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Journal of Neuro-Oncology

, Volume 119, Issue 1, pp 169–176 | Cite as

Stereotactic radiosurgery of petroclival meningiomas: a multicenter study

  • Robert Starke
  • Hideyuki Kano
  • Dale Ding
  • Peter Nakaji
  • Gene H. Barnett
  • David Mathieu
  • Veronica Chiang
  • James B. Yu
  • Judith Hess
  • Heyoung L. McBride
  • Norissa Honea
  • John Y. K. Lee
  • Gazanfar Rahmathulla
  • Wendi A. Evanoff
  • Michelle Alonso-Basanta
  • L. Dade Lunsford
  • Jason P. Sheehan
Clinical Study

Abstract

Petroclival meningiomas are difficult to treat due to their intimate location with critical structures, and complete microsurgical resection is often associated with significant morbidity. In this study, we evaluate the outcomes of petroclival meningiomas treated with Gamma Knife radiosurgery (GKRS) as an adjunct to microsurgery or a primary treatment modality. A multicenter study of 254 patients with a benign petroclival meningioma was conducted through the North American Gamma Knife Consortium. One hundred and forty patients were treated with upfront radiosurgery, and 114 following surgery. Multivariate analysis was used to determine predictors of favorable defined as no tumor progression following radiosurgery and the absence of any new or worsening neurological function. At mean follow up of 71 months (range 6–252), tumor volumes increased in 9 % of tumors, remained stable in 52 %, and decreased in 39 %. Kaplan–Meier actuarial progression free survival rates at 3, 5, 8, 10, and 12 years were 97, 93, 87, 84, and 80 % respectively. At last clinical follow-up, 93.6 % of patients demonstrated no change or improvement in their neurological condition whereas 6.4 % of patients experienced progression of symptoms. Favorable outcome was achieved in 87 % of patients and multivariate predictors of favorable outcome included smaller tumor volume (OR = 0.92; 95 % CI 0.87–0.97, p = 0.003), female gender (OR 0.37; 95 % CI 0.15–0.89, p = 0.027), no prior radiotherapy (OR 0.03; 95 % CI 0.01–0.36, p = 0.006), and decreasing maximal dose (OR 0.92; 95 % CI 0.96–0.98, p = 0.010). GKRS of petroclival meningiomas achieves neurological preservation in most patients and with a high rate of tumor control.

Keywords

Meningioma Radiosurgery Gamma Knife 

Abbreviations

GKRS

Gamma Knife radiosurgery

SRS

Stereotactic radiosurgery

MR

Magnetic resonance

CT

Computed tomography

IMRT

Tintensity-modulated radiotherapy

FSRT

Fractionated stereotactic radiotherapy

Notes

Conflict of interest

Dr. Lunsford is a consultant for and stockholder in Elekta AB.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Robert Starke
    • 1
  • Hideyuki Kano
    • 2
  • Dale Ding
    • 1
  • Peter Nakaji
    • 7
  • Gene H. Barnett
    • 5
  • David Mathieu
    • 4
  • Veronica Chiang
    • 6
  • James B. Yu
    • 6
  • Judith Hess
    • 6
  • Heyoung L. McBride
    • 7
  • Norissa Honea
    • 7
  • John Y. K. Lee
    • 3
  • Gazanfar Rahmathulla
    • 5
  • Wendi A. Evanoff
    • 5
  • Michelle Alonso-Basanta
    • 3
  • L. Dade Lunsford
    • 2
  • Jason P. Sheehan
    • 1
  1. 1.Department of Neurological SurgeryUniversity of VirginiaCharlottesvilleUSA
  2. 2.University of PittsburghPittsburghUSA
  3. 3.University of PennsylvaniaPhiladelphiaUSA
  4. 4.University of SherbrookeSherbrookeCanada
  5. 5.Cleveland ClinicClevelandUSA
  6. 6.Yale UniversityNew HavenUSA
  7. 7.Barrow Neurological InstitutePhoenixUSA

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