 38 (IQR 54) months, tumor control was achieved in 94.1% of patients. Early tumor expansion occurred in 67 (10.7%) patients and was associated with a loss of tumor control at the last follow-up (p = 0.001). Serviceable hearing preservation rates at the 5- and 10-year follow-ups were 65% and 44.6%, respectively. Gardner-Robertson class > 1 (p = 0.003) and cochlear dose ≥ 4 Gy (p = 0.02) were risk factors for hearing loss. Facial nerve function deterioration occurred in 19 (3.0%) patients at the last follow-up and was associated with margin doses ≥ 13 Gy (p = 0.03) and early tumor expansion (p = 0.04). Post-SRS, 33 patients developed hydrocephalus requiring shunting. Adverse radiation effects occurred in 92 patients and were managed medically or surgically in 34 and 18 cases, respectively. CONCLUSIONS SRS is a safe and effective method of obtaining tumor control in patients with Koos grade IV VS presenting with non-life-threatening or debilitating symptoms, especially those with surgical comorbidities that contraindicate resection. To decrease the incidence of post-SRS facial palsy, a prescription dose < 13 Gy is recommended.
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Affiliation(s)
- Stylianos Pikis
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Georgios Mantziaris
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Rithika Kormath Anand
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Ahmed M Nabeel
- 2Gamma Knife Center Cairo.,3Nasser Institute, Department of Neurosurgery, Benha University, Qalubya
| | - Darrah Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Kimball Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Wael A Reda
- 2Gamma Knife Center Cairo.,Departments of4Neurosurgery and
| | | | - Khaled Abdelkarim
- 2Gamma Knife Center Cairo.,5Clinical Oncology, Ain Shams University, Cairo
| | | | - Reem Emad Eldin
- 2Gamma Knife Center Cairo.,6Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Selcuk Peker
- 7Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- 7Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Tehila Kaisman-Elbaz
- 8Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Herwin Speckter
- 9Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santa Domingo, Dominican Republic
| | - Wenceslao Hernández
- 9Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santa Domingo, Dominican Republic
| | - Julio Isidor
- 9Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santa Domingo, Dominican Republic
| | | | - Renu Madan
- 11Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Brad E Zacharia
- 12Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, Pennsylvania
| | - Lekhaj C Daggubati
- 12Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, Pennsylvania
| | | | | | - Anne-Marie Langlois
- 14Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - David Mathieu
- 14Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | | | - Vivek R Sudhakar
- 15Department of Neurological Surgery, Emory University, Atlanta, Georgia
| | - Christopher P Cifarelli
- Departments of16Neurosurgery and.,17Radiation Oncology, West Virginia University, Morgantown, West Virginia
| | | | | | - Zhishuo Wei
- 18Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Ajay Niranjan
- 18Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Gene H Barnett
- 8Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - L Dade Lunsford
- 18Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Greg N Bowden
- 19Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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20
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Dumot C, Pikis S, Mantziaris G, Xu Z, Dayawansa S, Anand RK, Nabeel AM, Sheehan D, Sheehan K, Reda WA, Tawadros SR, Karim KA, El-Shehaby AMN, Eldin RME, Peker S, Samanci Y, Kaisman-Elbaz T, Speckter H, Hernández W, Isidor J, Tripathi M, Madan R, Zacharia BE, Daggubati LC, Moreno NM, Álvarez RM, Langlois AM, Mathieu D, Deibert CP, Sudhakar VR, Cifarelli CP, Icaza DA, Cifarelli DT, Wei Z, Niranjan A, Barnett GH, Lunsford LD, Bowden GN, Sheehan JP. Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in patients ≥ 65 years old: a multi-institutional retrospective study. Acta Neurochir (Wien) 2023; 165:211-220. [PMID: 36543963 DOI: 10.1007/s00701-022-05454-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Surgery is the preferred treatment for large vestibular schwannomas (VS). Good tumor control and cranial nerve outcomes were described in selected Koos IV VS after single-session stereotactic radiosurgery (SRS), but outcomes in elderly patients have never been specifically studied. The aim of this study is to report clinical and radiological outcomes after single-session SRS for Koos IV VS in patients ≥ 65 years old. METHOD This multicenter, retrospective study included patients ≥ 65 years old, treated with primary, single-session SRS for a Koos IV VS, and at least 12 months of follow-up. Patients with life-threatening or incapacitating symptoms were excluded. Tumor control rate, hearing, trigeminal, and facial nerve function were studied at last follow-up. RESULTS One-hundred and fifty patients (median age of 71.0 (IQR 9.0) years old with a median tumor volume of 8.3 cc (IQR 4.4)) were included. The median prescription dose was 12.0 Gy (IQR 1.4). The local tumor control rate was 96.0% and 86.2% at 5 and 10 years, respectively. Early tumor expansion occurred in 6.7% and was symptomatic in 40% of cases. A serviceable hearing was present in 16.1% prior to SRS and in 7.4% at a last follow-up of 46.5 months (IQR 55.8). The actuarial serviceable hearing preservation rate was 69.3% and 50.9% at 5 and 10 years, respectively. Facial nerve function preservation or improvement rates at 5 and 10 years were 98.7% and 91.0%, respectively. At last follow-up, the trigeminal nerve function was improved in 14.0%, stable in 80.7%, and worsened in 5.3% of the patients. ARE were noted in 12.7%. New hydrocephalus was seen in 8.0% of patients. CONCLUSION SRS can be a safe alternative to surgery for selected Koos IV VS in patients ≥ 65 years old. Further follow-up is warranted.
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Affiliation(s)
- Chloe Dumot
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA.,Department of Neurological Surgery, Hospices Civils de Lyon, Lyon, France
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA
| | - Sam Dayawansa
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA
| | - Rithika Kormath Anand
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Neurosurgery Department, Faculty of Medecine, Benha University, Qalubya, Egypt
| | - Darrah Sheehan
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA
| | - Kimball Sheehan
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Departments of Neurosurgery and Clinical Oncology, Faculty of Medeine, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Departments of Neurosurgery and Clinical Oncology, Faculty of Medeine, Ain Shams University, Cairo, Egypt
| | - Khaled Abdel Karim
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Departments of Neurosurgery and Clinical Oncology, Faculty of Medeine, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Departments of Neurosurgery and Clinical Oncology, Faculty of Medeine, Ain Shams University, Cairo, Egypt
| | - Reem M Emad Eldin
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Tehila Kaisman-Elbaz
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Herwin Speckter
- Department of Radiology and Dominican Gamma Knife Center, CEDIMAT, Santo Domingo, Dominican Republic
| | - Wenceslao Hernández
- Department of Radiology and Dominican Gamma Knife Center, CEDIMAT, Santo Domingo, Dominican Republic
| | - Julio Isidor
- Department of Radiology and Dominican Gamma Knife Center, CEDIMAT, Santo Domingo, Dominican Republic
| | - Manjul Tripathi
- Departments of Neurosurgery and Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Madan
- Departments of Neurosurgery and Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Brad E Zacharia
- Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA, USA
| | - Lekhaj C Daggubati
- Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA, USA
| | - Nuria Martínez Moreno
- Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA, USA
| | | | - Anne-Marie Langlois
- Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - David Mathieu
- Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | | | - Vivek R Sudhakar
- Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown, WV, USA
| | - Christopher P Cifarelli
- Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown, WV, USA
| | - Denisse Arteaga Icaza
- Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown, WV, USA
| | - Daniel T Cifarelli
- Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown, WV, USA
| | - Zhishuo Wei
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ajay Niranjan
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gene H Barnett
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Greg N Bowden
- Department of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA.
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21
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Pikis S, Mantziaris G, Peker S, Samanci Y, Nabeel AM, Reda WA, Tawadros SR, El-Shehaby AMN, Abdelkarim K, Eldin RME, Sheehan D, Sheehan K, Liscak R, Chytka T, Tripathi M, Madan R, Speckter H, Hernández W, Barnett GH, Hori YS, Dabhi N, Aldakhil S, Mathieu D, Kondziolka D, Bernstein K, Wei Z, Niranjan A, Kersh CR, Lunsford LD, Sheehan JP. Stereotactic radiosurgery for intracranial chordomas: an international multiinstitutional study. J Neurosurg 2022; 137:977-984. [PMID: 35120328 DOI: 10.3171/2021.12.jns212416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The object of this study was to evaluate the safety, efficacy, and long-term outcomes of stereotactic radiosurgery (SRS) in the management of intracranial chordomas. METHODS This retrospective multicenter study involved consecutive patients managed with single-session SRS for an intracranial chordoma at 10 participating centers. Radiological and neurological outcomes were assessed after SRS, and predictive factors were evaluated via statistical methodology. RESULTS A total of 93 patients (56 males [60.2%], mean age 44.8 years [SD 16.6]) underwent single-session SRS for intracranial chordoma. SRS was utilized as adjuvant treatment in 77 (82.8%) cases, at recurrence in 13 (14.0%) cases, and as primary treatment in 3 (3.2%) cases. The mean tumor volume was 8 cm3 (SD 7.3), and the mean prescription volume was 9.1 cm3 (SD 8.7). The mean margin and maximum radiosurgical doses utilized were 17 Gy (SD 3.6) and 34.2 Gy (SD 6.4), respectively. On multivariate analysis, treatment failure due to tumor progression (p = 0.001) was associated with an increased risk for post-SRS neurological deterioration, and a maximum dose > 29 Gy (p = 0.006) was associated with a decreased risk. A maximum dose > 29 Gy was also associated with improved local tumor control (p = 0.02), whereas the presence of neurological deficits prior to SRS (p = 0.04) and an age > 65 years at SRS (p = 0.03) were associated with worse local tumor control. The 5- and 10-year tumor progression-free survival rates were 54.7% and 34.7%, respectively. An age > 65 years at SRS (p = 0.01) was associated with decreased overall survival. The 5- and 10-year overall survival rates were 83% and 70%, respectively. CONCLUSIONS SRS appears to be a safe and relatively effective adjuvant management option for intracranial chordomas. The best outcomes were obtained in younger patients without significant neurological deficits. Further well-designed studies are necessary to define the best timing for the use of SRS in the multidisciplinary management of intracranial chordomas.
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Affiliation(s)
- Stylianos Pikis
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Georgios Mantziaris
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Selcuk Peker
- 2Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- 2Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Ahmed M Nabeel
- 3Gamma Knife Center Cairo, Nasser Institute, Cairo
- 4Department of Neurosurgery, Benha University, Benha
| | - Wael A Reda
- 3Gamma Knife Center Cairo, Nasser Institute, Cairo
- 5Ain Shams University, Cairo
| | - Sameh R Tawadros
- 3Gamma Knife Center Cairo, Nasser Institute, Cairo
- 5Ain Shams University, Cairo
| | - Amr M N El-Shehaby
- 3Gamma Knife Center Cairo, Nasser Institute, Cairo
- 5Ain Shams University, Cairo
| | - Khaled Abdelkarim
- 3Gamma Knife Center Cairo, Nasser Institute, Cairo
- 5Ain Shams University, Cairo
| | - Reem M Emad Eldin
- 3Gamma Knife Center Cairo, Nasser Institute, Cairo
- 6Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Darrah Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Kimball Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Roman Liscak
- 7Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Tomas Chytka
- 7Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Manjul Tripathi
- 8Department of Neurosurgery and Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Madan
- 8Department of Neurosurgery and Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Herwin Speckter
- 9Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
| | - Wenceslao Hernández
- 9Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
| | - Gene H Barnett
- 10Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Yusuke S Hori
- 10Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Nisha Dabhi
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Salman Aldakhil
- 11Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - David Mathieu
- 11Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | | | - Kenneth Bernstein
- 13Department of Radiation Oncology, New York University Langone, New York, New York
| | - Zhishuo Wei
- 14Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Ajay Niranjan
- 14Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Charles R Kersh
- 15Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia
| | - L Dade Lunsford
- 14Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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22
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Dumot C, Pikis S, Mantziaris G, Xu Z, Anand RK, Nabeel AM, Sheehan D, Sheehan K, Reda WA, Tawadros SR, Abdel Karim K, El-Shehaby AMN, Emad Eldin RM, Peker S, Samanci Y, Kaisman-Elbaz T, Speckter H, Hernández W, Isidor J, Tripathi M, Madan R, Zacharia BE, Daggubati LC, Moreno NM, Álvarez RM, Langlois AM, Mathieu D, Deibert CP, Sudhakar VR, Cifarelli CP, Icaza DA, Cifarelli DT, Wei Z, Niranjan A, Barnett GH, Lunsford LD, Bowden GN, Sheehan JP. Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in young patients: a multi-institutional study. J Neurooncol 2022; 160:201-208. [PMID: 36166113 DOI: 10.1007/s11060-022-04134-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Surgery is the treatment of choice for large vestibular schwannomas (VS). Stereotactic radiosurgery (SRS) has been suggested as an alternative to resection in selected patients. However, the safety and efficacy of SRS in Koos grade IV patients ≤ 45 years old has not been evaluated. The aim of this study is to describe the clinical and radiological outcomes of Koos grade IV in young patient managed with a single-session SRS. METHODS This retrospective, multicenter analysis included SRS-treated patients, ≤ 45 years old presenting with non-life threatening or incapacitating symptoms due to a Koos Grade IV VS and with follow-up ≥ 12 months. Tumor control and neurological outcomes were evaluated. RESULTS 176 patients [median age of 36.0 (IQR 9) and median tumor volume of 9.3 cm3 (IQR 4.7)] were included. The median prescription dose was 12 Gy (IQR 0.5). Median follow-up period was 37.5 (IQR 53.5) months. The 5- and 10-year progression-free survival was 90.9% and 86.7%. Early tumor enlargement occurred in 10.9% of cases and was associated with tumor progression at the last follow-up. The probability of serviceable hearing preservation at 5- and 10-years was 56.8% and 45.2%, respectively. The probability of improvement or preservation of facial nerve function was 95.7% at 5 and 10-years. Adverse radiation effects were noted in 19.9%. New-onset hydrocephalus occurred in 4.0%. CONCLUSION Single-session SRS is a safe and effective alternative to surgical resection in selected patients ≤ 45 years old particularly those with medical co-morbidities and those who decline resection. Longer term follow up is warranted.
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Affiliation(s)
- Chloe Dumot
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA.,Department of Neurological Surgery, Hospices civils de Lyon, Lyon, France
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Rithika Kormath Anand
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Neurosurgery Department, Faculty of Medecine, Benha University, Qalubya, Egypt
| | - Darrah Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Kimball Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Department of Neurosurgery, Faculty of Medecine, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Department of Neurosurgery, Faculty of Medecine, Ain Shams University, Cairo, Egypt
| | - Khaled Abdel Karim
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Department of Clinical Oncology, Faculty of Medecine, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Department of Neurosurgery, Faculty of Medecine, Ain Shams University, Cairo, Egypt
| | - Reem M Emad Eldin
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Tehila Kaisman-Elbaz
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Herwin Speckter
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
| | - Wenceslao Hernández
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
| | - Julio Isidor
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Madan
- Department of Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Brad E Zacharia
- Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA, USA
| | - Lekhaj C Daggubati
- Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA, USA
| | | | | | - Anne-Marie Langlois
- Division of Neurosurgery, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - David Mathieu
- Division of Neurosurgery, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Vivek R Sudhakar
- Department of Neurosurgery, West Virginia University, Morgantown, WV, USA
| | - Christopher P Cifarelli
- Department of Neurosurgery, West Virginia University, Morgantown, WV, USA.,Department of Radiation Oncology, West Virginia University, Morgantown, WV, USA
| | | | - Daniel T Cifarelli
- Department of Neurosurgery, West Virginia University, Morgantown, WV, USA
| | - Zhishuo Wei
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ajay Niranjan
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gene H Barnett
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Greg N Bowden
- Department of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA.
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23
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Emad Eldin RM, Abdel Karim KM, Reda WA, Tawadros SR, Nabil AM, El Shehaby AMN. P18.09.A Single-session stereotactic radiosurgery for large parasellar meningiomas. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The purpose of this study is to assess the long-term efficacy and safety of single-session stereotactic radiosurgery for large (10 cc or more) perioptic intracranial benign meningiomas.
Material and Methods
In this retrospective study we included 175 patients with large perioptic benign meningiomas (≥ 10 cc) who were treated by single-session SRS. Perioptic meningiomas were defined as meningiomas touching, compressing or within 3 mm of the optic pathway. The median tumor volume was 15 (10-57.3 cc (IQR 8.4 cc)). The median prescription dose was 12 Gy (9-14 Gy (IQR 1 Gy)).
Results
The median follow up period was 72 months (13-217 months (IQR 65 months)). The tumor control rate was 92%. The PFS at 5- and 10- years was 97% and 80%. Favorable (better/stable) visual outcome was reported in 169 patients (97%) and unfavorable (worse) outcome in 6 patients (3%). Temporary adverse radiation effects were observed in 21 patients (12%) but only 7 (4%) were symptomatic. Sixty-three patients had a blind/non-useful eye according the pre-treatment visual field examination. Visual improvement was observed in blind/non-useful eye in 17 patients (27%) while vision remained unchanged in 46 patients (73%). Ocular nerve palsy improved in 36 patients (61%). Tumor shrinkage was not a prerequisite for cranial nerve improvement.
Conclusion
Stereotactic radiosurgery provides an effective and safe treatment option for large perioptic meningiomas.
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Affiliation(s)
- R M Emad Eldin
- Radiation Oncology dep. National Cancer Institute Cairo University and Gamma Knife Center Nasser Institute , Cairo , Egypt
| | - K M Abdel Karim
- Clinical oncology dep. Ain Shams University and Gamma Knife Center Nasser Institute , Cairo , Egypt
| | - W A Reda
- Neurosurgery dep. Ain Shams University and Gamma Knife Center Nasser Institute , Cairo , Egypt
| | - S R Tawadros
- Neurosurgery dep Ain Shams University and Gamma Knife Center Nasser Institute , Cairo , Egypt
| | - A M Nabil
- Neurosurgery dep. Benha University and Gamma Knife Center Nasser Institute , Cairo , Egypt
| | - A M N El Shehaby
- Neurosurgery dep Ain Shams University and Gamma Knife Center Nasser Institute , Cairo , Egypt
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24
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Pikis S, Mantziaris G, Bunevicius A, Islim AI, Peker S, Samanci Y, Nabeel AM, Reda WA, Tawadros SR, El-Shehaby AMN, Abdelkarim K, Emad RM, Delabar V, Mathieu D, Lee CC, Yang HC, Liscak R, May J, Alvarez RM, Patel DN, Kondziolka D, Bernstein K, Moreno NM, Tripathi M, Speckter H, Albert C, Bowden GN, Benveniste RJ, Lunsford LD, Jenkinson MD, Sheehan J. Stereotactic Radiosurgery Compared With Active Surveillance for Asymptomatic, Parafalcine, and Parasagittal Meningiomas: A Matched Cohort Analysis From the IMPASSE Study. Neurosurgery 2022; 90:750-757. [PMID: 35319529 DOI: 10.1227/neu.0000000000001924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The optimal management of asymptomatic, presumed WHO grade I meningiomas remains controversial. OBJECTIVE To define the safety and efficacy of stereotactic radiosurgery (SRS) compared with active surveillance for the management of patients with asymptomatic parafalcine/parasagittal (PFPS) meningiomas. METHODS Data from SRS-treated patients from 14 centers and patients managed conservatively for an asymptomatic, PFPS meningioma were compared. Local tumor control rate and new neurological deficits development were evaluated in the active surveillance and the SRS-treated cohorts. RESULTS There were 173 SRS-treated patients and 98 patients managed conservatively in the unmatched cohorts. After matching for patient age and tumor volume, there were 98 patients in each cohort. The median radiological follow-up period was 43 months for the SRS cohort and 36 months for the active surveillance cohort (P = .04). The median clinical follow-up for the SRS and active surveillance cohorts were 44 and 36 months, respectively. Meningioma control was noted in all SRS-treated patients and in 61.2% of patients managed with active surveillance (P < .001). SRS-related neurological deficits occurred in 3.1% of the patients (n = 3), which were all transient. In the active surveillance cohort, 2% of patients (n = 2) developed neurological symptoms because of tumor progression (P = 1.0), resulting in death of 1 patient (1%). CONCLUSION Up-front SRS affords superior radiological PFPS meningioma control as compared with active surveillance and may lower the risk of meningioma-related permanent neurological deficit and/or death.
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Affiliation(s)
- Stylianos Pikis
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Adomas Bunevicius
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Abdurrahman I Islim
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
| | - Violaine Delabar
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - David Mathieu
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | | | | | - Roman Liscak
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jaromir May
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roberto Martinez Alvarez
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dev N Patel
- Department of Neurosurgery, New York University, New York, New York, USA
| | - Douglas Kondziolka
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kenneth Bernstein
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Manjul Tripathi
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Herwin Speckter
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
| | - Camilo Albert
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Greg N Bowden
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Ronald J Benveniste
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael D Jenkinson
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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25
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Islim AI, Mantziaris G, Pikis S, Chen CJ, Bunevicius A, Peker S, Samanci Y, Nabeel AM, Reda WA, Tawadros SR, El-Shehaby AMN, Abdelkarim K, Emad RM, Delabar V, Mathieu D, Lee CC, Yang HC, Liscak R, May J, Alvarez RM, Moreno NM, Tripathi M, Kondziolka D, Speckter H, Albert C, Bowden GN, Benveniste RJ, Lunsford LD, Sheehan JP, Jenkinson MD. Comparison of Active Surveillance to Stereotactic Radiosurgery for the Management of Patients with an Incidental Frontobasal Meningioma-A Sub-Analysis of the IMPASSE Study. Cancers (Basel) 2022; 14:cancers14051300. [PMID: 35267608 PMCID: PMC8909178 DOI: 10.3390/cancers14051300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/26/2022] [Accepted: 02/27/2022] [Indexed: 02/04/2023] Open
Abstract
Meningioma is a common incidental finding, and clinical course varies based on anatomical location. The aim of this sub-analysis of the IMPASSE study was to compare the outcomes of patients with an incidental frontobasal meningioma who underwent active surveillance to those who underwent upfront stereotactic radiosurgery (SRS). Data were retrospectively collected from 14 centres. The active surveillance (n = 28) and SRS (n = 84) cohorts were compared unmatched and matched for age, sex, and duration of follow-up (n = 25 each). The study endpoints included tumor progression, new symptom development, and need for further intervention. Tumor progression occurred in 52.0% and 0% of the matched active surveillance and SRS cohorts, respectively (p < 0.001). Five patients (6.0%) treated with SRS developed treatment related symptoms compared to none in the active monitoring cohort (p = 0.329). No patients in the matched cohorts developed symptoms attributable to treatment. Three patients managed with active surveillance (10.7%, unmatched; 12.0%, matched) underwent an intervention for tumor growth with no persistent side effects after treatment. No patients subject to SRS underwent further treatment. Active monitoring and SRS confer a similarly low risk of symptom development. Upfront treatment with SRS improves imaging-defined tumor control. Active surveillance and SRS are acceptable treatment options for incidental frontobasal meningioma.
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Affiliation(s)
- Abdurrahman I. Islim
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK;
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK
- Correspondence: ; Tel.: +44-(0)151-795-4400
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA 22903, USA; (G.M.); (S.P.); (C.-J.C.); (A.B.); (J.P.S.)
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA 22903, USA; (G.M.); (S.P.); (C.-J.C.); (A.B.); (J.P.S.)
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA 22903, USA; (G.M.); (S.P.); (C.-J.C.); (A.B.); (J.P.S.)
| | - Adomas Bunevicius
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA 22903, USA; (G.M.); (S.P.); (C.-J.C.); (A.B.); (J.P.S.)
| | - Selçuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul 34010, Turkey; (S.P.); (Y.S.)
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul 34010, Turkey; (S.P.); (Y.S.)
| | - Ahmed M. Nabeel
- Gamma Knife Center Cairo, Nasser Institute, Cairo 11796, Egypt; (A.M.N.); (W.A.R.); (S.R.T.); (A.M.N.E.-S.); (K.A.); (R.M.E.)
- Department of Neurosurgery, Benha University, Benha 13512, Egypt
| | - Wael A. Reda
- Gamma Knife Center Cairo, Nasser Institute, Cairo 11796, Egypt; (A.M.N.); (W.A.R.); (S.R.T.); (A.M.N.E.-S.); (K.A.); (R.M.E.)
- Department of Neurosurgery, Ain Shams University, Cairo 11566, Egypt
| | - Sameh R. Tawadros
- Gamma Knife Center Cairo, Nasser Institute, Cairo 11796, Egypt; (A.M.N.); (W.A.R.); (S.R.T.); (A.M.N.E.-S.); (K.A.); (R.M.E.)
- Department of Neurosurgery, Ain Shams University, Cairo 11566, Egypt
| | - Amr M. N. El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute, Cairo 11796, Egypt; (A.M.N.); (W.A.R.); (S.R.T.); (A.M.N.E.-S.); (K.A.); (R.M.E.)
- Department of Neurosurgery, Ain Shams University, Cairo 11566, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute, Cairo 11796, Egypt; (A.M.N.); (W.A.R.); (S.R.T.); (A.M.N.E.-S.); (K.A.); (R.M.E.)
- Department of Neurosurgery, Ain Shams University, Cairo 11566, Egypt
| | - Reem M. Emad
- Gamma Knife Center Cairo, Nasser Institute, Cairo 11796, Egypt; (A.M.N.); (W.A.R.); (S.R.T.); (A.M.N.E.-S.); (K.A.); (R.M.E.)
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Violaine Delabar
- Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (V.D.); (D.M.)
| | - David Mathieu
- Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (V.D.); (D.M.)
| | - Cheng-Chia Lee
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei City 11217, Taiwan; (C.-C.L.); (H.-C.Y.)
- Department of Neurosurgery, National Yang-Ming University, Beitou District, Taipei City 11221, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei City 11217, Taiwan; (C.-C.L.); (H.-C.Y.)
- Department of Neurosurgery, National Yang-Ming University, Beitou District, Taipei City 11221, Taiwan
| | - Roman Liscak
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, 150 00 Prague, Czech Republic; (R.L.); (J.M.)
| | - Jaromir May
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, 150 00 Prague, Czech Republic; (R.L.); (J.M.)
| | - Roberto Martinez Alvarez
- Department of Radiosurgery, Rúber International Hospital, 28034 Madrid, Spain; (R.M.A.); (N.M.M.)
| | - Nuria Martinez Moreno
- Department of Radiosurgery, Rúber International Hospital, 28034 Madrid, Spain; (R.M.A.); (N.M.M.)
| | - Manjul Tripathi
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Punjab, India;
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University, New York, NY 10016, USA;
- Department of Neurosurgery and Radiation Oncology, New York University, New York, NY 10016, USA
| | - Herwin Speckter
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo 10514, Dominican Republic; (H.S.); (C.A.)
| | - Camilo Albert
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo 10514, Dominican Republic; (H.S.); (C.A.)
| | - Greg N. Bowden
- Department of Neurosurgery, 2D1.02 Mackenzie Health Sciences Centre, University of Alberta, Edmonton, AB T6G 2B7, Canada;
| | - Ronald J. Benveniste
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | | | - Jason P. Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA 22903, USA; (G.M.); (S.P.); (C.-J.C.); (A.B.); (J.P.S.)
| | - Michael D. Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK;
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK
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26
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Pikis S, Mantziaris G, Islim AI, Peker S, Samanci Y, Nabeel AM, Reda WA, Abdelkarim K, El-Shehaby AMN, Tawadros SR, Emad RM, Delabar V, Mathieu D, Lee CC, Yang HC, Licsak R, Hanuska J, Alvarez RM, Patel DN, Kondziolka D, Bernstein K, Moreno NM, Tripathi M, Speckter H, Albert C, Bowden GN, Benveniste RJ, Lunsford DL, Jenkinson MD, Sheehan J. Stereotactic radiosurgery versus active surveillance for incidental, convexity meningiomas: a matched cohort analysis from the IMPASSE study. J Neurooncol 2022; 157:121-128. [DOI: 10.1007/s11060-022-03953-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/21/2022] [Indexed: 11/28/2022]
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27
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Mantziaris G, Pikis S, Samanci Y, Peker S, Nabeel AM, Reda WA, Tawadros SR, El-Shehaby AMN, Abdelkarim K, Emad RM, Delabar V, Mathieu D, Lee CC, Yang HC, Liscak R, Hanuska J, Alvarez RM, Moreno NM, Tripathi M, Speckter H, Albert C, Benveniste RJ, Bowden GN, Patel DN, Kondziolka D, Bernstein K, Lunsford LD, Jenkinson MD, Islim AI, Sheehan J. Stereotactic radiosurgery versus active surveillance for asymptomatic, skull-based meningiomas: an international, multicenter matched cohort study. J Neurooncol 2022; 156:509-518. [DOI: 10.1007/s11060-021-03923-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
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28
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Bunevicius A, Anand RK, Suleiman M, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Chytka T, Liscak R, Sheehan K, Sheehan D, Caceres MP, Mathieu D, Lee CC, Yang HC, Picozzi P, Franzini A, Attuati L, Speckter H, Olivo J, Patel S, Cifarelli CP, Cifarelli DT, Hack JD, Strickland BA, Zada G, Chang EL, Fakhoury KR, Rusthoven CG, Warnick RE, Sheehan J. Stereotactic Radiosurgery for Perioptic Meningiomas: An International, Multicenter Study. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa544_s117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Mehta GU, Lekovic GP, Slattery WH, Brackmann DE, Long H, Kano H, Kondziolka D, Mureb M, Bernstein K, Langlois AM, Mathieu D, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Mohammed N, Urgosik D, Liscak R, Lee CC, Yang HC, Montazeripouragha A, Kaufmann AM, Joshi KC, Barnett GH, Trifiletti DM, Lunsford LD, Sheehan JP. Effect of Anatomic Segment Involvement on Stereotactic Radiosurgery for Facial Nerve Schwannomas: An International Multicenter Cohort Study. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa313_s078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Pikis S, Mantziaris G, Samanci Y, Peker S, Nabeel AM, Reda WA, Tawadros SR, El-Shehaby AMN, Abdelkarim K, Emad RM, Lee CC, Yang HC, Liscak R, Hanuska J, Alvarez RM, Moreno NM, Tripathi M, Speckter H, Albert C, Sheehan J. Stereotactic Radiosurgery for Incidentally Discovered Cavernous Sinus Meningiomas: A Multi-institutional Study. World Neurosurg 2021; 158:e675-e680. [PMID: 34785361 DOI: 10.1016/j.wneu.2021.11.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The initial management of asymptomatic, incidentally discovered, cavernous sinus (CS) meningiomas remains incompletely defined. This study evaluated the safety and efficacy of stereotactic radiosurgery (SRS) for patients presenting with an asymptomatic CS meningioma. METHODS This is an international, retrospective study included patients treated with upfront SRS for an asymptomatic CS meningioma. Local tumor control, tumor and SRS-related complications, and the development of new neurologic deficits after SRS were evaluated. RESULTS A total of 37 patients (29 men; mean ± SD age: 55.05 ± 11.56 years) treated with upfront SRS for an asymptomatic, CS meningioma were included in the study. The mean ± SD margin dose was 12.27 ± 2.3 Gy. The median clinical and radiological follow-up periods were 66 (IQR 84) and 72 (IQR 84) months, respectively. At the last follow-up, tumor regression and stability were noted in 19 (51.35%) and 18 (48.65%) of CS meningiomas, respectively. SRS-related complications occurred in 2 patients (5.4%) and were managed conservatively. CONCLUSIONS Upfront SRS is a safe and effective treatment option for asymptomatic CS meningiomas. SRS may be considered at the time of initial diagnosis of a CS meningioma. If observation is the initial management chosen, SRS should be recommended when CS meningioma growth is documented on follow-up imaging.
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Affiliation(s)
- Stylianos Pikis
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo-Nasser Institute, Cairo, Egypt; Department of Neurosurgery, Benha University, Benha, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo-Nasser Institute, Cairo, Egypt; Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo-Nasser Institute, Cairo, Egypt; Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo-Nasser Institute, Cairo, Egypt; Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo-Nasser Institute, Cairo, Egypt; Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo-Nasser Institute, Cairo, Egypt; Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Cheng-Chia Lee
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Roman Liscak
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir Hanuska
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | | | | | - Manjul Tripathi
- Department of Neurosurgery and Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Herwin Speckter
- Department of Radiology, Dominican Gamma Knife Center, Santo Domingo, Dominican Republic; CEDIMAT, Santo Domingo, Dominican Republic
| | - Camilo Albert
- Department of Radiology, Dominican Gamma Knife Center, Santo Domingo, Dominican Republic; CEDIMAT, Santo Domingo, Dominican Republic
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
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31
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Bunevicius A, Pikis S, Anand RK, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Chytka T, Liscak R, Caceres MP, Mathieu D, Lee CC, Yang HC, Picozzi P, Franzini A, Attuati L, Speckter H, Olivo J, Patel S, Cifarelli CP, Cifarelli DT, Hack JD, Strickland BA, Zada G, Chang EL, Fakhoury KR, Rusthoven CG, Warnick RE, Sheehan J. Stereotactic radiosurgery for clinoid meningiomas: a multi-institutional study. Acta Neurochir (Wien) 2021; 163:2861-2869. [PMID: 34427769 DOI: 10.1007/s00701-021-04972-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Resection of clinoid meningiomas can be associated with significant morbidity. Experience with stereotactic radiosurgery (SRS) for clinoid meningiomas remains limited. We studied the safety and effectiveness of SRS for clinoid meningiomas. METHODS From twelve institutions participating in the International Radiosurgery Research Foundation, we pooled patients treated with SRS for radiologically suspected or histologically confirmed WHO grade I clinoid meningiomas. RESULTS Two hundred seven patients (median age: 56 years) underwent SRS for clinoid meningiomas. Median treatment volume was 8.02 cm3, and 87% of tumors were immediately adjacent to the optic apparatus. The median tumor prescription dose was 12 Gy, and the median maximal dose to the anterior optic apparatus was 8.5 Gy. During a median post-SRS imaging follow-up of 51.1 months, 7% of patients experienced tumor progression. Greater margin SRS dose (HR = 0.700, p = 0.007) and pre-SRS radiotherapy (HR = 0.004, p < 0.001) were independent predictors of better tumor control. During median visual follow-up of 48 months, visual function declined in 8% of patients. Pre-SRS visual deficit (HR = 2.938, p = 0.048) and maximal radiation dose to the optic apparatus of ≥ 10 Gy (HR = 11.297, p = 0.02) independently predicted greater risk of post-SRS visual decline. Four patients experienced new post-SRS cranial nerve V neuropathy. CONCLUSIONS SRS allows durable control of clinoid meningiomas and visual preservation in the majority of patients. Greater radiosurgical prescription dose is associated with better tumor control. Radiation dose to the optic apparatus of ≥ 10 Gy and visual impairment before the SRS increase risk of visual deterioration.
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Affiliation(s)
- Adomas Bunevicius
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, 22908, USA
| | - Stylianos Pikis
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, 22908, USA
| | | | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- National Cancer Institute, Cairo, Egypt
| | - Tomas Chytka
- Stereotactic and Radiation Neurosurgery Department, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- Stereotactic and Radiation Neurosurgery Department, Na Homolce Hospital, Prague, Czech Republic
| | - Marco Perez Caceres
- Department of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Piero Picozzi
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rome, Italy
| | - Andrea Franzini
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rome, Italy
| | - Luca Attuati
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rome, Italy
| | - Herwin Speckter
- Centro Gamma Knife Dominicano and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Jeremy Olivo
- Centro Gamma Knife Dominicano and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Samir Patel
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Canada
| | - Christopher P Cifarelli
- Department of Neurosurgery, West Virginia University, Morgantown, USA
- Department of Radiation Oncology, West Virginia University, Morgantown, USA
| | | | - Joshua D Hack
- Department of Radiation Oncology, West Virginia University, Morgantown, USA
| | - Ben A Strickland
- Department of Neurosurgery, University of Southern California, Los Angeles, USA
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California, Los Angeles, USA
| | - Eric L Chang
- Department of Radiation Oncology, University of Southern California, Los Angeles, USA
| | - Kareem R Fakhoury
- Department of Radiation Oncology, University of Colorado, Boulder, USA
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado, Boulder, USA
| | | | - Jason Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, 22908, USA.
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Asuzu DT, Bunevicius A, Kormath Anand R, Suleiman M, Nabeel AM, Reda WA, Tawadros SR, Abdel Karim K, El-Shehaby AMN, Emad Eldin RM, Chytka T, Liščák R, Sheehan K, Sheehan D, Perez Caceres M, Mathieu D, Lee CC, Yang HC, Picozzi P, Franzini A, Attuati L, Speckter H, Olivo J, Patel S, Cifarelli CP, Cifarelli DT, Hack JD, Strickland BA, Zada G, Chang EL, Fakhoury KR, Rusthoven CG, Warnick RE, Sheehan JP. Clinical and radiologic outcomes after stereotactic radiosurgery for meningiomas in direct contact with the optic apparatus: an international multicenter study. J Neurosurg 2021; 136:1070-1076. [PMID: 34560648 DOI: 10.3171/2021.3.jns21328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/30/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Resection of meningiomas in direct contact with the anterior optic apparatus carries risk of injury to the visual pathway. Stereotactic radiosurgery (SRS) offers a minimally invasive alternative. However, its use is limited owing to the risk of radiation-induced optic neuropathy. Few SRS studies have specifically assessed the risks and benefits of treating meningiomas in direct contact with the optic nerve, chiasm, or optic tract. The authors hypothesized that SRS is safe for select patients with meningiomas in direct contact with the anterior optic apparatus. METHODS The authors performed an international multicenter retrospective analysis of 328 patients across 11 institutions. All patients had meningiomas in direct contract with the optic apparatus. Patients were followed for a median duration of 56 months after SRS. Neurological examinations, including visual function evaluations, were performed at follow-up visits. Clinical and treatment variables were collected at each site according to protocol. Tumor volumes were assessed with serial MR imaging. Variables predictive of visual deficit were identified using univariable and multivariable logistic regression. RESULTS SRS was the initial treatment modality for 64.6% of patients, and 93% of patients received SRS as a single fraction. Visual information was available for 302 patients. Of these patients, visual decline occurred in 29 patients (9.6%), of whom 12 (41.4%) had evidence of tumor progression. Visual decline in the remaining 17 patients (5.6%) was not associated with tumor progression. Pre-SRS Karnofsky Performance Status predicted visual decline in adjusted analysis (adjusted OR 0.9, 95% CI 0.9-1.0, p < 0.01). Follow-up imaging data were available for 322 patients. Of these patients, 294 patients (91.3%) had radiographic evidence of stability or tumor regression at last follow up. Symptom duration was associated with tumor progression in adjusted analysis (adjusted OR 1.01, adjusted 95% CI 1.0-1.02, adjusted p = 0.02). CONCLUSIONS In this international multicenter study, the vast majority of patients exhibited tumor control and preservation of visual function when SRS was used to treat meningioma in direct contact with the anterior optic pathways. SRS is a relatively safe treatment modality for select patients with perioptic meningiomas in direct contact with the optic apparatus.
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Affiliation(s)
- David T Asuzu
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.,20Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Adomas Bunevicius
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Mohanad Suleiman
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Ahmed M Nabeel
- 2Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,3Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Wael A Reda
- 2Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,4Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- 2Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,4Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Khaled Abdel Karim
- 2Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,6Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- 2Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,4Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Reem M Emad Eldin
- 2Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,5Radiation Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Tomas Chytka
- 7Stereotactic and Radiation Neurosurgery Department, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liščák
- 7Stereotactic and Radiation Neurosurgery Department, Na Homolce Hospital, Prague, Czech Republic
| | - Kimball Sheehan
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Darrah Sheehan
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Marco Perez Caceres
- 8Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - David Mathieu
- 8Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Cheng-Chia Lee
- 9Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,10School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- 9Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,10School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Piero Picozzi
- 11Department of Neurosurgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Andrea Franzini
- 11Department of Neurosurgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Luca Attuati
- 11Department of Neurosurgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Herwin Speckter
- 12Centro Gamma Knife Dominicano and CEDIMAT Radiology Department, Santo Domingo, Dominican Republic
| | - Jeremy Olivo
- 12Centro Gamma Knife Dominicano and CEDIMAT Radiology Department, Santo Domingo, Dominican Republic
| | - Samir Patel
- 13Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Canada
| | - Christopher P Cifarelli
- 14Department of Neurosurgery, West Virginia University, Morgantown, West Virginia.,15Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia
| | - Daniel T Cifarelli
- 14Department of Neurosurgery, West Virginia University, Morgantown, West Virginia
| | - Joshua D Hack
- 15Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia
| | - Ben A Strickland
- 16Department of Neurosurgery, University of Southern California, Los Angeles, California
| | - Gabriel Zada
- 16Department of Neurosurgery, University of Southern California, Los Angeles, California
| | - Eric L Chang
- 17Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Kareem R Fakhoury
- 18Department of Radiation Oncology, University of Colorado, Aurora, Colorado
| | - Chad G Rusthoven
- 18Department of Radiation Oncology, University of Colorado, Aurora, Colorado
| | - Ronald E Warnick
- 19Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio; and
| | - Jason P Sheehan
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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Emad Eldin RM, Abdel Karim KM, El-Shehaby AMN, Reda WA, Nabeel AM, Tawadros SR. P14.67 Long-term results of gamma knife radiosurgery for treatment of intracranial glomus jugulare tumors. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Glomus Jugulare tumors are benign but locally aggressive ones that represent a therapeutic challenge. Previous studies about the use of Gamma Knife Radiosurgery (GRS) in those tumors have documented good results that needed larger number of patients and longer follow up periods to be confirmed.
MATERIAL AND METHODS
Between August 2001 and December 2017, 70 patients with glomus jugulare tumors were treated at the Gamma Knife Center, Cairo. They were 46 females and 24 males. The mean age was 48 years (16–71 years). Nineteen of these patients were previously operated, 5 were partially embolized, 3 underwent embolization and subsequent surgery and 43 had gamma knife as their primary treatment. Volume-staged gamma knife radiosurgery was used in 10 patients and single-session in 60 patients, with a total of 86 sessions. The mean target volume was 12.7 cm3 (range 0.2 to 34.5 cm3). The mean tumor volume was 15.5 cm3 (range 0.2 to 105 cm3). The mean prescription dose was 14.5 Gy (range 12 to 18 Gy).
RESULTS
The mean follow up period was 60 months (range 18 to 206 months), and by the time of the data analysis, two of the patients were dead (66 and 24 months after GK treatment). The tumor control was 98.6% (69/70). Thirty-two tumors became smaller and 37 were unchanged. The symptoms improved in 36 patients, were stable in 32 patients, and worsened in 2 patients who developed a transient facial palsy and worsened hearing. Symptomatic improvement began before any reduction in tumor volume could be detected, where the mean time to clinical improvement was 7 months whereas the mean time to tumor shrinkage was 18 months.
CONCLUSION
This study about the long term follow up of the GKR for the intracranial glomus jugulare tumors confirmed that this is a highly effective and safe treatment. This data shows that the clinical improvement is not correlated with the radiological volume reduction.
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Affiliation(s)
- R M Emad Eldin
- Radiation Oncology dep, National Cancer Institute, Cairo University, Cairo, Egypt
- Gamma Knife Center, Nasser Institute, Cairo, Egypt
| | - K M Abdel Karim
- Clinical oncology dep, Ain Shams university, Cairo, Egypt
- Gamma Knife Center, Nasser Institute, Cairo, Egypt
| | - A M N El-Shehaby
- Neurosurgery dep, Ain Shams university, Cairo, Egypt
- Gamma Knife Center, Nasser Institute, Cairo, Egypt
| | - W A Reda
- Neurosurgery dep, Ain Shams university, Cairo, Egypt
- Gamma Knife Center, Nasser Institute, Cairo, Egypt
| | - A M Nabeel
- Neurosurgery dep, Benha university, Cairo, Egypt
- Gamma Knife Center, Nasser Institute, Cairo, Egypt
| | - S R Tawadros
- Neurosurgery dep, Ain Shams university, Cairo, Egypt
- Gamma Knife Center, Nasser Institute, Cairo, Egypt
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34
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Bunevicius A, Ahn J, Fribance S, Peker S, Hergunsel B, Sheehan D, Sheehan K, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Chytka T, Liscak R, Alvarez RM, Moreno NM, Langlois AM, Mathieu D, Lee CC, Yang HC, Tripathi M, Warnick RE, Speckter H, Albert C, Picozzi P, Franzini A, Attuati L, Strickland BA, Zada G, Chang EL, Feliciano Valls CE, Carbini CH, Patel S, Sheehan J. Stereotactic Radiosurgery for Olfactory Groove Meningiomas: An International, Multicenter Study. Neurosurgery 2021; 89:784-791. [PMID: 34383951 DOI: 10.1093/neuros/nyab291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/06/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is increasingly considered for selected olfactory groove meningiomas (OGMs). OBJECTIVE To investigate the safety and efficacy of SRS for OGMs. METHODS From 20 institutions participating in the International Radiosurgery Research Foundation, we pooled patients who underwent SRS for histologically confirmed or radiologically suspected WHO grade I OGMs and were followed for 6 mo or more after the SRS. RESULTS In total, 278 (median age 57 yr) patients underwent SRS for histologically confirmed (29%) or radiologically suspected (71%) WHO grade I OGMs Median treatment volume was 4.60 cm3 (range: 0.12-27.3 cm3), median prescription dose was 12 Gy, and median dose to the olfactory nerve was 11.20 Gy. During median post-SRS imaging follow-up of 39 mo (range: 6-240 mo), 43% of patients had partial or marginal response, 54% of patients had stable disease, and 3% of patients experienced progression. During median post-SRS clinical follow-up of 51 mo (range: 6-240 mo), 36 (13%) patients experienced clinical and/or radiological adverse radiation events (AREs). Elevated risk of AREs was associated with larger OGM volume (P = .009) and pre-SRS peritumoral T2/fluid-attenuated inversion-recovery signal abnormalities (P < .001). After the SRS, olfaction remained stable, improved, or deteriorated in 90%, 8%, and 2% of patients, respectively. Complete post-SRS anosmia was predicted by partial/complete anosmia before the SRS (odds ratio [OR] = 83.125; 95% CI [24.589-281.01], P < .001) and prior resection of OGM (OR = 3.919; 95% CI [1.713-8.970], P = .001). CONCLUSION SRS is associated with durable local control of the majority of OGM patients with acceptable safety profile. SRS allows preservation or improvement of olfactory function in the majority of OGM patients.
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Affiliation(s)
- Adomas Bunevicius
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Jungeun Ahn
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Sarah Fribance
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Selcuk Peker
- Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Batu Hergunsel
- Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Darrah Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Kimball Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Tomas Chytka
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | | | | | - Anne-Marie Langlois
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ronald E Warnick
- Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio, USA
| | - Herwin Speckter
- Gamma Knife, Radiology Department Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
| | - Camilo Albert
- Gamma Knife, Radiology Department Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
| | - Piero Picozzi
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Andrea Franzini
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luca Attuati
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ben A Strickland
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Eric L Chang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Caleb E Feliciano Valls
- Department of Neurosurgery, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
| | - Carlos H Carbini
- Administración de Servicios Médicos de Puerto Rico, Centro Gamma Knife de Puerto Rico y El Caribe, San Juan, Puerto Rico
| | - Samir Patel
- Division of Radiation Oncology, University of Alberta, Edmonton, Canada
| | - Jason Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
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35
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Sheehan J, Pikis S, Islim A, Chen CJ, Bunevicius A, Peker S, Samanci Y, Nabeel AM, Reda WA, Tawadros SR, El-Shehaby AMN, Abdelkarim K, Emad RM, Delabar V, Mathieu D, Lee CC, Yang HC, Liscak R, Hanuska J, Alvarez RM, Patel D, Kondziolka D, Moreno NM, Tripathi M, Speckter H, Albert C, Bowden GN, Benveniste RJ, Lunsford LD, Jenkinson MD. An International Multicenter Matched Cohort Analysis of Incidental Meningioma Progression During Active Surveillance or After Stereotactic Radiosurgery: The IMPASSE Study. Neuro Oncol 2021; 24:116-124. [PMID: 34106275 DOI: 10.1093/neuonc/noab132] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The optimal management of patients with an incidental meningiomas remains unclear. The aim of this study was to characterize the radiologic and neurological outcomes of expectant and SRS management of asymptomatic meningioma patients. METHODS Using data from 14 centers across 10 countries, the study compares SRS outcomes to active surveillance of asymptomatic meningiomas. Local tumor control of asymptomatic meningiomas and development of new neurological deficits attributable to the tumor were evaluated in the SRS and conservatively managed groups. RESULTS In unmatched cohorts, 727 meningioma patients underwent SRS and were followed for a mean of 57.2 months. In the conservatively managed cohort, 388 patients were followed for a mean of 43.5 months. Tumor control was 99.0% of SRS and 64.2% of conservatively managed patients (p<0.001; OR 56.860 (95%CI 26.253-123.150))). New neurological deficits were 2.5% in the SRS and 2.8% of conservatively managed patients (p=0.764; OR 0.890 (95% CI 0.416-1.904)). After 1:1 propensity matching for patient age, tumor volume, location, and imaging follow-up, tumor control in the SRS and conservatively managed cohorts was 99.4% and 62.1%, respectively (p<0.001; OR 94.461 (95% CI 23.082-386.568)). In matched cohorts, new neurological deficits were noted in 2.3% of SRS treated and 3.2% of conservatively managed patients (p=0.475; OR 0.700 (95% CI 0.263-1.863)). CONCLUSIONS SRS affords superior radiologic tumor control compared to active surveillance without increasing the risk of neurological deficits in asymptomatic meningioma patients. While SRS and active surveillance are reasonable options, SRS appears to alter the natural history of asymptomatic meningiomas including tumor progression in the majority of patients treated.
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Affiliation(s)
- Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Abdurrahman Islim
- Department of Neurosurgery, University of Liverpool & The Walton Centre NHS Trust, Lower Lane, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Trust, Lower Lane, Liverpool, UK
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Adomas Bunevicius
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Davutpaşa, Topkapı, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Davutpaşa, Topkapı, Istanbul, Turkey
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo- National Cancer Institute, Cairo University, Cairo, Egypt.,Nasser Institute, Department of Neurosurgery, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo- National Cancer Institute, Cairo University, Cairo, Egypt.,Benha University, Benha, Egypt and Ain Shams University, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo- National Cancer Institute, Cairo University, Cairo, Egypt.,Benha University, Benha, Egypt and Ain Shams University, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo- National Cancer Institute, Cairo University, Cairo, Egypt.,Benha University, Benha, Egypt and Ain Shams University, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo- National Cancer Institute, Cairo University, Cairo, Egypt.,Benha University, Benha, Egypt and Ain Shams University, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo- National Cancer Institute, Cairo University, Cairo, Egypt.,Cairo, Egypt and Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Violaine Delabar
- Division of Neurosurgery, Centre HospitalierUniversitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Qc, Canada
| | - David Mathieu
- Division of Neurosurgery, Centre HospitalierUniversitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Qc, Canada
| | - Cheng-Chia Lee
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan and National Yang-Ming University, Beitou District, Taipei City, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan and National Yang-Ming University, Beitou District, Taipei City, Taiwan
| | - Roman Liscak
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Roentgenova Czech Republic
| | - Jaromir Hanuska
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Roentgenova Czech Republic
| | | | - Dev Patel
- Department of Neurosurgery, New York University, Bevington Hills Ct. Cary, NC. USA
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University, Bevington Hills Ct. Cary, NC. USA.,Department of Radiation Oncology, New York University, Bevington Hills Ct. Cary, NC. USA
| | | | - Manjul Tripathi
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Herwin Speckter
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Plaza de la Salud, Santo Domingo, DN, Dominican Republic
| | - Camilo Albert
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Plaza de la Salud, Santo Domingo, DN, Dominican Republic
| | - Greg N Bowden
- Department of Neurosurgery, University of Alberta, Canada, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Ronald J Benveniste
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, USA
| | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, USA
| | - Michael D Jenkinson
- Department of Neurosurgery, University of Liverpool & The Walton Centre NHS Trust, Lower Lane, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Trust, Lower Lane, Liverpool, UK
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36
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Bunevicius A, Anand RK, Suleiman M, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Chytka T, Liscak R, Sheehan K, Sheehan D, Caceres MP, Mathieu D, Lee CC, Yang HC, Picozzi P, Franzini A, Attuati L, Speckter H, Olivo J, Patel S, Cifarelli CP, Cifarelli DT, Hack JD, Strickland BA, Zada G, Chang EL, Fakhoury KR, Rusthoven CG, Warnick RE, Sheehan J. Stereotactic Radiosurgery for Perioptic Meningiomas: An International, Multicenter Study. Neurosurgery 2021; 88:828-837. [PMID: 33475718 DOI: 10.1093/neuros/nyaa544] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/10/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is increasingly used for management of perioptic meningiomas. OBJECTIVE To study the safety and effectiveness of SRS for perioptic meningiomas. METHODS From 12 institutions participating in the International Radiosurgery Research Foundation (IRRF), we retrospectively assessed treatment parameters and outcomes following SRS for meningiomas located within 3 mm of the optic apparatus. RESULTS A total of 438 patients (median age 51 yr) underwent SRS for histologically confirmed (29%) or radiologically suspected (71%) perioptic meningiomas. Median treatment volume was 8.01 cm3. Median prescription dose was 12 Gy, and median dose to the optic apparatus was 8.50 Gy. A total of 405 patients (93%) underwent single-fraction SRS and 33 patients (7%) underwent hypofractionated SRS. During median imaging follow-up of 55.6 mo (range: 3.15-239 mo), 33 (8%) patients experienced tumor progression. Actuarial 5-yr and 10-yr progression-free survival was 96% and 89%, respectively. Prescription dose of ≥12 Gy (HR: 0.310; 95% CI [0.141-0.679], P = .003) and single-fraction SRS (HR: 0.078; 95% CI [0.016-0.395], P = .002) were associated with improved tumor control. A total of 31 (10%) patients experienced visual decline, with actuarial 5-yr and 10-yr post-SRS visual decline rates of 9% and 21%, respectively. Maximum dose to the optic apparatus ≥10 Gy (HR = 2.370; 95% CI [1.086-5.172], P = .03) and tumor progression (HR = 4.340; 95% CI [2.070-9.097], P < .001) were independent predictors of post-SRS visual decline. CONCLUSION SRS provides durable tumor control and quite acceptable rates of vision preservation in perioptic meningiomas. Margin dose of ≥12 Gy is associated with improved tumor control, while a dose to the optic apparatus of ≥10 Gy and tumor progression are associated with post-SRS visual decline.
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Affiliation(s)
- Adomas Bunevicius
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Mohanad Suleiman
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Radiation Oncology Department, National Cancer Institute, Cairo University, Giza, Egypt
| | - Tomas Chytka
- Stereotactic and Radiation Neurosurgery Department, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- Stereotactic and Radiation Neurosurgery Department, Na Homolce Hospital, Prague, Czech Republic
| | - Kimball Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Darrah Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Marco Perez Caceres
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Piero Picozzi
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Andrea Franzini
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Luca Attuati
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Herwin Speckter
- Centro Gamma Knife Dominicano and CEDIMAT Radiology Department, Santo Domingo, Dominican Republic
| | - Jeremy Olivo
- Centro Gamma Knife Dominicano and CEDIMAT Radiology Department, Santo Domingo, Dominican Republic
| | - Samir Patel
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Canada
| | - Christopher P Cifarelli
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia.,Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia
| | - Daniel T Cifarelli
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia
| | - Joshua D Hack
- Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia
| | - Ben A Strickland
- Department of Neurosurgery, University of Southern California, Los Angeles, California
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California, Los Angeles, California
| | - Eric L Chang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Kareem R Fakhoury
- Department of Radiation Oncology, University of Colorado, Denver, Colorado
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado, Denver, Colorado
| | - Ronald E Warnick
- Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio
| | - Jason Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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Mehta GU, Lekovic GP, Slattery WH, Brackmann DE, Long H, Kano H, Kondziolka D, Mureb M, Bernstein K, Langlois AM, Mathieu D, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Mohammed N, Urgosik D, Liscak R, Lee CC, Yang HC, Montazeripouragha A, Kaufmann AM, Joshi KC, Barnett GH, Trifiletti DM, Lunsford LD, Sheehan JP. Effect of Anatomic Segment Involvement on Stereotactic Radiosurgery for Facial Nerve Schwannomas: An International Multicenter Cohort Study. Neurosurgery 2021; 88:E91-E98. [PMID: 32687577 DOI: 10.1093/neuros/nyaa313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/13/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Facial nerve schwannomas are rare, challenging tumors to manage due to their nerve of origin. Functional outcomes after stereotactic radiosurgery (SRS) are incompletely defined. OBJECTIVE To analyze the effect of facial nerve segment involvement on functional outcome for these tumors. METHODS Patients who underwent single-session SRS for facial nerve schwannomas with at least 3 mo follow-up at 11 participating centers were included. Preoperative and treatment variables were recorded. Outcome measures included radiological tumor response and neurological function. RESULTS A total of 63 patients (34 females) were included in the present study. In total, 75% had preoperative facial weakness. Mean tumor volume and margin dose were 2.0 ± 2.4 cm3 and 12.2 ± 0.54 Gy, respectively. Mean radiological follow-up was 45.5 ± 38.9 mo. Progression-free survival at 2, 5, and 10 yr was 98.1%, 87.2%, and 87.2%, respectively. The cumulative proportion of patients with regressing tumors at 2, 5, and 10 yr was 43.1%, 63.6%, and 63.6%, respectively. The number of involved facial nerve segments significantly predicted tumor progression (P = .04). Facial nerve function was stable or improved in 57 patients (90%). Patients with involvement of the labyrinthine segment of the facial nerve were significantly more likely to have an improvement in facial nerve function after SRS (P = .03). Hearing worsened in at least 6% of patients. Otherwise, adverse radiation effects included facial twitching (3 patients), facial numbness (2 patients), and dizziness (2 patients). CONCLUSION SRS for facial nerve schwannomas is effective and spares facial nerve function in most patients. Some patients may have functional improvement after treatment, particularly if the labyrinthine segment is involved.
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Affiliation(s)
- Gautam U Mehta
- Division of Neurosurgery, House Ear Institute, Los Angeles, California
| | - Gregory P Lekovic
- Division of Neurosurgery, House Ear Institute, Los Angeles, California
| | | | | | - Hao Long
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Monica Mureb
- Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Kenneth Bernstein
- Department of Radiation Oncology, NYU Langone Medical Center, New York, New York
| | - Anne-Marie Langlois
- Department of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nasser Mohammed
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Dusan Urgosik
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | | | - Krishna C Joshi
- Department of Neuro-oncology, Cleveland Clinic, Cleveland, Ohio
| | - Gene H Barnett
- Department of Neuro-oncology, Cleveland Clinic, Cleveland, Ohio
| | | | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
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El-Shehaby AMN, Reda WA, Abdel Karim KM, Nabeel AM, Emad Eldin RM, Tawadros SR. Single-Session Stereotactic Radiosurgery for Large Benign Meningiomas: Medium-to Long-Term Results. World Neurosurg 2021; 150:e324-e336. [PMID: 33727203 DOI: 10.1016/j.wneu.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The use of stereotactic radiosurgery for the treatment of intracranial meningiomas has been established as an effective and safe treatment modality. Larger meningiomas typically are managed by surgery followed by radiosurgery. Treatment of large meningiomas (usually defined as >10 cc) by stereotactic radiosurgery has been investigated in some recent reports, either by single-session, volume-staged, or the hypofractionation technique. We sought to assess the long-term efficacy and safety of single-session stereotactic radiosurgery for large (10 cc or more) intracranial benign meningiomas. PATIENTS AND METHODS In this retrospective study, we included 273 patients with large benign meningiomas (≥10 cc) who were treated by single-session SRS and followed up for more than 2 years. Tumors were in a basal location in 228 patients (84%). There were 161 tumors (59%) in the perioptic location. The median tumor volume was 15.5 (10-57.3 cc [interquartile range {IQR} 12.3 cc]). The median prescription dose was 12 Gy (9-15 Gy [IQR 1 Gy]). RESULTS The median follow-up period was 6.1 years (2-18 years [IQR 5.5 years]). The tumor control rate was 90%. The progression-free survival at 5 and 10 years was 96% and 81%, respectively, for the whole cohort. Among 161 patients with perioptic meningiomas, favorable (better/stable) visual outcome was reported in 155 patients (96%) and unfavorable (worse) outcome in 6 patients (4%). Temporary adverse radiation effects were observed in 41 patients (15%) but only 16 (6%) were symptomatic. CONCLUSIONS Stereotactic radiosurgery provides an effective and safe treatment option for large meningiomas.
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Affiliation(s)
- Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute for Research and Treatment, Cairo, Egypt; Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute for Research and Treatment, Cairo, Egypt; Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Khaled M Abdel Karim
- Gamma Knife Center Cairo, Nasser Institute for Research and Treatment, Cairo, Egypt; Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute for Research and Treatment, Cairo, Egypt; Neurosurgery Department, Faculty of Medicine, Benha University, Qalubya, Egypt
| | - Reem M Emad Eldin
- Gamma Knife Center Cairo, Nasser Institute for Research and Treatment, Cairo, Egypt; Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute for Research and Treatment, Cairo, Egypt; Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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39
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Hung YC, Lee CC, Yang HC, Mohammed N, Kearns KN, Nabeel AM, Abdel Karim K, Emad Eldin RM, El-Shehaby AMN, Reda WA, Tawadros SR, Liscak R, Jezkova J, Lunsford LD, Kano H, Sisterson ND, Martínez Álvarez R, Martínez Moreno NE, Kondziolka D, Golfinos JG, Grills I, Thompson A, Borghei-Razavi H, Maiti TK, Barnett GH, McInerney J, Zacharia BE, Xu Z, Sheehan JP. The benefit and risk of stereotactic radiosurgery for prolactinomas: an international multicenter cohort study. J Neurosurg 2019; 133:1-10. [PMID: 31374549 DOI: 10.3171/2019.4.jns183443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 04/03/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The most common functioning pituitary adenoma is prolactinoma. Patients with medically refractory or residual/recurrent tumors that are not amenable to resection can be treated with stereotactic radiosurgery (SRS). The aim of this multicenter study was to evaluate the role of SRS for treating prolactinomas. METHODS This retrospective study included prolactinomas treated with SRS between 1997 and 2016 at ten institutions. Patients' clinical and treatment parameters were investigated. Patients were considered to be in endocrine remission when they had a normal level of prolactin (PRL) without requiring dopamine agonist medications. Endocrine control was defined as endocrine remission or a controlled PRL level ≤ 30 ng/ml with dopamine agonist therapy. Other outcomes were evaluated including new-onset hormone deficiency, tumor recurrence, and new neurological complications. RESULTS The study cohort comprised 289 patients. The endocrine remission rates were 28%, 41%, and 54% at 3, 5, and 8 years after SRS, respectively. Following SRS, 25% of patients (72/289) had new hormone deficiency. Sixty-three percent of the patients (127/201) with available data attained endocrine control. Three percent of patients (9/269) had a new visual complication after SRS. Five percent of the patients (13/285) were recorded as having tumor progression. A pretreatment PRL level ≤ 270 ng/ml was a predictor of endocrine remission (p = 0.005, adjusted HR 0.487). An increasing margin dose resulted in better endocrine control after SRS (p = 0.033, adjusted OR 1.087). CONCLUSIONS In patients with medically refractory prolactinomas or a residual/recurrent prolactinoma, SRS affords remarkable therapeutic effects in endocrine remission, endocrine control, and tumor control. New-onset hypopituitarism is the most common adverse event.
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Affiliation(s)
- Yi-Chieh Hung
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
- 2Departments of Neurosurgery and Surgery, Chi-Mei Medical Center, Tainan
- 3Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy and Science, Tainan
| | - Cheng-Chia Lee
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 5School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
| | - Nasser Mohammed
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Kathryn N Kearns
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Ahmed M Nabeel
- 6Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo
- 7Department of Neurosurgery, Benha University, Qalubya, Egypt
| | - Khaled Abdel Karim
- 6Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo
- 17Clinical Oncology, Ain Shams University, Cairo; and
| | - Reem M Emad Eldin
- 6Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo
- 18Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Amr M N El-Shehaby
- 6Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo
- Departments of16Neurosurgery and
| | - Wael A Reda
- 6Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo
- Departments of16Neurosurgery and
| | - Sameh R Tawadros
- 6Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo
- Departments of16Neurosurgery and
| | - Roman Liscak
- 8Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague
| | - Jana Jezkova
- 9Department of Endocrinology and Metabolism, 3rd Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - L Dade Lunsford
- 10Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- 10Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | | | | | | | - Douglas Kondziolka
- 12Department of Neurosurgery, NYU Langone Health System, New York, New York
| | - John G Golfinos
- 12Department of Neurosurgery, NYU Langone Health System, New York, New York
| | - Inga Grills
- 13Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Andrew Thompson
- 13Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | | | | | - Gene H Barnett
- 14Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - James McInerney
- 15Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Brad E Zacharia
- 15Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Zhiyuan Xu
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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40
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El-Shehaby AMN, Reda WA, Abdel Karim KM, Nabeel AM, Emad Eldin RM, Tawadros SR. Hearing preservation after Gamma Knife radiosurgery for cerebellopontine angle meningiomas. J Neurosurg 2018; 129:38-46. [DOI: 10.3171/2018.7.gks181308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe objective of this study was to assess hearing function after Gamma Knife treatment of cerebellopontine angle (CPA) meningiomas and assess factors affecting hearing outcome. Additionally, the authors opted to compare these results with those after Gamma Knife treatment of vestibular schwannomas (VSs), because most of the information on hearing outcome after stereotactic radiosurgery (SRS) comes from reports on VS treatment. Hearing preservation, to the best of the authors’ knowledge, has never been separately addressed in studies involving Gamma Knife radiosurgery (GKRS) for CPA meningiomas.METHODSThis study included all patients who underwent a single session of GKRS between 2002 and 2014. The patients were divided into two groups. Group A included 66 patients with CPA meningiomas with serviceable hearing and tumor extension into the region centered on the internal auditory meatus. Group B included 144 patients with VSs with serviceable hearing. All patients had serviceable hearing before treatment (Gardner-Robertson [GR] Grades I and II). The median prescription dose was 12 Gy (range 10–12 Gy) in both groups. The median follow-up of groups A and B was 42 months (range 6–149 months) and 49 months (range 6–149 months), respectively.RESULTSAt the last follow-up, the tumor control rate was 97% and 94% in groups A and B, respectively. Hearing preservation was defined as maintained serviceable hearing according to GR hearing score. The hearing preservation rate was 98% and 66% and the 7-year actuarial serviceable hearing preservation rate was 75% and 56%, respectively, between both groups. In group A, the median maximum cochlear dose in the patients with stable and worsened hearing grade was 6.3 Gy and 5.5 Gy, respectively. In group B, factors affecting hearing preservation were cochlear dose ≤ 7 Gy, follow-up duration, and tumor control. The only determinant of hearing preservation between both groups was tumor type.CONCLUSIONSGKRS for CPA meningiomas provides excellent hearing preservation in addition to high tumor control rate. Hearing outcome is better with CPA meningiomas than with VSs. Further long-term prospective studies on determinants of hearing outcome after GKRS for CPA meningiomas should be conducted.
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Affiliation(s)
| | - Wael A. Reda
- 1Gamma Knife Center Cairo
- 2Neurosurgery Department, and
| | - Khaled M. Abdel Karim
- 1Gamma Knife Center Cairo
- 3Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo
| | - Ahmed M. Nabeel
- 1Gamma Knife Center Cairo
- 5Neurosurgery Department, Faculty of Medicine, Benha University, Qalubya, Egypt
| | - Reem M. Emad Eldin
- 1Gamma Knife Center Cairo
- 4Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo; and
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41
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Abdel Karim K, Reda WA, El Shehaby AMN, Emad R, Tawadros SR, Nabeel A. P05.06 Hearing preservation after gamma knife radiosurgery for cerebellopontine angle meningiomas. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Abdel Karim
- Clinical Oncology Department, Ain Shams University, Cairo, Egypt
- Gamma Knife Centre, Cairo, Egypt
| | - W A Reda
- Gamma Knife Centre, Cairo, Egypt
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - A M N El Shehaby
- Gamma Knife Centre, Cairo, Egypt
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - R Emad
- Radiation Oncology Department, NCI, Cairo University, Cairo, Egypt
- Gamma Knife Centre, Cairo, Egypt
| | - S R Tawadros
- Gamma Knife Centre, Cairo, Egypt
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - A Nabeel
- Gamma Knife Centre, Cairo, Egypt
- Neurosurgery Department, Benha University, Qalubya, Egypt
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42
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Emad R, El Shehaby ANM, Reda WA, Abdel Karim K, Nabeel A, Tawadros SR. P01.006 Gamma knife radiosurgery for diffuse low-grade gliomas: An Egyptian experience. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Emad
- Radiation Oncology Department, NCI, Cairo University, Cairo, Egypt
- Gamma Knife Centre, Cairo, Egypt
| | - A N M El Shehaby
- Gamma Knife Centre, Cairo, Egypt
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - W A Reda
- Gamma Knife Centre, Cairo, Egypt
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - K Abdel Karim
- Clinical Oncology Department, Ain Shams University, Cairo, Egypt
- Gamma Knife Centre, Cairo, Egypt
| | - A Nabeel
- Neurosurgery Department, Benha University, Qalubya, Egypt
- Gamma Knife Centre, Cairo, Egypt
| | - S R Tawadros
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
- Gamma Knife Centre, Cairo, Austria
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43
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Abdel Karim K, El Shehaby AMN, Reda WA, Nabeel A, Emad R, Tawadros SR. P05.05 Gamma knife radiosurgery for foramen magnum meningiomas: a single centre study. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Abdel Karim
- Clinical Oncology Department, Ain Shams University, Cairo, Egypt
- Gamma Knife Centre, Cairo, Egypt
| | - A M N El Shehaby
- Gamma Knife Centre, Cairo, Egypt
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - W A Reda
- Gamma Knife Centre, Cairo, Egypt
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - A Nabeel
- Gamma Knife Centre, Cairo, Egypt
- Neurosurgery Department, Benha University, Qalubya, Egypt
| | - R Emad
- Radiation Oncology Department, NCI, Cairo University, Cairo, Egypt
- Gamma Knife Centre, Cairo, Egypt
| | - S R Tawadros
- Gamma Knife Centre, Cairo, Egypt
- Gamma Knife Centre, Cairo, Egypt
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44
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Abstract
OBJECT The primary concern when performing Gamma Knife surgery for pituitary adenoma is preservation of vision and pituitary function while achieving tumor growth control. Higher prescribed radiation doses are typically correlated with higher incidences of postradiosurgical hormone deficiencies. The goal of the present study was to retrospectively analyze the feasibility of using a lower prescribed radiation dose in the treatment of nonfunctioning pituitary adenomas and the effect of this dose on vision, pituitary function, and tumor growth control. METHODS The study was conducted in 38 patients with nonfunctioning pituitary adenomas, who were treated between January 2002 and July 2008. Twenty-one patients were available for follow-up (13 men and 8 women). The mean follow-up period was 44 months (range 24-90 months). Nineteen patients had previously undergone surgery. Pituitary dysfunction developed after surgery in 3 patients. One patient had an abnormal pituitary hormone profile before radiosurgery due to an attack of pituitary apoplexy. Visual field defects were present in 12 patients. The prescribed radiation dose was 12 Gy in all patients. The tumor volume ranged from 0.5 to 11.8 cm(3) (mean 4.8 cm(3)). The maximum dose to the visual pathway was kept below 10 Gy. The mean maximum dose delivered to the visual pathway was 7.9 Gy. RESULTS The patients were followed up for a period of 24 to 90 months (mean 44 months). The size of the tumor decreased in 11 patients (52%) and remained stable in 9 patients (43%). In 1 patient there was tumor growth outside the previous radiation field (on the contralateral side). Among the 12 patients with visual field defects, 9 (75%) experienced an improvement and the remaining patients' vision remained stable. In only 4 patients was the visual improvement associated with tumor shrinkage. The hormone profile remained normal in all patients except for the 4 patients who had pituitary dysfunction before radiosurgery. CONCLUSIONS The 12-Gy prescribed dose used in this study seems to be sufficient for producing tumor control while sparing the patient from radiation-induced pituitary dysfunction. In addition, visual improvement was reported in a number of cases. A larger series and longer follow-up are required to confirm these results.
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