Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 12/2015

01-12-2015 | Original Article

Stereotactic LINAC radiosurgery for the treatment of typical intracranial meningiomas

Efficacy and safety after a follow-up of over 12 years

Authors: Mustafa El-Khatib, M.D., Faycal El Majdoub, M.D., PD Stefan Hunsche, Ph.D., Mauritius Hoevels, Martin Kocher, M.D., Prof. Volker Sturm, M.D., PD Mohammad Maarouf, M.D., Assoc. Professor

Published in: Strahlentherapie und Onkologie | Issue 12/2015

Login to get access

Abstract

Purpose

The efficacy and safety of stereotactic radiosurgery (SRS) for treatment of intracranial meningiomas has been demonstrated in numerous studies with short- and intermediate-term follow-up. In this retrospective single-center study, we present long-term outcomes of SRS performed with a linear accelerator (LINAC) for typical intracranial meningiomas.

Patients and methods

Between August 1990 and December 2007, 148 patients with 168 typical intracranial meningiomas were treated with stereotactic LINAC-SRS, either as primary treatment or after microsurgical resection. A median tumor surface dose of 12 Gy (range 7–20 Gy) and a median maximum dose of 24.1 Gy (range 11.3–58.6 Gy) was applied. The median target volume was 4.7 ml (range 0.2–32.8 ml, SD ± 4.8 ml).

Results

Overall mean radiological follow-up was 12.6 years. Tumor shrinkage was seen in 75 (44.6 %) and stable disease in 85 (50.6 %) cases. Eight of 168 meningiomas (4.8 %) showed local tumor progression. The tumor control rate (TCR) after 5, 10, and 15 years was 93.6 % at each time point, and the progression-free survival (PSF) rates were 92, 89, and 89 %, respectively. The neurological symptoms existing prior to LINAC-SRS improved in 77 patients (59.7 %), remained unchanged in 42 (32.6 %), and deteriorated in 10 (7.8 %) patients.

Conclusion

Our study emphasizes the efficacy of LINAC-SRS for de novo, residual and recurrent typical intracranial meningiomas. A high long-term local TCR with a low morbidity rate could be achieved. LINAC-SRS should thus be considered as a primary treatment option, as one arm of a combined treatment approach for incompletely resected meningiomas, or as a salvage therapy for recurrences.
Literature
1.
El Majdoub F, Elawady M, Buhrle C, El-Khatib M, Hoevels M, Treuer H, Muller RP, Sturm V, Maarouf M (2012) muMLC-LINAC radiosurgery for intracranial meningiomas of complex shape. Acta Neurochir 154:599–604. doi:10.1007/s00701-012-1278-4CrossRefPubMed
2.
El-Khatib M, El Majdoub F, Hoevels M, Kocher M, Muller RP, Steiger HJ, Sturm V, Maarouf M (2011) Stereotactic LINAC radiosurgery for incompletely resected or recurrent atypical and anaplastic meningiomas. Acta Neurochir 153:1761–1767. doi:10.1007/s00701-011-1073-7CrossRefPubMed
3.
Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114:97–109. doi:10.1007/s00401-007-0243-4PubMedCentralCrossRefPubMed
4.
Lin BJ, Chou KN, Kao HW, Lin C, Tsai WC, Feng SW, Lee MS, Hueng DY (2014) Correlation between magnetic resonance imaging grading and pathological grading in meningioma. J Neurosurg 121:1201–1208. doi:10.3171/2014.7.JNS 132359CrossRefPubMed
5.
Osborn AG (2007) Diagnostic imaging: brain, 1. edn. Amirsys, Salt Lake City
6.
Runge MJ, Maarouf M, Hunsche S, Kocher M, Ruge MI, El Majdoub F, Treuer H, Mueller RP, Voges J, Sturm V (2012) LINAC-radiosurgery for nonsecreting pituitary adenomas. Long-term results. Strahlenther Onkol 188:319–325. doi:10.1007/s00066-011-0052-5CrossRefPubMed
7.
Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280PubMed
8.
Chang SD, Adler JR Jr (1997) Treatment of cranial base meningiomas with linear accelerator radiosurgery. Neurosurgery 41:1019–1025. (discussion 1025–1017)CrossRefPubMed
9.
Chuang CC, Chang CN, Tsang NM, Wei KC, Tseng CK, Chang JT, Pai PC (2004) Linear accelerator-based radiosurgery in the management of skull base meningiomas. J Neurooncol 66:241–249CrossRefPubMed
10.
DiBiase SJ, Kwok Y, Yovino S, Arena C, Naqvi S, Temple R, Regine WF, Amin P, Guo C, Chin LS (2004) Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 60:1515–1519. doi:10.1016/j.ijrobp.2004.05.073CrossRefPubMed
11.
Kondziolka D, Flickinger JC, Perez B (1998) Judicious resection and/or radiosurgery for parasagittal meningiomas: outcomes from a multicenter review. Gamma Knife Meningioma Study Group. Neurosurgery 43:405–413. (discussion 413–404)CrossRefPubMed
12.
Liscak R, Simonova G, Vymazal J, Janouskova L, Vladyka V (1999) Gamma knife radiosurgery of meningiomas in the cavernous sinus region. Acta Neurochir 141:473–480CrossRefPubMed
13.
Morita A, Coffey RJ, Foote RL, Schiff D, Gorman D (1999) Risk of injury to cranial nerves after gamma knife radiosurgery for skull base meningiomas: experience in 88 patients. J Neurosurg 90:42–49. doi:10.3171/jns.1999.90.1.0042CrossRefPubMed
14.
Nicolato A, Foroni R, Alessandrini F, Maluta S, Bricolo A, Gerosa M (2002) The role of Gamma Knife radiosurgery in the management of cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys 53:992–1000CrossRefPubMed
15.
Pollock BE, Stafford SL, Link MJ (2000) Gamma knife radiosurgery for skull base meningiomas. Neurosurg Clinics N Am 11:659–666
16.
Roche PH, Pellet W, Fuentes S, Thomassin JM, Regis J (2003) Gamma knife radiosurgical management of petroclival meningiomas results and indications. Acta Neurochir 145:883–888. doi:10.1007/s00701-003-0123-1. (discussion 888)CrossRefPubMed
17.
Santacroce A, Walier M, Regis J, Liscak R, Motti E, Lindquist C, Kemeny A, Kitz K, Lippitz B, Martinez Alvarez R, Pedersen PH, Yomo S, Lupidi F, Dominikus K, Blackburn P, Mindermann T, Bundschuh O, van Eck AT, Fimmers R, Horstmann GA (2012) Long-term tumor control of benign intracranial meningiomas after radiosurgery in a series of 4565 patients. Neurosurgery 70:32–39. doi:10.1227/NEU.0b013e31822d408a. (discussion 39)CrossRefPubMed
18.
19.
Little KM, Friedman AH, Sampson JH, Wanibuchi M, Fukushima T (2005) Surgical management of petroclival meningiomas: defining resection goals based on risk of neurological morbidity and tumor recurrence rates in 137 patients. Neurosurgery 56:546–559. (discussion 546–559)CrossRefPubMed
20.
Marinov M, Kirkesseljan A (1993) Intracranial meningioma: analysis of radical surgery in 668 patients. Zentralblatt Neurochirurgie 54:174–178
21.
Larson JJ, van Loveren HR, Balko MG, Tew JM Jr (1995) Evidence of meningioma infiltration into cranial nerves: clinical implications for cavernous sinus meningiomas. J Neurosurg 83:596–599. doi:10.3171/jns.1995.83.4.0596CrossRefPubMed
22.
Adegbite AB, Khan MI, Paine KW, Tan LK (1983) The recurrence of intracranial meningiomas after surgical treatment. J Neurosurg 58:51–56. doi:10.3171/jns.1983.58.1.0051CrossRefPubMed
23.
Chan RC, Thompson GB (1984) Morbidity, mortality, and quality of life following surgery for intracranial meningiomas. A retrospective study in 257 cases. J Neurosurg 60:52–60. doi:10.3171/jns.1984.60.1.0052CrossRefPubMed
24.
Giombini S, Solero CL, Lasio G, Morello G (1984) Immediate and late outcome of operations for Parasagittal and falx meningiomas. Report of 342 cases. Surg Neurol 21:427–435CrossRefPubMed
25.
Mathiesen T, Lindquist C, Kihlstrom L, Karlsson B (1996) Recurrence of cranial base meningiomas. Neurosurgery 39:2–7. (discussion 8–9)CrossRefPubMed
26.
Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL (1985) Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 62:18–24. doi:10.3171/jns.1985.62.1.0018CrossRefPubMed
27.
Yamashita J, Handa H, Iwaki K, Abe M (1980) Recurrence of intracranial meningiomas, with special reference to radiotherapy. Surg Neurol 14:33–40PubMed
28.
Couldwell WT, Fukushima T, Giannotta SL, Weiss MH (1996) Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 84:20–28. doi:10.3171/jns.1996.84.1.0020CrossRefPubMed
29.
Barbaro NM, Gutin PH, Wilson CB, Sheline GE, Boldrey EB, Wara WM (1987) Radiation therapy in the treatment of partially resected meningiomas. Neurosurgery 20:525–528CrossRefPubMed
30.
Goldsmith BJ, Wara WM, Wilson CB, Larson DA (1994) Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 80:195–201. doi:10.3171/jns.1994.80.2.0195CrossRefPubMed
31.
De Jesus O, Sekhar LN, Parikh HK, Wright DC, Wagner DP (1996) Long-term follow-up of patients with meningiomas involving the cavernous sinus: recurrence, progression, and quality of life. Neurosurgery 39:915–919. (discussion 919–920)CrossRefPubMed
32.
Hakim R, Alexander E 3rd, Loeffler JS, Shrieve DC, Wen P, Fallon MP, Stieg PE, Black PM (1998) Results of linear accelerator-based radiosurgery for intracranial meningiomas. Neurosurgery 42:446–453. (discussion 453–444)CrossRefPubMed
33.
Akagami R, Napolitano M, Sekhar LN (2002) Patient-evaluated outcome after surgery for basal meningiomas. Neurosurgery 50:941–948. (discussion 948–949)PubMed
34.
Black PM, Villavicencio AT, Rhouddou C, Loeffler JS (2001) Aggressive surgery and focal radiation in the management of meningiomas of the skull base: preservation of function with maintenance of local control. Acta Neurochir 143:555–562CrossRefPubMed
35.
DeMonte F, Smith HK, al-Mefty O (1994) Outcome of aggressive removal of cavernous sinus meningiomas. J Neurosurg 81:245–251. doi:10.3171/jns.1994.81.2.0245CrossRefPubMed
36.
Nutting C, Brada M, Brazil L, Sibtain A, Saran F, Westbury C, Moore A, Thomas DG, Traish D, Ashley S (1999) Radiotherapy in the treatment of benign meningioma of the skull base. J Neurosurg 90:823–827. doi:10.3171/jns.1999.90.5.0823CrossRefPubMed
37.
Samii M, Tatagiba M, Monteiro ML (1996) Meningiomas involving the parasellar region. Acta Neurochir Suppl 65:63–65PubMed
38.
Kobayashi T, Kida Y, Mori Y (2001) Long-term results of stereotactic gamma radiosurgery of meningiomas. Surg Neurol 55:325–331CrossRefPubMed
39.
Pendl G, Unger F, Papaefthymiou G, Eustacchio S (2000) Staged radiosurgical treatment for large benign cerebral lesions. J Neurosurg 93:107–112. doi:10.3171/jns.2000.93.supplement 3.0107PubMed
40.
Subach BR, Lunsford LD, Kondziolka D, Maitz AH, Flickinger JC (1998) Management of petroclival meningiomas by stereotactic radiosurgery. Neurosurgery 42:437–443. (discussion 443–435)CrossRefPubMed
41.
Roche PH, Regis J, Dufour H, Fournier HD, Delsanti C, Pellet W, Grisoli F, Peragut JC (2000) Gamma knife radiosurgery in the management of cavernous sinus meningiomas. J Neurosurg 93:68–73. doi:10.3171/jns.2000.93.supplement 3.0068CrossRefPubMed
42.
Taylor BW Jr, Marcus RB Jr, Friedman WA, Ballinger WE Jr, Million RR (1988) The meningioma controversy: postoperative radiation therapy. Int J Radiat Oncol Biol Phys 15:299–304CrossRefPubMed
43.
Correa SF, Marta GN, Teixeira MJ (2014) Neurosymptomatic carvenous sinus meningioma: a 15-years experience with fractionated stereotactic radiotherapy and radiosurgery. Radiat Oncol 9:27. doi:10.1186/1748-717X-9-27PubMedCentralCrossRefPubMed
Metadata
Title
Stereotactic LINAC radiosurgery for the treatment of typical intracranial meningiomas
Efficacy and safety after a follow-up of over 12 years
Authors
Mustafa El-Khatib, M.D.
Faycal El Majdoub, M.D.
PD Stefan Hunsche, Ph.D.
Mauritius Hoevels
Martin Kocher, M.D.
Prof. Volker Sturm, M.D.
PD Mohammad Maarouf, M.D., Assoc. Professor
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 12/2015
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-015-0880-9

Other articles of this Issue 12/2015

Strahlentherapie und Onkologie 12/2015 Go to the issue

Literatur kommentiert

Körperstereotaxie und Lobektomie im randomisierten Vergleich beim NSCLC Stadium I – endlich Level-I-Evidenz?

Original Article

Metformin influences progression in diabetic glioblastoma patients

Literatur kommentiert

Hodgkin-Lymphom in Kindheit oder Jugend: Keine niedrigere Mutterschaftsrate nach Bestrahlungen außerhalb des Beckens

Literatur kommentiert

Update zur kombinierten Radio-, Radiochemo- und alleinigen Chemotherapie bei der multimodalen Therapie des Nasopharynxkarzinoms – eine MAC-NPC-Metaanalyse

Editorial

Clinical radiation oncology trials in Germany

Letter to the Editor

Reply to: Comment on Dornoff et al.: re-irradiation with cetuximab or cisplatin-based chemotherapy for recurrent squamous cell carcinoma of the head and neck