Gamma Knife Stereotactic Radiosurgery for Grade 2 Meningiomas

Tamer Refaat; Michelle Gentile; Sean Sachdev; Prarthana Dalal; Anish Butala; Stanley Gutiontov; Irene Helenowksi; Plato Lee; Vythialinga Sathiaseelan; Orin Bloch; James Chandler; John A. Kalapurakal

doi:10.1055/s-0036-1597834

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2017; 78(04): 288-294
DOI: 10.1055/s-0036-1597834

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Gamma Knife Stereotactic Radiosurgery for Grade 2 Meningiomas

Tamer Refaat

¹Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States

²Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt

³Paramount Oncology Group, FHN Leonard C. Ferguson Cancer Center, Freeport, Illinois, United States

,

Michelle Gentile

¹Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States

,

Sean Sachdev

¹Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States

,

Prarthana Dalal

¹Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States

,

Anish Butala

¹Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States

,

Stanley Gutiontov

¹Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States

,

Irene Helenowksi

⁴Department of Preventive Medicine, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States

,

Plato Lee

¹Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States

,

Vythialinga Sathiaseelan

¹Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States

,

Orin Bloch

⁵Department of Neurological Surgery, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States

,

James Chandler

⁵Department of Neurological Surgery, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States

,

John A. Kalapurakal

¹Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States

› Author Affiliations

Abstract

Purpose This study aims to report long-term clinical outcomes after Gamma Knife radiosurgery (GKRS) for intracranial grade 2 meningiomas.

Methods In this Institutional Review Board approved study, we reviewed records of all patients with grade 2 meningiomas treated with GKRS between 1998 and 2014.

Results A total of 97 postoperative histopathologically confirmed grade 2 meningiomas in 75 patients were treated and are included in this study. After a mean follow-up of 41 months, 28 meningiomas had local recurrence (29.79%). Median time to local recurrence was 89 months (mean: 69, range: 47–168). The 3- and 5-year actuarial local control (LC) rates were 68.9 and 55.7%, respectively. The 3- and 5-year overall survival rates were 88.6 and 81.1%, respectively. There was a trend toward worse LC with tumors treated with radiation doses ≤ 13 versus > 13 Gy. There was no radiation necrosis or second malignant tumors noted in our series.

Conclusion This report, one of the largest GKRS series for grade 2 meningiomas, demonstrates that GKRS is a safe and effective treatment modality for patients with grade 2 meningiomas with durable tumor control and minimal toxicity. Adjuvant GKRS could be considered as a reasonable treatment approach for patients with grade 2 meningiomas.

Keywords

Gamma Knife - radiosurgery - meningioma - grade 2 - stereotactic

Full Text

References

References
1 Baldi I, Engelhardt J, Bonnet C. , et al. Epidemiology of meningiomas. Neurochirurgie 2014;
2 Ostrom QT, Gittleman H, Farah P. , et al. CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2006-2010. Neuro-oncol 2013; 15 (Suppl. 02) ii1-ii56
3 Perry A, Louis DN, Scheithauer BW. , et al. Meningiomas. In: Louis DN, Ohgaki H, Wiestler OD. , eds. WHO Classification of Tumours of the Central Nervous System. Lyon: IARC Press; 2007: 164
4 Whittle IR, Smith C, Navoo P, Collie D. Meningiomas. Lancet 2004; 363 (9420): 1535-1543
5 Milker-Zabel S, Zabel-du Bois A, Huber P, Schlegel W, Debus J. Fractionated stereotactic radiation therapy in the management of benign cavernous sinus meningiomas : long-term experience and review of the literature. Strahlenther Onkol 2006; 182 (11) 635-640
6 Pasquier D, Bijmolt S, Veninga T. , 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 (05) 1388-1393
7 Newman SA. Meningiomas: a quest for the optimum therapy. J Neurosurg 1994; 80 (02) 191-194
8 Goyal LK, Suh JH, Mohan DS, Prayson RA, Lee J, Barnett GH. Local control and overall survival in atypical meningioma: a retrospective study. Int J Radiat Oncol Biol Phys 2000; 46 (01) 57-61
9 Aboukais R, Zairi F, Lejeune JP. , et al. Grade 2 meningioma and radiosurgery. J Neurosurg 2015; 122 (05) 1157-1162
10 Attia A, Chan MD, Mott RT. , et al. Patterns of failure after treatment of atypical meningioma with Gamma Knife radiosurgery. J Neurooncol 2012; 108 (01) 179-185
11 Choi CY, Soltys SG, Gibbs IC. , et al. Cyberknife stereotactic radiosurgery for treatment of atypical (WHO grade II) cranial meningiomas. Neurosurgery 2010; 67 (05) 1180-1188
12 Ferraro DJ, Funk RK, Blackett JW. , et al. A retrospective analysis of survival and prognostic factors after stereotactic radiosurgery for aggressive meningiomas. Radiat Oncol 2014; 9: 38 . Doi: 10.1186/1748-717X-9-38
13 Kim JW, Kim DG, Paek SH. , et al. Radiosurgery for atypical and anaplastic meningiomas: histopathological predictors of local tumor control. Stereotact Funct Neurosurg 2012; 90 (05) 316-324
14 Mori Y, Tsugawa T, Hashizume C, Kobayashi T, Shibamoto Y. Gamma Knife stereotactic radiosurgery for atypical and malignant meningiomas. Acta Neurochir Suppl (Wien) 2013; 116: 85-89
15 Schwartz M. Stereotactic radiosurgery: comparing different technologies. CMAJ 1998; 158 (05) 625-628
16 Kondziolka D, Mathieu D, Lunsford LD. , et al. Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 2008; 62 (01) 53-58 , discussion 58–60
17 Pollock BE, Stafford SL, Utter A, Giannini C, Schreiner SA. 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 (04) 1000-1005
18 Starke RM, Przybylowski CJ, Sugoto M. , et al. Gamma Knife radiosurgery of large skull base meningiomas. J Neurosurg 2015; 122 (02) 363-372
19 Przybylowski CJ, Raper DM, Starke RM, Xu Z, Liu KC, Sheehan JP. Stereotactic radiosurgery of meningiomas following resection: predictors of progression. J Clin Neurosci 2015; 22 (01) 161-165