Artikel
Location, but not previous resection influences the occurrence of radiation necrosis in meningiomas undergoing radiosurgery
Die Lokalisation, nicht aber eine frühere Resektion beeinflusst das Auftreten von Strahlennekrosen bei radiochirurgisch therapierten Meningeomen
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Autoren
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Matthias Demetz
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
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Johannes Kerschbaumer
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
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Aleksandrs Krigers
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
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Meinhard Nevinny-Stickel
- Medizinische Universität Innsbruck, Radiotherapy/Radiation Oncology, Innsbruck, Österreich
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Claudius Thomé
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
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Christian F. Freyschlag
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Radiosurgery is an interdisciplinary treatment concept for meningiomas with a similar postoperative outcome compared to surgical resection. Radiation necrosis is a possible complication, but there are still only few known risk factors for its occurrence. The aim of this study was to identify risk factors for radiation necrosis in patients with meningiomas after radiosurgery.
Methods: All patients with meningiomas treated with radiosurgery at the author’s institution between January 2004 and November 2020 were retrospectively included. The clinical, imaging and medication data were gained from patient records. The largest axial diameter of the tumors was measured using MRI scans in T1 weighted imaging. Patients with radiation necrosis and patients without radiation necrosis were compared.
Results: 52 patients were included with a median age of 53 years (47-63). The mean tumor diameter was 18mm (±4.9mm) and the median isodose amounted to 14 Gy (14-16). 40.4% of the meningiomas were located at the skull base (SB), 59.6% were distributed over the rest of the cranium. The median overall dose of cortisone for prophylaxis of radiation necrosis was 120mg (72-120). 48.1% of patients had already undergone at least one surgical resection at the time of radiosurgery. 18 (34.6%) patients showed radiation necrosis at a median of 8 months (6-12), 7 (38.9%) of whom needed conservative treatment.
In this series a significant difference in radiation necrosis between SB meningiomas compared to those of other locations was found. SB meningiomas showed a significantly lower risk of radiation necrosis with an Odd’s Ratio (OR) of 0.241, p<0.001.
Interestingly, administered steroid dose did not correlate with the risk of radiation necrosis. Furthermore, no significant difference of radiation necrosis between previously operated and newly diagnosed meningiomas was found.
Conclusion: The risk of radiation necrosis for SB meningiomas appears to be low. For extended meningiomas of the skull base, combinations of a surgical approach and radiosurgery have already become increasingly important. Furthermore, no difference between previously resected tumors and tumors treated primarily with radiosurgery was found, which may underpin the use of radiosurgical treatment for patients with recurrent meningiomas.
