Journal Article

Long-term Tumor Control of Benign Intracranial Meningiomas After Radiosurgery in a Series of 4565 Patients

Motti, Enrico, Lindquist, Christer, Mindermann, Thomas, Lippitz, Bodo, Yomo, Shoji, Dominikus, Karlheinz, Liščák, Roman, Blackburn, Philip, Bundschuh, Otto, Fimmers, Rolf, Kemeny, Andras, Horstmann, Gerhard A., Lupidi, Francesco, Régis, Jean, Pedersen, Paal-Henning, Kitz, Klaus, Santacroce, Antonio, van Eck, A.T.C.J., Álvarez, Roberto Martínez, Walier, Maja

2012

Overview

Abstract BACKGROUND Radiosurgery is the main alternative to microsurgical resection for benign meningiomas. OBJECTIVE To assess the long-term efficacy and safety of radiosurgery for meningiomas with respect to tumor growth and prevention of associated neurological deterioration. Medium- to long-term outcomes have been widely reported, but no large multicenter series with long-term follow-up have been published. METHODS From 15 participating centers, we performed a retrospective observational analysis of 4565 consecutive patients harboring 5300 benign meningiomas. All were treated with Gamma Knife radiosurgery at least 5 years before assessment for this study. Clinical and imaging data were retrieved from each center and uniformly entered into a database by 1 author (A.S.). RESULTS Median tumor volume was 4.8 cm3, and median dose to tumor margin was 14 Gy. All tumors with imaging follow-up > 24 months were excluded. Detailed results from 3768 meningiomas (71%) were analyzed. Median imaging follow-up was 63 months. The volume of treated tumors decreased in 2187 lesions (58%), remained unchanged in 1300 lesions (34.5%), and increased in 281 lesions (7.5%), giving a control rate of 92.5%. Only 84 (2.2%) enlarging tumors required further treatment. Five- and 10-year progression-free survival rates were 95.2% and 88.6%, respectively. Tumor control was higher for imaging defined tumors vs grade I meningiomas (P > .001), for female vs male patients (P > .001), for sporadic vs multiple meningiomas (P > .001), and for skull base vs convexity tumors (P > .001). Permanent morbidity rate was 6.6% at the last follow-up. CONCLUSION Radiosurgery is a safe and effective method for treating benign meningiomas even in the medium to long term.

• Publisher: Oxford University Press,Lippincott Williams & Wilkins,Wolters Kluwer Health, Inc
• Subject: Adult / Aged / Biological and medical sciences / Brain cancer / Female / Humans / Kaplan-Meier Estimate / Longitudinal Studies / Magnetic Resonance Imaging / Male / Medical sciences / Meningeal Neoplasms - mortality / Meningeal Neoplasms - pathology / Meningeal Neoplasms - surgery / Meningioma - mortality / Meningioma - pathology / Meningioma - surgery / Microsurgery - methods / Middle Aged / Neurosurgery / Radiosurgery - methods / Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases / Tomography, X-Ray Computed / Tumor Burden / Tumors