Article
Long-term outcome for benign meningiomas after stereotactic LINAC radiosurgery
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Authors
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Mustafa El-Khatib
- Klinik für funktionelle Neurochirurgie und Stereotaxie der Universitätskliniken Köln, Deutschland; Klinik für Neurochirurgie der Heinrich Heine Universität Düsseldorf, Deutschland
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Mauritius Hoevel
- Klinik für funktionelle Neurochirurgie und Stereotaxie der Universitätskliniken Köln, Deutschland
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Martin Kocher
- Klinik für Strahlentherapie der Universitätskliniken Köln, Deutschland
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Hans-Jakob Steiger
- Klinik für Neurochirurgie der Heinrich Heine Universität Düsseldorf, Deutschland
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Volker Sturm
- Klinik für funktionelle Neurochirurgie und Stereotaxie der Universitätskliniken Köln, Deutschland
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Mohammed Maarouf
- Klinik für funktionelle Neurochirurgie und Stereotaxie der Universitätskliniken Köln, Deutschland
| Published: | September 16, 2010 |
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Outline
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Objective: Microsurgery is still the gold standard for the therapy of meningiomas. In cases with eloquent localizations many surgeons prefer a subtotal resection to avoid morbidity. Numerous short- and intermediate-term studies showed high tumor control rate with low morbidity after RS for recurrent meningiomas. For small and deep meningiomas RS is established as an alternative to microsurgery. We present our radiological and clinical long-term outcome of LINAC RS for benign cranial meningiomas.
Methods: From August 1990 to December 2003 118 patients with 131 lesions and radiological or histological findings of benign meningiomas were treated by stereotactic LINAC-RS in our institution. 60 meningiomas underwent RS as primary treatment and 71 after prior microsurgical resection. 85 meningiomas were located at the skull base with involvement of the cavernous sinus in 66 cases, 31 at the falx and 15 at the convexity. According to the irradiation parameters a median surface dose of 12 Gy (range: 7–20 Gy) was applied and a median maximum dose of 29 Gy (range 11.3–58.6 Gy) was achieved. The median target volume was 4.75 ml (range: 0.2–32.8 ml).
Results: The overall mean radiological follow-up was 99 months (median 100 months, range 3.7–205 months). Tumor shrinkage was seen in 61/131 (46.6%) meningiomas and stable disease in 67/131 (51.1%). 3/131 (2.3%) showed a local tumor progression. The overall tumor control rate (TCR) was 98% and the progression free survival (PFS) was 97%, 92% and 92% after 5, 10 and 15 years. For residual or recurrent meningiomas the corresponding TCR was 96% and PFS was 94%, 89% and 89% and for primary treated meningiomas the TCR was 100% and PFS was 100%, 95% and 95% after 5, 10 and 15 years, respectively. Regarding the clinical Status after a mean clinical follow-up of 103 months (median 102 months, range 6–206 months) clinical improvement was observed in 49 (41.5%), unchanged symptoms in 60 (50.8%) and deterioration in 9 (7.6%) patients.
Conclusions: Our study shows the efficacy of LINAC-RS for recurrent and residual cranial meningiomas. Regardless to primary treatment or for residual or recurrent meningiomas high local tumor control rate and low morbidity were achieved. Thus, RS should be considered as one arm of a combined treatment for incompletely resected or recurrent meningiomas. In case of small and surgically high risk meningiomas RS is a good alternative to microsurgery.
