Radiosurgery and stereotactic radiotherapy with cyberknife system for meningioma treatment

Abstract

Objective

The aim of this work was to evaluate the impact of stereotactic radiosurgery/fractionated stereotactic radiotherapy with the Cyberknife system on local disease control, clinical outcome and toxicity in patients with meningioma, according to the site and histological grade of lesion. From January 2013 to April 2017, 52 patients with intracranial meningiomas were treated with the Cyberknife system. Twenty-four patients had undergone previous surgery: 38% gross total resection, 10% subtotal resection; 27 patients underwent no surgery; 22 patients had a recurrence of meningioma.

Methods

Radiosurgery was used for lesions smaller than 2 cm, stereotactic radiotherapy for lesions larger than 2 cm, or smaller but close to a critical site such as the optical chiasm, optic pathway or brainstem.

Results

Local control and clinical outcomes were analysed. Median follow-up was 20 months: six patients died, one after re-surgery died from post-surgical sepsis, three from heart disease. Progression-free survival had a mean value of 38.3 months and overall survival of 41.6 months. We evaluated at 12 months 28 patients (100% local control); at 24 months 19 patients (89% local control); at 36 months nine patients (89% local control). At baseline, 44/52 patients (85%) were symptomatic: 19 visual disorders, 17 motor disorders, six hearing disorders, 10 headache and six epilepsy. Visual symptoms remained unchanged in 52%, improved in 32%, resolved in 16%. Headache was improved in 40%, resolved in 10%, unchanged in 50%. Epilepsy was resolved in 17%, unchanged in 33%, worsened in 33%.

Conclusions

Stereotactic radiosurgery/fractionated stereotactic radiotherapy with Cyberknife provides a good local disease control, improving visual, hearing and motor symptoms.

Keywords

Meningiomas Cyberknife stereotactic radiosurgery fractionated stereotactic radiotherapy

Get full access to this article

View all access options for this article.

References

Alexiou

Gogou

Markoula

et al.

Management of meningiomas. Clin Neurol Neurosurg 2010; 112: 177–182.

Louis

Ohgaki

Wiestler

et al.

The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007; 114: 97–109.

Aghi

Carter

Cosgrove

et al.

Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation. Neurosurgery 2009; 64: 56–60.

Stafford

Perry

Suman

et al.

Primarily resected meningiomas: outcome and prognostic factors in 581 Mayo Clinic patients, 1978 through 1988. Mayo Clin Proc 1998; 73: 936–942.

Goyal

Suh

Mohan

et al.

Local control and overall survival in atypical meningioma: a retrospective study. Int J Radiat Oncol Biol Phys 2000; 46: 57–61.

Salvinelli

Trivelli

Greco

et al.

Acoustic neuromas and meningiomas. Histopathological aspect. A post mortem study on temporal bones. Eur Rev Med Pharmacol Sci 1999; 3: 221–224.

Coke

Corn

Werner-Wasik

et al.

Atypical and malignant meningiomas: an outcome report of seventeen cases. J Neurooncol 1998; 39: 65–70.

Yang

Park

et al.

Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. J Neurol Neurosurg Psychiatry 2008; 79: 574–580.

Pasquier

Bijmolt

Veninga

et al.

Rare Cancer Network. Atypical and malignant meningioma: outcome and prognostic factors in 119 irradiated patients. A multicenter, retrospective study of the Rare Cancer Network. Int J Radiat Oncol Biol Phys 2008; 71: 1388–1393.

10.

Perry

Scheithauer

Stafford

et al.

“Malignancy” in meningiomas: a clinicopathologic study of 116 patients, with grading implications. Cancer 1999; 85: 2046–2056.

11.

Palma

Celli

Franco

et al.

Long-term prognosis for atypical and malignant meningiomas: a study of 71 surgical cases. J Neurosurg 1997; 86: 793–800.

12.

Di Franco

Borzillo

Giugliano

et al.

Integrazione dell’imaging morfologico nel contouring delle lesioni cerebrali: la fusione di immagini nella radiochirurgia con Cyberknife. Il Giornale Italiano di Radiologia Medica 2015; 2: 601–608.

13.

Simpson

. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 1957; 20: 22–39.

14.

Barbaro

Gutin

Wilson

et al.

Radiation therapy in the treatment of partially resected meningiomas. Neurosurgery 1987; 20: 525–528.

15.

Soyuer

Chang

Selek

et al.

Radiotherapy after surgery for benign cerebral meningioma. Radiother Oncol 2004; 71: 85–90.

16.

Rogers

Mehta

. Role of radiation therapy in treating intracranial meningiomas. Neurosurg Focus 2007; 23: E4.

17.

Colombo

Casentini

Cavedon

et al.

Cyberknife radiosurgery for benign meningiomas: short-term results in 199 patients. Neurosurgery 2009; 64: A7–A13.

18.

Louis

Ohgaki

Wiestler

et al.

The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007; 114: 97–109.

19.

Kondziolka

Mathieu

Lunsford

et al.

Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 2008; 62: 53–58.

20.

Minniti

Amichetti

Enrici

. Radiotherapy and radiosurgery for benign skull base meningiomas. Radiat Oncol 2009; 4: 42.

21.

Weber

Lovblad

Rogers

. New pathology classification, imagery techniques and prospective trials for meningiomas: the future looks bright. Curr Opin Neurol 2010; 23: 563–570.

22.

Miralbell

Linggood

de la Monte

et al.

The role of radiotherapy in the treatment of subtotally resected benign meningiomas. J Neurooncol 1992; 13: 157–164.

23.

Kondziolka

Flickinger

Perez

. Judicious resection and/or radiosurgery for parasagittal meningiomas: outcomes from a multicenter review. Gamma Knife Meningioma Study Group. Neurosurgery 1998; 43: 405–413.

24.

Pollock

Stafford

Utter

et al.

Stereotactic radiosurgery provides equivalent tumor control to Simpson Grade 1 resection for patients with small- to medium-size meningiomas. Int J Radiat Oncol Biol Phys 2003; 55: 1000–1005.

25.

DiBiase

Kwok

Yovino

et al.

Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 2004; 60: 1515–1519.

26.

Ganz

Schröttner

Pendl

. Radiation-induced edema after Gamma Knife treatment for meningiomas. Stereotact Funct Neurosurg 1996; 1: 129–133.

27.

Oermann

Collins

Erickson

et al.

CyberKnife enhanced conventionally fractionated chemoradiation for high grade glioma in close proximity to critical structures. J Hematol Oncol 2010; 3: 22.

28.

Timmerman

. An overview of hypofractionation and introduction to this issue of seminars in radiation oncology. Semin Radiat Oncol 2008; 18: 215–222.

29.

Coke

Corn

Werner-Wasik

et al.

Atypical and malignant meningiomas: an outcome report of seventeen cases. J Neurooncol 1998; 39: 65–70.

30.

Kondziolka

Levy

Niranjan

et al.

Long-term outcomes after meningioma radiosurgery: physician and patient perspectives. J Neurosurg 1999; 91: 44–50.

31.

Kondziolka

Lunsford

Coffey

et al.

Stereotactic radiosurgery of meningiomas. J Neurosurg 1991; 74: 552–559.

32.

Kondziolka

Mathieu

Lunsford

et al.

Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 2008; 62: 53–58.

33.

Kreil

Luggin

Fuchs

et al.

Long term experience of gamma knife radiosurgery for benign skull base meningiomas. J Neurol Neurosurg Psychiatry 2005; 76: 1425–1430.

34.

Lee

Kondziolka

Flickinger

et al.

Radiosurgery for intracranial meningiomas. Prog Neurol Surg 2007; 20: 142–149.

35.

Levine

Buchanan

Sekhar

et al.

Proposed grading system to predict the extent of resection and outcomes for cranial base meningiomas. Neurosurgery 1999; 45: 221–230.

36.

Linskey

Davis

Ratanatharathorn

. Relative roles of microsurgery and stereotactic radiosurgery for the treatment of patients with cranial meningiomas: a single-surgeon 4-year integrated experience with both modalities. J Neurosurg 2005; 102: 59–70.

37.

Shrieve

Hazard

Boucher

et al.

Dose fractionation in stereotactic radiotherapy for parasellar meningiomas: radiobiological considerations of efficacy and optic nerve tolerance. J Neurosurg 2004; 101: 390–395.

38.

Dutton

. Optic nerve sheath meningiomas. Surv Ophthalmol 1992; 37: 167–183.

39.

Miller

Primary and secondary tumors of the optic nerve and its sheath. In: Kidd

Newman

Biousse

(eds). Neuro-ophthalmology, Philadelphia: Butterworth-Heinemann, 2008, pp. 215–223.

40.

Cho

Hall

et al.

Single dose versus fractionated stereotactic radiotherapy for meningiomas. Can J Neurol Sci 2002; 29: 240–248.

41.

Conti

Pontoriero

Midili

et al.

CyberKnife multisession stereotactic radiosurgery and hypofractionated stereotactic radiotherapy for perioptic meningiomas: intermediate-term results and radiobiological considerations. Springerplus 2015; 4: 37.