Skip to main content
SpringerLink
Log in

Brachytherapy with surgical resection as salvage treatment for recurrent high-grade meningiomas: a matched cohort study

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate surgical resection with brachytherapy placement as a salvage treatment in patients with recurrent high-grade meningioma who exhausted prior external beam treatment options.

Methods

Single-center retrospective review of our institutional experience of brachytherapy implantation from 2012 to 2018. The primary outcome of the study was progression free survival (PFS). Secondary outcomes included overall survival (OS) and complications. A matched cohort of patients not treated with brachytherapy over the same time period was evaluated as a control group. All patients had received prior radiation treatment and underwent planned gross total resection (GTR) surgery.

Results

A total of 27 cases were evaluated. Compared with prior treatment, brachytherapy implantation demonstrated a statistically significant improvement in tumor control [HR 0.316 (0.101 − 0.991), p = 0.034]. PFS-6 and PFS-12 were 92.3% and 84.6%, respectively. Compared with the matched control cohort, brachytherapy treatment demonstrated improved PFS [HR 0.310 (0.103 − 0.933), p = 0.030]. Overall survival was not statistically significantly different between groups [HR 0.381 (0.073 − 1.982), p = 0.227]. Overall postoperative complications were comparable between groups, although there was a higher incidence of radiation necrosis in the brachytherapy cohort.

Conclusion

Brachytherapy with planned GTR improved PFS in recurrent high-grade meningioma patients who exhausted prior external beam radiation treatment options. Future improvement of brachytherapy dose delivery methods and techniques may continue to prolong control rates and improve outcomes for this challenging group of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kaley T, Barani I, Chamberlain M, McDermott M, Panageas K, Raizer J, Rogers L, Schiff D, Vogelbaum M, Weber D, Wen P (2014) Historical benchmarks for medical therapy trials in surgery- and radiation-refractory meningioma: a RANO review. Neuro Oncol 16(6):829–840. https://doi.org/10.1093/neuonc/not330

    Article  PubMed  PubMed Central  Google Scholar 

  2. Magill ST, Lee DS, Yen AJ, Lucas CG, Raleigh DR, Aghi MK, Theodosopoulos PV, McDermott MW (2018) Surgical outcomes after reoperation for recurrent skull base meningiomas. J Neurosurg 1:1–8. https://doi.org/10.3171/2017.11.JNS172278

    Article  Google Scholar 

  3. Magill ST (2018) Surgical outcomes after reoperation for recurrent non-skull base meningiomas. J Neurosurg 1:1–9. https://doi.org/10.3171/2018.6.JNS18118

    Article  Google Scholar 

  4. Chohan MO, Ryan CT, Singh R, Lanning RM, Reiner AS, Rosenblum MK, Tabar V, Gutin PH (2018) Predictors of treatment response and survival outcomes in meningioma recurrence with atypical or anaplastic histology. Neurosurgery 82(6):824–832. https://doi.org/10.1093/neuros/nyx312

    Article  PubMed  Google Scholar 

  5. Lin AJ, Hui C, Dahiya S, Lu HC, Kim AH, Campian JL, Tsien C, Zipfel GJ, Rich KM, Chicoine M, Huang J (2018) Radiologic response and disease control of recurrent intracranial meningiomas treated with reirradiation. Int J Radiat Oncol Biol Phys 102(1):194–203. https://doi.org/10.1016/j.ijrobp.2018.05.011

    Article  PubMed  Google Scholar 

  6. Wojcieszynski AP, Ohri N, Andrews DW, Evans JJ, Dicker AP, Werner-Wasik M (2012) Reirradiation of recurrent meningioma. J Clin Neurosci 19(9):1261–1264. https://doi.org/10.1016/j.jocn.2012.01.023

    Article  PubMed  Google Scholar 

  7. Kim M, Lee DH, Kim Rn HJ, Cho YH, Kim JH, Kwon DH (2017) Analysis of the results of recurrent intracranial meningiomas treated with re-radiosurgery. Clin Neurol Neurosurg 153:93–101. https://doi.org/10.1016/j.clineuro.2016.12.014

    Article  PubMed  Google Scholar 

  8. Brastianos PK, Galanis E, Butowski N, Chan JW, Dunn IF, Goldbrunner R, Herold-Mende C, Ippen FM, Mawrin C, McDermott MW, Sloan A, Snyder J, Tabatabai G, Tatagiba M, Tonn JC, Wen PY, Aldape K, Nassiri F, Zadeh G, Jenkinson MD, Raleigh DR, International Consortium on M (2019) Advances in multidisciplinary therapy for meningiomas. Neuro Oncology 21:i18–i31. https://doi.org/10.1093/neuonc/noy136

    Article  Google Scholar 

  9. Gupta S, Bi WL, Dunn IF (2018) Medical management of meningioma in the era of precision medicine. Neurosurg Focus 44(4):E3. https://doi.org/10.3171/2018.1.FOCUS17754

    Article  PubMed  Google Scholar 

  10. Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20(1):22–39

    Article  CAS  Google Scholar 

  11. Bernstein M, Laperriere N, Leung P, McKenzie S (1990) Interstitial brachytherapy for malignant brain tumors: preliminary results. Neurosurgery 26(3):371–379

    Article  CAS  Google Scholar 

  12. Brahimaj B, Lamba M, Breneman JC, Warnick RE (2016) Iodine-125 seed migration within brain parenchyma after brachytherapy for brain metastasis: case report. J Neurosurg 125(5):1167–1170. https://doi.org/10.3171/2015.11.JNS151464

    Article  PubMed  Google Scholar 

  13. Heros DO, Kasdon DL, Chun M (1988) Brachytherapy in the treatment of recurrent solitary brain metastases. Neurosurgery 23(6):733–737

    Article  CAS  Google Scholar 

  14. Huang K, Sneed PK, Kunwar S, Kragten A, Larson DA, Berger MS, Chan A, Pouliot J, McDermott MW (2009) Surgical resection and permanent iodine-125 brachytherapy for brain metastases. J Neurooncol 91(1):83–93. https://doi.org/10.1007/s11060-008-9686-2

    Article  CAS  PubMed  Google Scholar 

  15. Matsumoto K, Tada E, Tamesa N, Tomita S, Ohmoto T (1998) Stereotactic brachytherapy for a cystic metastatic brain tumor in the midbrain. Case report. J Neurosurg 88(1):141–144. https://doi.org/10.3171/jns.1998.88.1.0141

    Article  CAS  PubMed  Google Scholar 

  16. Pham A, Yondorf MZ, Parashar B, Scheff RJ, Pannullo SC, Ramakrishna R, Stieg PE, Schwartz TH, Wernicke AG (2016) Neurocognitive function and quality of life in patients with newly diagnosed brain metastasis after treatment with intra-operative cesium-131 brachytherapy: a prospective trial. J Neurooncol 127(1):63–71. https://doi.org/10.1007/s11060-015-2009-5

    Article  CAS  PubMed  Google Scholar 

  17. Raleigh DR, Seymour ZA, Tomlin B, Theodosopoulos PV, Berger MS, Aghi MK, Geneser SE, Krishnamurthy D, Fogh SE, Sneed PK, McDermott MW (2017) Resection and brain brachytherapy with permanent iodine-125 sources for brain metastasis. J Neurosurg 126(6):1749–1755. https://doi.org/10.3171/2016.4.JNS152530

    Article  CAS  PubMed  Google Scholar 

  18. Rogers LR, Rock JP, Sills AK, Vogelbaum MA, Suh JH, Ellis TL, Stieber VW, Asher AL, Fraser RW, Billingsley JS, Lewis P, Schellingerhout D, Shaw EG, Brain Metastasis Study G (2006) Results of a phase II trial of the GliaSite radiation therapy system for the treatment of newly diagnosed, resected single brain metastases. J Neurosurg 105(3):375–384. https://doi.org/10.3171/jns.2006.105.3.375

    Article  Google Scholar 

  19. Wernicke AG, Yondorf MZ, Peng L, Trichter S, Nedialkova L, Sabbas A, Kulidzhanov F, Parashar B, Nori D, Clifford Chao KS, Christos P, Kovanlikaya I, Pannullo S, Boockvar JA, Stieg PE, Schwartz TH (2014) Phase I/II study of resection and intraoperative cesium-131 radioisotope brachytherapy in patients with newly diagnosed brain metastases. J Neurosurg 121(2):338–348. https://doi.org/10.3171/2014.3.JNS131140

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wernicke AG, Hirschfeld CB, Smith AW, Taube S, Yondorf MZ, Parashar B, Nedialkova L, Kulidzhanov F, Trichter S, Sabbas A, Ramakrishna R, Pannullo S, Schwartz TH (2017) Clinical outcomes of large brain metastases treated with neurosurgical resection and intraoperative cesium-131 brachytherapy: results of a prospective trial. Int J Radiat Oncol Biol Phys 98(5):1059–1068. https://doi.org/10.1016/j.ijrobp.2017.03.044

    Article  PubMed  Google Scholar 

  21. Wernicke AG, Smith AW, Taube S, Yondorf MZ, Parashar B, Trichter S, Nedialkova L, Sabbas A, Christos P, Ramakrishna R, Pannullo SC, Stieg PE, Schwartz TH (2017) Cesium-131 brachytherapy for recurrent brain metastases: durable salvage treatment for previously irradiated metastatic disease. J Neurosurg 126(4):1212–1219. https://doi.org/10.3171/2016.3.JNS152836

    Article  CAS  PubMed  Google Scholar 

  22. Ruge MI, Suchorska B, Maarouf M, Runge M, Treuer H, Voges J, Sturm V (2011) Stereotactic 125iodine brachytherapy for the treatment of singular brain metastases: closing a gap? Neurosurgery 68(5):1209–1218. https://doi.org/10.1227/NEU.0b013e31820b526a

    Article  PubMed  Google Scholar 

  23. Hood TW, McKeever PE (1989) Stereotactic management of cystic gliomas of the brain stem. Neurosurgery 24(3):373–378

    Article  CAS  Google Scholar 

  24. Korinthenberg R, Neuburger D, Trippel M, Ostertag C, Nikkhah G (2011) Long-term results of brachytherapy with temporary iodine-125 seeds in children with low-grade gliomas. Int J Radiat Oncol Biol Phys 79(4):1131–1138. https://doi.org/10.1016/j.ijrobp.2009.12.040

    Article  PubMed  Google Scholar 

  25. Ruge MI, Kickingereder P, Simon T, Treuer H, Sturm V (2012) Stereotactic iodine-125 brachytherapy for treatment of inoperable focal brainstem gliomas of WHO grades I and II: feasibility and long-term outcome. J Neurooncol 109(2):273–283. https://doi.org/10.1007/s11060-012-0889-1

    Article  CAS  PubMed  Google Scholar 

  26. Kickingereder P, Hamisch C, Suchorska B, Galldiks N, Visser-Vandewalle V, Goldbrunner R, Kocher M, Treuer H, Voges J, Ruge MI (2014) Low-dose rate stereotactic iodine-125 brachytherapy for the treatment of inoperable primary and recurrent glioblastoma: single-center experience with 201 cases. J Neurooncol 120(3):615–623. https://doi.org/10.1007/s11060-014-1595-y

    Article  CAS  PubMed  Google Scholar 

  27. Abou Al-Shaar H, Almefty KK, Abolfotoh M, Arvold ND, Devlin PM, Reardon DA, Loeffler JS, Al-Mefty O (2015) Brachytherapy in the treatment of recurrent aggressive falcine meningiomas. J Neurooncol 124(3):515–522. https://doi.org/10.1007/s11060-015-1873-3

    Article  CAS  PubMed  Google Scholar 

  28. Magill ST, Lau D, Raleigh DR, Sneed PK, Fogh SE, McDermott MW (2017) Surgical resection and interstitial iodine-125 brachytherapy for high-grade meningiomas: a 25-year series. Neurosurgery 80(3):409–416. https://doi.org/10.1227/NEU.0000000000001262

    Article  PubMed  Google Scholar 

  29. Ware ML, Larson DA, Sneed PK, Wara WW, McDermott MW (2004) Surgical resection and permanent brachytherapy for recurrent atypical and malignant meningioma. Neurosurgery 54(1):55–64. https://doi.org/10.1227/01.Neu.0000097199.26412.2a

    Article  PubMed  Google Scholar 

  30. Gutin PH, Leibel SA, Hosobuchi Y, Crumley RL, Edwards MS, Wilson CB, Lamb S, Weaver KA (1987) Brachytherapy of recurrent tumors of the skull base and spine with iodine-125 sources. Neurosurgery 20(6):938–945

    Article  CAS  Google Scholar 

  31. Kumar PP, Good RR, Patil AA, Leibrock LG (1989) Permanent high-activity iodine-125 in the management of petroclival meningiomas: case reports. Neurosurgery 25(3):436–441

    Article  CAS  Google Scholar 

  32. Obasi PC, Barnett GH, Suh JH (2002) Brachytherapy for intracranial meningioma using a permanently implanted iodine-125 seed. Stereotact Funct Neurosurg 79(1):33–43. https://doi.org/10.1159/000069502

    Article  PubMed  Google Scholar 

  33. Brachman DG, Youssef E, Dardis CJ, Sanai N, Zabramski JM, Smith KA, Little AS, Shetter AG, Thomas T, McBride HL, Sorensen S, Spetzler RF, Nakaji P (2018) Resection and permanent intracranial brachytherapy using modular, biocompatible cesium-131 implants: results in 20 recurrent, previously irradiated meningiomas. J Neurosurg 1:1–10. https://doi.org/10.3171/2018.7.JNS18656

    Article  Google Scholar 

  34. Shafiq AR, Wernicke AG, Riley CA, Morgenstern PF, Nedialkova L, Pannullo SC, Parashar B, Magge R, Schwartz TH (2019) Placement of cesium-131 permanent brachytherapy seeds using the endoscopic endonasal approach for recurrent anaplastic skull base meningioma: case report and technical note. J Neurosurg 1:1–6. https://doi.org/10.3171/2018.11.JNS181943

    Article  Google Scholar 

  35. Koch MJ (2019) Brachytherapy as an adjuvant for recurrent atypical and malignant meningiomas. Neurosurgery. https://doi.org/10.1093/neuros/nyz115/5479423

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ramkissoon SH, Bi WL, Schumacher SE, Ramkissoon LA, Haidar S, Knoff D, Dubuc A, Brown L, Burns M, Cryan JB, Abedalthagafi M, Kang YJ, Schultz N, Reardon DA, Lee EQ, Rinne ML, Norden AD, Nayak L, Ruland S, Doherty LM, LaFrankie DC, Horvath M, Aizer AA, Russo A, Arvold ND, Claus EB, Al-Mefty O, Johnson MD, Golby AJ, Dunn IF, Chiocca EA, Trippa L, Santagata S, Folkerth RD, Kantoff P, Rollins BJ, Lindeman NI, Wen PY, Ligon AH, Beroukhim R, Alexander BM, Ligon KL (2015) Clinical implementation of integrated whole-genome copy number and mutation profiling for glioblastoma. Neuro Oncology 17(10):1344–1355. https://doi.org/10.1093/neuonc/nov015

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Aizer AA, Abedalthagafi M, Bi WL, Horvath MC, Arvold ND, Al-Mefty O, Lee EQ, Nayak L, Rinne ML, Norden AD, Reardon DA, Wen PY, Ligon KL, Ligon AH, Beroukhim R, Dunn IF, Santagata S, Alexander BM (2016) A prognostic cytogenetic scoring system to guide the adjuvant management of patients with atypical meningioma. Neuro Oncology 18(2):269–274. https://doi.org/10.1093/neuonc/nov177

    Article  CAS  PubMed  Google Scholar 

  38. USDHHS (2009) Common terminology criteria for adverse events (CTCAE) Version 4.0. US Department of Health and Human Services, Bethesda.

  39. Cifarelli CP, Brehmer S, Vargo JA, Hack JD, Kahl KH, Sarria-Vargas G, Giordano FA (2019) Intraoperative radiotherapy (IORT) for surgically resected brain metastases: outcome analysis of an international cooperative study. J Neurooncol. https://doi.org/10.1007/s11060-019-03309-6

    Article  PubMed  Google Scholar 

  40. Giordano FA, Brehmer S, Murle B, Welzel G, Sperk E, Keller A, Abo-Madyan Y, Scherzinger E, Clausen S, Schneider F, Herskind C, Glas M, Seiz-Rosenhagen M, Groden C, Hanggi D, Schmiedek P, Emami B, Souhami L, Petrecca K, Wenz F (2019) Intraoperative radiotherapy in newly diagnosed glioblastoma (intrago): an open-label, dose-escalation phase i/ii trial. Neurosurgery 84(1):41–49. https://doi.org/10.1093/neuros/nyy018

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the Goss family for their generosity and support of meningioma research at the Brigham and Women’s Hospital.

Author information

Author notes

  1. Ossama Al-Mefty and Phillip M. Devlin have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Barrow Neurological Institute, 350 W. Thomas Rd, Phoenix, AZ, USA

    Michael A. Mooney

  2. Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA

    Michael A. Mooney, Wenya Linda Bi, Kyle C. Wu, Lucas L. Possatti, Parikshit Juvekar, Ian F. Dunn & Ossama Al-Mefty

  3. Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA

    Liangge Hsu

  4. Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, USA

    Jonathan M. Cantalino, Thomas C. Harris & Phillip M. Devlin

Authors
  1. Michael A. Mooney
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wenya Linda Bi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jonathan M. Cantalino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kyle C. Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas C. Harris
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lucas L. Possatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Parikshit Juvekar
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Liangge Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ian F. Dunn
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ossama Al-Mefty
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Phillip M. Devlin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael A. Mooney.

Ethics declarations

Conflict of interest

The authors declares that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 12 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mooney, M.A., Bi, W.L., Cantalino, J.M. et al. Brachytherapy with surgical resection as salvage treatment for recurrent high-grade meningiomas: a matched cohort study. J Neurooncol 146, 111–120 (2020). https://doi.org/10.1007/s11060-019-03342-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-019-03342-5

Keywords

Search

Navigation