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.

Artist’s illustration of the classic mulberry appearance of a cavernoma. This illustration represents the Seven Cavernomas series by Dr. Michael Lawton, a collection of articles defining the tenets and techniques for the treatment of cavernous malformations, a taxonomy for classifying these lesions, and the nuances of their surgical approaches. Artist: Peter M. Lawrence. Used with permission from Barrow Neurological Institute, Phoenix, Arizona. See the article by Garcia et al. (pp 671–682).

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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.

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