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69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

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Treatment of intracranial meningiomas with radiosurgery (RS) and multisession radiosurgery (msRS)

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  • Susanne Fichte - CyberKnifeCentrum Mitteldeutschland, Erfurt, Deutschland
  • Hans-Ulrich Herold - CyberKnifeCentrum Mitteldeutschland, Erfurt, Deutschland
  • Gunnar Surber - CyberKnifeCentrum Mitteldeutschland, Erfurt, Deutschland
  • Klaus Hamm - CyberKnifeCentrum Mitteldeutschland, Erfurt, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocP012

doi: 10.3205/18dgnc353, urn:nbn:de:0183-18dgnc3537

Published: June 18, 2018

© 2018 Fichte et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Radiosurgery (RS) is a well-accepted therapeutic option for meningiomas in the interdisciplinary approach. With multisession radiosurgery (msRS), larger tumors in critical regions can be treated with the same precision, yet using the advantages of fractionation. The authors describe the treatment strategies and outcomes of patients treated in our department after implementation of a CyberKnife robotic radiosurgery system.

Methods: From October 2012 to April 2015, 129 (98 female, 31 male) patients were treated for intracranial meningiomas. Patient data, planning details and imaging were analyzed retrospectively. For follow-ups, contrast-enhanced MRI was fused to the initial imaging. Tumor response was evaluated and local control rate as well as marginal failure (tumor relapse adjacent to target volume) was assessed. Kaplan-Meier estimation was used for statistical analysis of survival and local control.

Results: 129 patients underwent 130 treatments for a total of 154 intracranial meningiomas (1-4 per session), one patient was treated twice during the observation period. Multisession RS (3-5 fractions) was used in case of large target volumes and/or critical localization (e.g. vicinity to the optical pathway or brainstem) in 36% of procedures. Mean target volume was 2,5 cm3 in patients treated with RS and 9,7 cm3 for msRS. Follow-up was complete for 127 patients. Mean time of follow-up was 28,1 (1,4 – 52,5) months. Overall survival was 99% and 97% at 1 and 2 years, respectively. Post-treatment changes on imaging occurred in 25% of patients after a mean follow-up of 5,5 months, resulting in temporary pseudoprogression in 14%. Post-treatment edema was seen in 8 patients (6%). Local failure occurred in 7 patients. Estimated local control rate was 98% and 95% at 1 and 2 years. Marginal progression occurred in 3 patients.

Conclusion: RS and msRS are safe and effective treatment options for intracranial meningiomas with high local control and a low rate of complications. For larger tumors in critical regions, msRS is recommended.