Journal Article

μMLC-LINAC radiosurgery for intracranial meningiomas of complex shape

Elawady, Moataz, Hoevels, Mauritius, El Majdoub, Faycal, El-Khatib, Mustapha, Sturm, Volker, Bührle, Christian, Maarouf, Mohammad, Treuer, Harald, Müller, Rolf-Peter

2012

Overview

Background We present the long-term results of a consecutive series of patients with meningiomas treated by LINAC-radiosurgery using the micro-multi-leaf collimator technique (μMLC). Methods Between May 2001 and July 2009, 78 patients (m:f = 24:54; median age, 56.8 years; range, 20.1–81 years) with 87 intracranial meningiomas (78 WHO I, seven WHO II, two WHO III) were treated with μMLC-LINAC radiosurgery at our institution, either as a primary or salvage treatment following one or more microsurgical procedures. Fifty-eight of 87 tumors (66.7%) were located in the skull base. The remaining 29 meningiomas (33.3%) were located in the convexity of the brain. The median tumor volume was 4.8 ml (range, 0.2–18.3 ml). The median tumor surface dose, maximal dose, and therapeutic isodose were 12 Gy, 16 Gy, and 75%, respectively. Results For retrospective evaluation, we included 70 patients (78 tumors) with a minimum radiological follow-up of 24 months. After a median follow-up of 79.7 months (range, 24.2–109.1 months), 24 patients (34.3%) improved in their clinical status (paresis of N. abducens 18/48, facial paresis 4/8, and hemiparesis 2/9), 41 patients remained stable (58.6%), three patients had treatment-related temporary complaints (4.3%); two patients developed vertigo, and one had a left-sided hemihypesthesia. All complaints recovered completely after steroid medication within 2 weeks. Two patients (2.8%) developed permanent trigeminal neuralgia. Follow-up MR images showed a partial remission in 21 tumors (26.9%) and a stable tumor size in 55 cases (70.5%). Two patients with high-grade meningiomas showed a tumor progression (one WHO II and one WHO III meningioma). At the end of follow-up (July 2010), the actuarial 5- and 9-year progression-free survival after radiosurgery were 98 and 96%, respectively. There was no treatment-related mortality. Conclusions LINAC radiosurgery using a micro multi-leaf collimator for complex shaped intracranial meningiomas is effective yielding a high local tumor control, whereas the treatment-related morbidity remains low.

• Publisher: Springer Vienna
• Subject: Adult / Age / Aged / Aged, 80 and over / Brain / Brain - diagnostic imaging / Brain - pathology / Brain - surgery / Brain tumors / Clinical Article / Female / Follow-Up Studies / Humans / Interventional Radiology / Male / Medicine / Medicine & Public Health / Meningeal Neoplasms - mortality / Meningeal Neoplasms - pathology / Meningeal Neoplasms - surgery / meningioma / Meningioma - mortality / Meningioma - pathology / Meningioma - surgery / Microsurgery - instrumentation / Microsurgery - methods / Middle Aged / Minimally Invasive Surgery / Morbidity / Mortality / Neuralgia / Neurology / Neuroradiology / Neurosurgery / Paresis / Radiography / Radiosurgery - methods / Radiosurgery - mortality / Remission / Retrospective Studies / Skull / Skull - diagnostic imaging / Skull - pathology / Skull - surgery / Steroid hormones / Surgical Orthopedics / Survival / Tactile stimuli / Tumors / vertigo / Young Adult