gms | German Medical Science

Objective: Microsurgical resection is the treatment of choice for meningeomas, but especially in the skull base regions the risk of postoperative neurological deficits can be high. In addition complete tumor removal cannot be reached in many of these cases, therefore recurrences are more probably. Radiosurgery (RS) and stereotactic radiotherapy (SRT) offer an alternate or additional treatment option in those patients.

Methods: 420 patients suffering from 474 meningeomas were treated with RS or SRT (2000–2011), among them 164 (39%) with residual and 112 (27%) with recurrent meningeomas after 1–5 microsurgical resections. 36 patients (8.6%) received 2 or more RS / SRT. We investigated the results until now with a mean follow-up of 68 months (6–125). RS was applied in 101 cases (22%). Their tumor volume ranged from 0.2 ccm to 3.9 ccm. The other patients had larger tumor volumes up to 99.7 ccm or a meningeoma close to critical structures. Therefore 271 patients (59%) were treated with SRT in conventional fractions of 1.8 / 2 Gy single dose up to 52.2–55.8 Gy. Hypofractionation with single fraction doses of 5 or 4 Gy was applied in 84 cases.

Results: Until now the tumor control rate was 95% – a partial tumor regression was proved 218x (52%), no change 181x (43%) and progression 21x (5%). In cases treated with SRT in single fractions of 2 or 1.8 Gy we have only seen 7x an unusual reaction with temporary worsening of the preexisting symptoms. In the RS group MRI showed more often (26 patients) surrounding radiation effects after 6 months, but there were only clinical side effects according to CTC grade I-II temporary in 6 cases.

Conclusions: RS and SRT are low risk and effective treatment options for tumor control in meningeomas – particularly in case of meningeomas compressing optical structures SRT should be the treatment of choice. An interdisciplinary decision is very important for each patient.