TY - JOUR
T1 - Stereotactic radiosurgery for treatment of radiation-induced meningiomas
T2 - A multiinstitutional study
AU - Bunevicius, Adomas
AU - Suleiman, Mohand
AU - Patel, Samir
AU - Álvarez, Roberto Martínez
AU - Moreno, Nuria E.Martinez
AU - Liscak, Roman
AU - Hanuska, Jaromir
AU - Langlois, Anne Marie
AU - Mathieu, David
AU - Mau, Christine
AU - Caldwell, Catherine
AU - Tuanquin, Leonard C.
AU - Zacharia, Brad E.
AU - McInerney, James
AU - Lee, Cheng Chia
AU - Yang, Huai Che
AU - Peterson, Jennifer L.
AU - Trifiletti, Daniel M.
AU - Ogino, Akiyoshi
AU - Kano, Hideyuki
AU - Warnick, Ronald E.
AU - Saylany, Anissa
AU - Buch, Love Y.
AU - Lee, John Y.K.
AU - Strickland, Ben A.
AU - Zada, Gabriel
AU - Chang, Eric L.
AU - Lunsford, L. Dade
AU - Sheehan, Jason
N1 - Publisher Copyright:
© 2021 American Association of Neurological Surgeons. All rights reserved.
PY - 2021/9
Y1 - 2021/9
N2 - OBJECTIVE Radiation-induced meningiomas (RIMs) are associated with aggressive clinical behavior. Stereotactic radiosurgery (SRS) is sometimes considered for selected RIMs. The authors investigated the effectiveness and safety of SRS for the management of RIMs. METHODS From 12 institutions participating in the International Radiosurgery Research Foundation, the authors pooled patients who had prior cranial irradiation and were subsequently clinically diagnosed with WHO grade I meningiomas that were managed with SRS. RESULTS Fifty-two patients underwent 60 SRS procedures for histologically confirmed or radiologically suspected WHO grade I RIMs. The median ages at initial cranial radiation therapy and SRS for RIM were 5.5 years and 39 years, respectively. The most common reasons for cranial radiation therapy were leukemia (21%) and medulloblastoma (17%). There were 39 multiple RIMs (35%), the mean target volume was 8.61}7.80 cm3, and the median prescription dose was 14 Gy. The median imaging follow-up duration was 48 months (range 4.195 months). RIM progressed in 9 patients (17%) at a median duration of 30 months (range 3.45 months) after SRS. Progression-free survival at 5 years post-SRS was 83%. Treatment volume . 5 cm3 predicted progression (HR 8.226, 95% CI 1.028.65.857, p = 0.047). Seven patients (14%) developed new neurological symptoms or experienced SRS-related complications or T2 signal change from 1 to 72 months after SRS. CONCLUSIONS SRS is associated with durable local control of RIMs in the majority of patients and has an acceptable safety profile. SRS can be considered for patients and tumors that are deemed suboptimal, poor surgical candidates, and those whose tumor again progresses after removal.
AB - OBJECTIVE Radiation-induced meningiomas (RIMs) are associated with aggressive clinical behavior. Stereotactic radiosurgery (SRS) is sometimes considered for selected RIMs. The authors investigated the effectiveness and safety of SRS for the management of RIMs. METHODS From 12 institutions participating in the International Radiosurgery Research Foundation, the authors pooled patients who had prior cranial irradiation and were subsequently clinically diagnosed with WHO grade I meningiomas that were managed with SRS. RESULTS Fifty-two patients underwent 60 SRS procedures for histologically confirmed or radiologically suspected WHO grade I RIMs. The median ages at initial cranial radiation therapy and SRS for RIM were 5.5 years and 39 years, respectively. The most common reasons for cranial radiation therapy were leukemia (21%) and medulloblastoma (17%). There were 39 multiple RIMs (35%), the mean target volume was 8.61}7.80 cm3, and the median prescription dose was 14 Gy. The median imaging follow-up duration was 48 months (range 4.195 months). RIM progressed in 9 patients (17%) at a median duration of 30 months (range 3.45 months) after SRS. Progression-free survival at 5 years post-SRS was 83%. Treatment volume . 5 cm3 predicted progression (HR 8.226, 95% CI 1.028.65.857, p = 0.047). Seven patients (14%) developed new neurological symptoms or experienced SRS-related complications or T2 signal change from 1 to 72 months after SRS. CONCLUSIONS SRS is associated with durable local control of RIMs in the majority of patients and has an acceptable safety profile. SRS can be considered for patients and tumors that are deemed suboptimal, poor surgical candidates, and those whose tumor again progresses after removal.
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U2 - 10.3171/2020.7.JNS202064
DO - 10.3171/2020.7.JNS202064
M3 - Article
C2 - 33385995
AN - SCOPUS:85113295304
SN - 0022-3085
VL - 135
SP - 862
EP - 870
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 3
ER -