Single-Session Stereotactic Radiosurgery for Large Benign Meningiomas: Medium-to Long-Term Results

Amr M N El-Shehaby; Wael A Reda; Khaled M Abdel Karim; Ahmed M Nabeel; Reem M Emad Eldin; Sameh R Tawadros

doi:10.1016/j.wneu.2021.03.003

Single-Session Stereotactic Radiosurgery for Large Benign Meningiomas: Medium-to Long-Term Results

World Neurosurg. 2021 Jun:150:e324-e336. doi: 10.1016/j.wneu.2021.03.003. Epub 2021 Mar 13.

Authors

Amr M N El-Shehaby¹, Wael A Reda², Khaled M Abdel Karim³, Ahmed M Nabeel⁴, Reem M Emad Eldin⁵, Sameh R Tawadros²

Affiliations

¹ Gamma Knife Center Cairo, Nasser Institute for Research and Treatment, Cairo, Egypt; Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Electronic address: amrelshehaby@yahoo.com.
² Gamma Knife Center Cairo, Nasser Institute for Research and Treatment, Cairo, Egypt; Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
³ Gamma Knife Center Cairo, Nasser Institute for Research and Treatment, Cairo, Egypt; Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
⁴ Gamma Knife Center Cairo, Nasser Institute for Research and Treatment, Cairo, Egypt; Neurosurgery Department, Faculty of Medicine, Benha University, Qalubya, Egypt.
⁵ Gamma Knife Center Cairo, Nasser Institute for Research and Treatment, Cairo, Egypt; Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.

PMID: 33727203
DOI: 10.1016/j.wneu.2021.03.003

Abstract

Background: The use of stereotactic radiosurgery for the treatment of intracranial meningiomas has been established as an effective and safe treatment modality. Larger meningiomas typically are managed by surgery followed by radiosurgery. Treatment of large meningiomas (usually defined as >10 cc) by stereotactic radiosurgery has been investigated in some recent reports, either by single-session, volume-staged, or the hypofractionation technique. We sought to assess the long-term efficacy and safety of single-session stereotactic radiosurgery for large (10 cc or more) intracranial benign meningiomas.

Patients and methods: In this retrospective study, we included 273 patients with large benign meningiomas (≥10 cc) who were treated by single-session SRS and followed up for more than 2 years. Tumors were in a basal location in 228 patients (84%). There were 161 tumors (59%) in the perioptic location. The median tumor volume was 15.5 (10-57.3 cc [interquartile range {IQR} 12.3 cc]). The median prescription dose was 12 Gy (9-15 Gy [IQR 1 Gy]).

Results: The median follow-up period was 6.1 years (2-18 years [IQR 5.5 years]). The tumor control rate was 90%. The progression-free survival at 5 and 10 years was 96% and 81%, respectively, for the whole cohort. Among 161 patients with perioptic meningiomas, favorable (better/stable) visual outcome was reported in 155 patients (96%) and unfavorable (worse) outcome in 6 patients (4%). Temporary adverse radiation effects were observed in 41 patients (15%) but only 16 (6%) were symptomatic.

Conclusions: Stereotactic radiosurgery provides an effective and safe treatment option for large meningiomas.

Keywords: Brainstem; Cavernous malformation; Gamma knife; Large; Long-term; Meningiomas; Perioptic; Radiosurgery; Staged.

MeSH terms

Adult
Aged
Aged, 80 and over
Brain Neoplasms / mortality
Brain Neoplasms / surgery*
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Male
Meningioma / mortality
Meningioma / surgery*
Middle Aged
Neurosurgical Procedures / adverse effects
Neurosurgical Procedures / methods*
Neurosurgical Procedures / mortality
Progression-Free Survival
Radiation Dosage
Radiosurgery / adverse effects
Radiosurgery / methods*
Radiosurgery / mortality
Retrospective Studies
Skull Base Neoplasms / surgery
Treatment Outcome
Vision, Ocular
Young Adult