Top

Published in:

01-12-2018 | Original Research

Experience with hypofractionated stereotactic radiosurgery in a series of patients with skull base tumors

Authors: Diego Aldo Hernández, Juan M. Zaloff Dakoff, Cynthia Auad, Víctor Eduardo Derechinsky, Roberto Rosler, Julio García, Ana Martínez, María Luisa Filomía, Luisa Rafailovici

Published in: Journal of Radiation Oncology | Issue 4/2018

Abstract

Introduction and objective

Although the effectiveness of single-fraction brain stereotactic radiosurgery has been extensively demonstrated, recent evidence is suggesting that when skull base lesions are the targets, radiation near critical structures (e.g., optic nerves, and brainstem) should be reduced to avoid radiotoxic effects, with the risk of treatment inefficacy. Hence, in these tumors, hypofractionated stereotactic radiosurgery (HSRS) would offer a therapeutical opportunity. Here, we present our experience with this modality in the management of patients with skull base tumors.

Methods

A series of patients with skull base tumors was retrospectively analyzed to evaluate the treatment with HSRS. The primary endpoint was tumor control in post-treatment imaging. Age, sex, tumor histology, tumor volume, type of radiation protocol, pre-treatment Karnofsky performance status (KPS), previous neurosurgery, and prior radiotherapy were analyzed.

Results

A total of 84 patients were treated between January/2009 to January/2017. Median age: 51.5 years. Female gender: 53.6%. There was 92.7% of non-progression after HSRS, with a median f/u of 36 months. Main tumors treated were pituitary adenomas, acoustic schwannomas, and skull base meningioma. Most of the patients were treated with a 5-day fraction scheme of a 25 Gy total dose. No late radiotoxicity was observed. In multivariate analysis, a high KPS was associated with non-progression.

Conclusions

In our series of patients, the high incidence of non-progression of tumors indicated that HSRS could be a therapeutic option in some cases of skull base lesions, mainly residuals or tumoral recurrences of pituitary adenomas, schwannomas, and meningiomas.

Hormone-secreting pituitary adenomas were excluded given that the appropriate outcome, in this case, is not the tumor non-progression, but the biochemical normalization of hormone secretion.

Amichetti M, Amelio D, Minniti G (2012) Radiosurgery with photons or protons for benign and malignant tumours of the skull base: a review. Radiat Oncol 7:210CrossRef

Anker CJ, Shrieve DC (2009) Basic principles of radiobiology applied to radiosurgery and radiotherapy of benign skull base tumors. Otolaryngol Clin N Am 42(4):601–621CrossRef

De Witte O, Hassid S, Massager N (2009) Tumors involving the base of the skull: diagnostic and therapeutic approaches. Curr Opin Oncol 21(3):238–231CrossRef

Ding D, Yen CP, Starke RM, Lee CC, Sheehan JP (2014) Unyielding progress: recent advances in the treatment of central nervous system neoplasms with radiosurgery and radiation therapy. J Neuro-Oncol 119(3):513–529CrossRef

Fernandez-Miranda JC, Gardner PA, Snyderman CH, Devaney KO, Mendenhall WM, Suárez C et al (2014) Clival chordomas: a pathological, surgical, and radiotherapeutic review. Head Neck 36(6):892–906CrossRef

Prabhu SS, Demonte F (2003) Treatment of skull base tumors. Curr Opin Oncol 15(3):209–212CrossRef

Suh JH, Saxton JP (2000) Conventional radiation therapy for skull base tumors: an overview. Neurosurg Clin N Am 11(4):575–586CrossRef

Abdelaziz OS, Kandil A, El-Assaal S, Abdelaziz A, Rostom Y, Rashed Y (2011) Linear accelerator-based stereotactic radiosurgery of intracranial meningiomas: results of the first 5 years of clinical practice. Neurosurg Rev 34(1):87–99CrossRef

Conley GS, Hirsch BE (2010) Stereotactic radiation treatment of vestibular schwannoma: indications, limitations, and outcomes. Curr Opin Otolaryngol Head Neck Surg 18(5):351–356CrossRef

10.

Deinsberger R, Tidstrand J (2005) Linac radiosurgery as a tool in neurosurgery. Neurosurg Rev 28(2):79–88CrossRef

11.

Friedman WA, Foote KD (2003) Linear accelerator-based radiosurgery for vestibular schwannoma. Neurosurg Focus 14(5):e2PubMed

12.

Kondziolka D, Flickinger JC, Lunsford LD (2008) The principles of skull base radiosurgery. Neurosurg Focus 24(5):E11CrossRef

13.

McCutcheon IE (2013) Stereotactic radiosurgery for malignant extracerebral intracranial tumors: patient selection, efficacy, and technical nuances. Acta Neurochir Suppl 116:71–83PubMed

14.

Pollock BE, Foote RL (2004) The evolving role of stereotactic radiosurgery for patients with skull base tumors. J Neuro-Oncol 69(1–3):199–207CrossRef

15.

Betti O, Derechinsky V (1983) Multiple-beam stereotactic irradiation. Neurochirurgie 29(4):295–298 French

16.

Betti OO, Derechinsky VE (1984) Hyperselective encephalic irradiation with linear accelerator. Acta Neurochir Suppl 33:385–390

17.

Betti OO, Galmarini D, Derechinsky V (1991) Radiosurgery with a linear accelerator. Methodol Aspects Stereotact Funct Neurosurg 57(1–2):87–98

18.

Emami B (2013) Tolerance of normal tissue to therapeutic radiation. Reports of Radiother Oncol 1(1):35–48

19.

Leavitt JA, Stafford SL, Link MJ, Pollock BE (2013) Long-term evaluation of radiation-induced optic neuropathy after single-fraction stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 87(3):524–527CrossRef

20.

Killory BD, Kresl JJ, Wait SD, Ponce FA, Porter R, White WL (2009) Hypofractionated CyberKnife radiosurgery for perichiasmatic pituitary adenomas: early results. Neurosurgery 64(2 Suppl):A19–A25CrossRef

21.

Astradsson A, Wiencke AK, Munck AF, Rosenschold P, Engelholm SA, Ohlhues L, Roed H, Juhler M (2014) Visual outcome after fractionated stereotactic radiation therapy of benign anterior skull base tumors. J Neuro-Oncol 118(1):101–108CrossRef

22.

Chun SG, Nedzi LA, Choe KS, Abdulrahman RE, Chen SA, Yordy JS, Timmerman RD, Kutz JW, Isaacson B (2014) A retrospective analysis of tumor volumetric responses to five fraction stereotactic radiotherapy for paragangliomas of the head and neck (glomus tumors). Stereotact Funct Neurosurg 92(3):153–159CrossRef

23.

Coppa ND, Raper DM, Zhang Y, Collins BT, Harter KW, Gagnon GJ, Collins SP, Jean WC (2009) Treatment of malignant tumors of the skull base with multi-session radiosurgery. Hematol Oncol 2:16CrossRef

24.

Tuniz F, Soltys SG, Choi CY, Chang SD, Gibbs IC, Fischbein NJ, Adler JR Jr (2009) Multisession cyberknife stereotactic radiosurgery of large, benign cranial base tumors: preliminary study. Neurosurgery 65(5):898–907CrossRef

25.

Combs SE, Adeberg S, Dittmar JO, Welzel T, Rieken S, Habermehl D, Huber PE, Debus J (2013) Skull base meningiomas: Long-term results and patient self-reported outcome in 507 patients treated with fractionated stereotactic radiotherapy (FSRT) or intensity modulated radiotherapy (IMRT). Radiother Oncol 106(2):186–191 2012 Aug 18CrossRef

26.

Litré CF, Colin P, Noudel R, Peruzzi P, Bazin A, Sherpereel B, Bernard MH, Rousseaux P (2009) Fractionated stereotactic radiotherapy treatment of cavernous sinus meningiomas: a study of 100 cases. Int J Radiat Oncol Biol Phys 74(4):1012–1017CrossRef

27.

McGregor JM, Sarkar A (2009) Stereotactic radiosurgery and stereotactic radiotherapy in the treatment of skull base meningiomas. Otolaryngol Clin N Am 42(4):677–688CrossRef

28.

Minniti G, Amichetti M, Enrici RM (2009) Radiotherapy and radiosurgery for benign skull base meningiomas. Radiat Oncol 4:42CrossRef

29.

Minniti G, Clarke E, Cavallo L, Osti MF, Esposito V, Cantore G, Cappabianca P, Enrici RM (2011) Fractionated stereotactic conformal radiotherapy for large benign skull base meningiomas. Radiat Oncol 6:36CrossRef

30.

Solberg TD, Selch MT, Smathers JB, DeSalles AA (1998 Fall) Fractionated stereotactic radiotherapy: rationale and methods. Med Dosim 23(3):209–219CrossRef

31.

De Salles AA, Gorgulho AA, Pereira JL, McLaughlin N (2013) Intracranial stereotactic radiosurgery: concepts and techniques. Neurosurg Clin N Am 24(4):491–498CrossRef

32.

Benghiat H, Heyes G, Nightingale P, Hartley A, Tiffany M, Spooner D, Geh JI, Cruickshank G, Irving RM, Sanghera P (2014) Linear accelerator stereotactic radiosurgery for vestibular schwannomas: a UK series. Clin Oncol (R Coll Radiol) 26(6):309–315CrossRef

33.

Combs SE, Ganswindt U, Foote RL, Kondziolka D, Tonn JC (2012) State-of-the-art treatment alternatives for base of skull meningiomas: complementing and controversial indications for neurosurgery, stereotactic and robotic based radiosurgery or modern fractionated radiation techniques. Radiat Oncol 7:226CrossRef

34.

Han J, Girvigian MR, Chen JC, Miller MJ, Lodin K, Rahimian J, Arellano A, Cahan BL, Kaptein JS (2014) A comparative study of stereotactic radiosurgery, hypofractionated, and fractionated stereotactic radiotherapy in the treatment of skull base meningioma. Am J Clin Oncol 37(3):255–260CrossRef

35.

Ho JC, Phan J (2017 Oct 28) Reirradiation of skull base tumors with advanced highly conformal techniques. Curr Oncol Rep 19(12):82CrossRef

36.

Barnett GH, Linskey ME, Adler JR, Cozzens JW, Friedman WA, Heilbrun P et al (2007) Stereotactic radiosurgery—an organized neurosurgery sanctioned definition. J Neurosurg 106:1–5CrossRef

37.

Navarria P, Pessina F, Cozzi L, Clerici E, Villa E, Ascolese AM, De Rose F, Comito T, Franzese C, D'Agostino G, Lobefalo F, Fogliata A, Reggiori G, Fornari M, Tomatis S, Bello L, Scorsetti M (2015) Hypofractionated stereotactic radiation therapy in skull base meningiomas. J Neuro-Oncol 124(2):283–289CrossRef

38.

Patibandla MR, Lee CC, Sheehan J Stereotactic radiosurgery of central skull base meningioma’s - volumetric evaluation and long-term outcomes. World Neurosurg. 2017

39.

Meijer OW, Weijmans EJ, Knol DL, Slotman BJ, Barkhof F, Vandertop WP et al (2008) Tumor-volume changes after radiosurgery for vestibular schwannoma: implications for follow-up MR imaging protocol. AJNR Am J Neuroradiol 29:906–910CrossRef

40.

Hauptman JS, Barkhoudarian G, Safaee M, Gorgulho A, Tenn S, Agazaryan N, Selch M, De Salles AA (2012) Challenges in linear accelerator radiotherapy for chordomas and chondrosarcomas of the skull base: focus on complications. Int J Radiat Oncol Biol Phys 83(2):542–551CrossRef

41.

Kano H, Lunsford LD (2013) Stereotactic radiosurgery of intracranial chordomas, chondrosarcomas, and glomus tumors. Neurosurg Clin N Am 24(4):553–560CrossRef

42.

Klinger DR, Flores BC, Lewis JJ, Barnett SL (2013) The treatment of cavernous sinus meningiomas: evolution of a modern approach. Neurosurg Focus 35(6):E8CrossRef

43.

Somers T, Van Havenbergh T (2012) Multidisciplinary management of vestibular schwannomas: state of the art. B-ENT 8(4):235–240PubMed

44.

Collen C, Ampe B, Gevaert T, Moens M, Linthout N, De Ridder M, Verellen D, D’Haens J, Storme G (2011) Single fraction versus fractionated linac-based stereotactic radiotherapy for vestibular schwannoma: a single institution experience. Int J Radiat Oncol Biol Phys 81(4):e503–e509CrossRef

45.

Stelzer KJ (2000) Acute and long-term complications of therapeutic radiation for skull base tumors. Neurosurg Clin N Am 11(4):597–604CrossRef

Title: Experience with hypofractionated stereotactic radiosurgery in a series of patients with skull base tumors
Authors: Diego Aldo Hernández
Juan M. Zaloff Dakoff
Cynthia Auad
Víctor Eduardo Derechinsky
Roberto Rosler
Julio García
Ana Martínez
María Luisa Filomía
Luisa Rafailovici
Publication date: 01-12-2018
Publisher: Springer Berlin Heidelberg
Published in: Journal of Radiation Oncology / Issue 4/2018
Print ISSN: 1948-7894
Electronic ISSN: 1948-7908
DOI: https://doi.org/10.1007/s13566-018-0365-4

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction and objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2018

Acute toxicities after volumetric modulated arc therapy for craniospinal irradiation in adults

A fiducial-less tracking method for radiation therapy of liver tumors by diaphragm disparity analysis part 2: validation study by using clinical data

Evaluation of effectiveness of palliative radiotherapy for bone metastases: a prospective cohort study

Relationship among different skin dose definitions in high-dose-rate (HDR) balloon breast brachytherapy

Inter-fraction movements of the prostate and pelvic lymph nodes during IGRT

Clinical evidence for dose tolerance of the central nervous system in hypofractionated radiotherapy

Keynote webinar | Spotlight on antibody–drug conjugates in cancer