Artikel
LINAC-radiosurgery for the treatment of skull base meningiomas
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Veröffentlicht: | 4. Juni 2012 |
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Objective: We present our long-term results of a consecutive series of patients with skull base meningiomas treated by LINAC-Radiosurgery.
Methods: Between August 1991 and July 2011, 129 patients (m:f = 39:101; median age, 51.9 years; range, 9.7–80.2 years) with 134 skull base meningiomas (81 WHO I, 9 WHO II, 2 WHO III, 42 Tumors with no histology) were treated with LINAC Radiosurgery at our institution, either as a primary (n = 42) or salvage treatment following one or more microsurgical procedures (n = 92). The meningiomas were located at the sphenoid wing/ sinus cavernosus (n = 104, 77.6%), petroclival (n = 18, 13.4%), olfactorial (n = 8, 6%) and in the cerebellopontine angle (n = 4, 3%). The median tumor volume was 5.7 ml (range, 0.2–51.4 ml). The median tumor surface dose, maximal dose and therapeutic isodose were 12 Gy, 29.1 Gy and 65%, respectively.
Results: For retrospective evaluation we included 112 patients (117 tumors) with a minimum radiological follow-up of 12 months. After a median follow-up of 56.7 months (range, 12.1–231.4 months) 68 patients (60.7%) improved in their clinical status (paresis of N. abducens, seizures, facial paresis, and hemiparesis; 35 patients (31.2%) remained stable, 7 patients (6.3%) had treatment-related temporary complaints; 2 patients developed vertigo, another 2 had double visions, 2 patients exhibited seizures and 1 had a left-sided hemihypesthesia. All complaints recovered completely after steroid medication within one month. Two patients (1.8%) developed permanent medication controlled trigeminal neuralgia. Follow-up MR images showed partial remission in 41 tumors (35%) and a stable tumor in 66 cases (56.4%). Five patients (4.3%), all of them with high grade meningiomas showed a tumor progression (3 WHO II and 2 WHO III meningioma). At the end of follow-up (July 2011) the actuarial 5-, 10- and 15-year progression-free survival after radiosurgery were each 94%, respectively. There was no treatment-related mortality.
Conclusions: LINAC-Radiosurgery for skull base meningiomas yields a high long-term local tumor control. The treatment-related morbidity is low.