Stereotactic radiosurgery for treatment of radiation-induced meningiomas: a multiinstitutional study

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  • 1 Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;
  • 2 Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada;
  • 3 Gamma Knife Radiosurgery, Hospital Ruber Internacional, Madrid, Spain;
  • 4 Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic;
  • 5 Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada;
  • 6 Penn State Health, Hershey Medical Center, Hershey, Pennsylvania;
  • 7 Neurological Institute, Taipei Veterans General Hospital, and National Yang-Ming University, Taipei, Taiwan;
  • 8 Radiation Oncology, Mayo Clinic, Jacksonville, Florida;
  • 9 Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;
  • 10 Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio;
  • 11 Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
  • 12 University of Southern California, Los Angeles, California
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OBJECTIVE

Radiation-induced meningiomas (RIMs) are associated with aggressive clinical behavior. Stereotactic radiosurgery (SRS) is sometimes considered for selected RIMs. The authors investigated the effectiveness and safety of SRS for the management of RIMs.

METHODS

From 12 institutions participating in the International Radiosurgery Research Foundation, the authors pooled patients who had prior cranial irradiation and were subsequently clinically diagnosed with WHO grade I meningiomas that were managed with SRS.

RESULTS

Fifty-two patients underwent 60 SRS procedures for histologically confirmed or radiologically suspected WHO grade I RIMs. The median ages at initial cranial radiation therapy and SRS for RIM were 5.5 years and 39 years, respectively. The most common reasons for cranial radiation therapy were leukemia (21%) and medulloblastoma (17%). There were 39 multiple RIMs (35%), the mean target volume was 8.61 ± 7.80 cm3, and the median prescription dose was 14 Gy. The median imaging follow-up duration was 48 months (range 4–195 months). RIM progressed in 9 patients (17%) at a median duration of 30 months (range 3–45 months) after SRS. Progression-free survival at 5 years post-SRS was 83%. Treatment volume ≥ 5 cm3 predicted progression (HR 8.226, 95% CI 1.028–65.857, p = 0.047). Seven patients (14%) developed new neurological symptoms or experienced SRS-related complications or T2 signal change from 1 to 72 months after SRS.

CONCLUSIONS

SRS is associated with durable local control of RIMs in the majority of patients and has an acceptable safety profile. SRS can be considered for patients and tumors that are deemed suboptimal, poor surgical candidates, and those whose tumor again progresses after removal.

ABBREVIATIONS CI = confidence interval; GKRS = Gamma Knife radiosurgery; HR = hazard ratio; IRRF = International Radiosurgery Research Foundation; NF1 = neurofibromatosis type 1; NF2 = NF type 2; OS = overall survival; PFS = progression-free survival; RIM = radiation-induced meningioma; RT = radiation therapy; SRS = stereotactic radiosurgery; WBRT = whole-brain RT.

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Contributor Notes

Correspondence Jason Sheehan: University of Virginia Health System, Charlottesville, VA. jsheehan@virginia.edu.

INCLUDE WHEN CITING Published online January 1, 2021; DOI: 10.3171/2020.7.JNS202064.

Disclosures Dr. Zacharia reports being a consultant for Medtronic, Inc., and being on the speakers bureau for NICO Corp. Dr. Lunsford reports direct stock ownership in Elekta and being a consultant to Insightec and DSMB. Dr. McInerney reports receiving funding for non–study-related research from Elekta.

  • 1

    Co JL, Swain M, Murray LJ, Meningioma screening with MRI in childhood leukemia survivors treated with cranial radiation. Int J Radiat Oncol Biol Phys. 2019;104(3):640643.

    • Search Google Scholar
    • Export Citation
  • 2

    Umansky F, Shoshan Y, Rosenthal G, Radiation-induced meningioma. Neurosurg Focus. 2008;24(5):E7.

  • 3

    Yamanaka R, Hayano A, Kanayama T. Radiation-induced meningiomas: an exhaustive review of the literature. World Neurosurg. 2017;97:635644.e8.

    • Search Google Scholar
    • Export Citation
  • 4

    Preston DL, Ron E, Yonehara S, Tumors of the nervous system and pituitary gland associated with atomic bomb radiation exposure. J Natl Cancer Inst. 2002;94(20):15551563.

    • Search Google Scholar
    • Export Citation
  • 5

    Sadamori N, Shibata S, Mine M, Incidence of intracranial meningiomas in Nagasaki atomic-bomb survivors. Int J Cancer. 1996;67(3):318322.

    • Search Google Scholar
    • Export Citation
  • 6

    Shintani T, Hayakawa N, Kamada N. High incidence of meningioma in survivors of Hiroshima. Lancet. 1997;349(9062):1369.

  • 7

    Cahan WG, Woodard HQ, Higinbotham NL, Sarcoma arising in irradiated bone: report of eleven cases. 1948. Cancer. 1998;82(1):834.

  • 8

    Harrison MJ, Wolfe DE, Lau TS, Radiation-induced meningiomas: experience at the Mount Sinai Hospital and review of the literature. J Neurosurg. 1991;75(4):564574.

    • Search Google Scholar
    • Export Citation
  • 9

    Jensen AW, Brown PD, Pollock BE, Gamma knife radiosurgery of radiation-induced intracranial tumors: local control, outcomes, and complications. Int J Radiat Oncol Biol Phys. 2005;62(1):3237.

    • Search Google Scholar
    • Export Citation
  • 10

    Kondziolka D, Kano H, Kanaan H, Stereotactic radiosurgery for radiation-induced meningiomas. Neurosurgery. 2009;64(3):463470.

  • 11

    Agnihotri S, Suppiah S, Tonge PD, Therapeutic radiation for childhood cancer drives structural aberrations of NF2 in meningiomas. Nat Commun. 2017;8(1):186.

    • Search Google Scholar
    • Export Citation
  • 12

    Shoshan Y, Chernova O, Juen SS, Radiation-induced meningioma: a distinct molecular genetic pattern? J Neuropathol Exp Neurol. 2000;59(7):614620.

    • Search Google Scholar
    • Export Citation
  • 13

    Rubinstein AB, Shalit MN, Cohen ML, Radiation-induced cerebral meningioma: a recognizable entity. J Neurosurg. 1984;61(5):966971.

  • 14

    Sadetzki S, Flint-Richter P, Ben-Tal T, Nass D. Radiation-induced meningioma: a descriptive study of 253 cases. J Neurosurg. 2002;97(5):10781082.

    • Search Google Scholar
    • Export Citation
  • 15

    Soffer D, Gomori JM, Siegal T, Shalit MN. Intracranial meningiomas after high-dose irradiation. Cancer. 1989;63(8):15141519.

  • 16

    Borovich B, Doron Y. Recurrence of intracranial meningiomas: the role played by regional multicentricity. J Neurosurg. 1986;64(1):5863.

    • Search Google Scholar
    • Export Citation
  • 17

    Borovich B, Doron Y, Braun J, Recurrence of intracranial meningiomas: the role played by regional multicentricity. Part 2: Clinical and radiological aspects. J Neurosurg. 1986;65(2):168171.

    • Search Google Scholar
    • Export Citation
  • 18

    Jääskeläinen J. Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysis. Surg Neurol. 1986;26(5):461469.

    • Search Google Scholar
    • Export Citation
  • 19

    Wilson CB. Meningiomas: genetics, malignancy, and the role of radiation in induction and treatment. The Richard C. Schneider Lecture. J Neurosurg. 1994;81(5):666675.

    • Search Google Scholar
    • Export Citation
  • 20

    Kuhn EN, Chan MD, Tatter SB, Ellis TL. Gamma knife stereotactic radiosurgery for radiation-induced meningiomas. Stereotact Funct Neurosurg. 2012;90(6):365369.

    • Search Google Scholar
    • Export Citation
  • 21

    Shaw E, Scott C, Souhami L, Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys. 2000;47(2):291298.

    • Search Google Scholar
    • Export Citation
  • 22

    Yang D-Y, Sheehan J, Liu Y-S, Analysis of factors associated with volumetric data errors in gamma knife radiosurgery. Stereotact Funct Neurosurg. 2009;87(1):17.

    • Search Google Scholar
    • Export Citation
  • 23

    Sheehan JP, Starke RM, Kano H, Gamma Knife radiosurgery for sellar and parasellar meningiomas: a multicenter study. J Neurosurg. 2014;120(6):12681277.

    • Search Google Scholar
    • Export Citation
  • 24

    Sheehan JP, Williams BJ, Yen CP. Stereotactic radiosurgery for WHO grade I meningiomas. J Neurooncol. 2010;99(3):407416.

  • 25

    Cohen-Inbar O, Lee CC, Schlesinger D, Long-term results of stereotactic radiosurgery for skull base meningiomas. Neurosurgery. 2016;79(1):5868.

    • Search Google Scholar
    • Export Citation
  • 26

    Pollock BE, Jacob JT, Brown PD, Nippoldt TB. Radiosurgery of growth hormone-producing pituitary adenomas: factors associated with biochemical remission. J Neurosurg. 2007;106(5):833838.

    • Search Google Scholar
    • Export Citation
  • 27

    Ding D, Starke RM, Hantzmon J, The role of radiosurgery in the management of WHO Grade II and III intracranial meningiomas. Neurosurg Focus. 2013;35(6):E16.

    • Search Google Scholar
    • Export Citation
  • 28

    Kondziolka D, Mathieu D, Lunsford LD, Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery. 2008;62(1):5360.

    • Search Google Scholar
    • Export Citation
  • 29

    Pollock BE, Stafford SL, Link MJ. Stereotactic radiosurgery of intracranial meningiomas. Neurosurg Clin N Am. 2013;24(4):499507.

  • 30

    Ge Y, Liu D, Zhang Z, Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients. Neurosurg Focus. 2019;46(6):E7.

    • Search Google Scholar
    • Export Citation
  • 31

    Starke RM, Przybylowski CJ, Sugoto M, Gamma Knife radiosurgery of large skull base meningiomas. J Neurosurg. 2015;122(2):363372.

  • 32

    Park K-J, Kano H, Iyer A, Gamma Knife stereotactic radiosurgery for cavernous sinus meningioma: long-term follow-up in 200 patients. J Neurosurg. 2019;130(6):17991808.

    • Search Google Scholar
    • Export Citation
  • 33

    Sheehan JP, Starke RM, Kano H, Gamma Knife radiosurgery for posterior fossa meningiomas: a multicenter study. J Neurosurg. 2015;122(6):14791489.

    • Search Google Scholar
    • Export Citation
  • 34

    Starke R, Kano H, Ding D, Stereotactic radiosurgery of petroclival meningiomas: a multicenter study. J Neurooncol. 2014;119(1):169176.

    • Search Google Scholar
    • Export Citation
  • 35

    Mehta GU, Zenonos G, Patibandla MR, Outcomes of stereotactic radiosurgery for foramen magnum meningiomas: an international multicenter study. J Neurosurg. 2018;129(2):383389.

    • Search Google Scholar
    • Export Citation
  • 36

    Cohen-Inbar O, Lee C-C, Sheehan JP. The contemporary role of stereotactic radiosurgery in the treatment of meningiomas. Neurosurg Clin N Am. 2016;27(2):215228.

    • Search Google Scholar
    • Export Citation
  • 37

    Kollová A, Liscák R, Novotný J Jr, Gamma Knife surgery for benign meningioma. J Neurosurg. 2007;107(2):325336.

  • 38

    Cai R, Barnett GH, Novak E, Principal risk of peritumoral edema after stereotactic radiosurgery for intracranial meningioma is tumor-brain contact interface area. Neurosurgery. 2010;66(3):513522.

    • Search Google Scholar
    • Export Citation
  • 39

    Unger KR, Lominska CE, Chanyasulkit J, Risk factors for posttreatment edema in patients treated with stereotactic radiosurgery for meningiomas. Neurosurgery. 2012;70(3):639645.

    • Search Google Scholar
    • Export Citation
  • 40

    Sheehan JP, Lee C-C, Xu Z, Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas. J Neurosurg. 2015;123(5):12871293.

    • Search Google Scholar
    • Export Citation
  • 41

    Goldbrunner R, Minniti G, Preusser M, EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol. 2016;17(9):e383e391.

    • Search Google Scholar
    • Export Citation
  • 42

    Islim AI, Mohan M, Moon RDC, Incidental intracranial meningiomas: a systematic review and meta-analysis of prognostic factors and outcomes. J Neurooncol. 2019;142(2):211221.

    • Search Google Scholar
    • Export Citation
  • 43

    Bunevicius A, Sheehan D, Vance ML, Outcomes of Cushing’s disease following Gamma Knife radiosurgery: effect of a center’s growing experience and era of treatment. J Neurosurg. 2021;134(2):547554.

    • Search Google Scholar
    • Export Citation
  • 44

    Scaringi C, Minniti G, Bozzao A, Radiation-induced malignant meningioma following proton beam therapy for a choroidal melanoma. J Clin Neurosci. 2015;22(6):10361037.

    • Search Google Scholar
    • Export Citation

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