Artikel
Stereotactic Micro-Multi-Leaf-LINAC-radiosurgery for intracranial meningiomas
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Autoren
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F. El Majdoub
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln, Köln
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M. Elawadi
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln, Köln
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C. Bührle
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln, Köln
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M. El Khatib
- Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Düsseldorf
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M. Hoevels
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln, Köln
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R.P. Müller
- Abteilung für Onkologische Bestrahlung, Klinikum der Universität zu Köln, Köln
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V. Sturm
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln, Köln
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M. Maarouf
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln, Köln
| Veröffentlicht: | 28. April 2011 |
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Gliederung
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Objective: Meningiomas are benign, slowly progressive neoplasms that often present the opportunity for a permanent cure. Microsurgery is the treatment of choice in most cases. Radiosurgery is emerging as a different, non-invasive modality for the treatment of meningiomas. We present the clinical and radiological outcome of a consecutive series of patients with meningiomas treated by LINAC-Radiosurgery using the Micro-Multi-Leaf Collimator technique (µMLC).
Methods: Between May 2001 and July 2009, 78 patients (24 male and 54 female, range: 20.1 to 81 years, median: 56.8 years) with 87 intracranial meningiomas (78 WHO I°, 7 WHO II°, 2 WHO III°) were treated at our institution with µMLC-LINAC Radiosurgery, either as a primary or salvage treatment following one or more microsurgical procedures. The locations of the tumors were the falx 20 (23%), sphenoid wing 14 (16.1%), cavernous sinus 11 (12.6%), CPA 8 (9.2%), tentorium 8 (9.2%), convexity 7 (8.1%) and other locations 19 (21.8%). The median tumor volume was 4.8ml (range: 0.2 to 18.3 ml). The median tumor surface dose, maximal dose and therapeutic isodose were 12Gy, 16 Gy and 75% respectively after a median follow-up period of 76.7 months (range: 11.8 to 109.1 months).
Results: There was clinical improvement in 24 patients improved (30.8%), 49 patients were stable (62.8%), 3 patients had treatment-related temporary complaints (3.8%); two patients developed vertigo and one had a left sided hemihypesthesia. All these complaints disappearedcompletely after steroid medication within two weeks. Two patients (2.6%) developed permanent trigeminal neuralgia. Follow-up MRI showed a partial remission in 21 tumors (24.1%) and a stable tumor size in 64 cases (73.6%). Two patients showed tumor progression (one WHO I° and one WHO III° meningioma). At the end of follow-up (July 2010), five patients had died; four due to old age and one patient due to pulmonary embolism. Overall actual 5- and 8-year survival rates after radiosurgery were 97% and 88% respectively. There was no treatment-related mortality.
Conclusions: µ-MLC-LINAC-Radiosurgery for intracranial meningiomas is a safe and effective treatment for complex small to moderate-sized meningiomas.
