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Long-term outcome of moderate hypofractionated stereotactic radiotherapy for meningiomas

Langzeitergebnisse moderater hypofraktionierter stereotaktischer Strahlentherapie bei Meningeomen

Strahlentherapie und Onkologie volume 191, pages 953–960 (2015)Cite this article

Abstract

Purpose

The aim of this work was to evaluate long-term results of moderate hypofractionated stereotactic radiotherapy (hFSRT) for intracranial meningiomas.

Patients and methods

In all, 77 consecutive patients with 80 lesions were included. Median age was 65 years (range 23–82 years), male/female ratio was 21/56, and the median Karnofsky performance status was 90 (range 60–100). In 31 lesions (39 %), diagnosis was based upon clinical and radiological data; 37 lesions were histologically proven as World Health Organization (WHO) grade I and 12 grade II meningiomas. Median treatment volume was 23 cc. Prescribed doses were 45 Gy in 15 fractions of 3 Gy (15 × 3 Gy) or 42 Gy in 14 fractions of 3 Gy (14 × 3 Gy).

Results

After a median follow-up of 56 months, 49 (61 %) lesions received 14 × 3 Gy and 31 (39 %) 15 × 3 Gy. Local control (LC) rate remained unchanged at 84 % at 5 and 10 years. Overall survival and disease-specific survival (DSS) were 76 and 93 % at 5 years, 72 and 89 % at 10 years, respectively. With univariate analysis, previous surgery and WHO grade II tumor were negative prognostic factors for LC and DSS. With multivariate analysis only tumor grade was an independent prognostic factor for LC. No clinically significant acute and/or late toxicities were observed.

Conclusion

Moderate hFSRT was effective and safe with an excellent tolerance profile. It can be an alternative treatment option for patients with recurrent or inoperable large meningiomas. The low number of fractions administered with hFSRT led to reduce treatment-related discomfort for patients. Grade II tumor and previous surgery were negative prognosis factors.

Zusammenfassung

Ziel

Untersucht wurden die Langzeitergebnisse von moderater hypofraktionierter stereotaktischer Strahlentherapie (hFSRT) bei intrakraniellen Meningeomen.

Patienten und Methoden

Es wurden 77 konsekutive Patienten mit 80 Läsionen ausgewählt. Das durchschnittliche Alter betrug 65 Jahre (Spanne 23–82 Jahre), das Verhältnis Männer/Frauen lag bei 21/56, der mediane Karnofsky-Index betrug 90 (Spanne 60–100). Bei 31 Läsionen (39 %) basierte die Diagnose auf klinischen und radiologischen Daten. Histologisch wurden 37 Läsionen wurden WHO-(World-Health-Organization-)Grad-I- und 12 Läsionen WHO-Grad-II-Meningeomen zugeordnet. Das mediane Behandlungsvolumen betrug 23 ml. Die verschriebene Dosis betrug 45 Gy in 15 Fraktionen von je 3 Gy (15 × 3 Gy) oder 42 Gy in 14 Fraktionen von je 3 Gy (14 × 3 Gy).

Ergebnisse

Nach einer medianen Nachbeobachtungszeit von 56 Monaten erhielten 49 (61 %) der Läsionen 14 × 3 Gy, die verbleibenden 31 (39 %) 15 × 3 Gy. Die lokale Kontrollrate (LC) blieb bei 84 % nach 5 bzw. 10 Jahren. Das Gesamtüberleben und das krankheitsspezifische Überleben (DSS) lagen jeweils bei 76 % bzw. 93 % nach 5 Jahren und bei 72 % bzw. 89 % nach 10 Jahren. Bei univariater Analyse waren frühere Operationen und WHO-Grad-II-Tumoren negative prognostische Faktoren für LC und DSS. Multivariat bleib nur der Tumorgrad ein unabhängiger prognostischer Faktor für LC. Es wurde keine klinisch relevante akute und/oder späte Toxizität beobachtet.

Schlussfolgerung

Moderate hFSRT zeigte sich als wirksam und sicher mit einem ausgezeichneten Verträglichkeitsprofil. Damit bietet sie eine alternative Behandlungsmethode für Patienten mit Rezidiven und inoperablen großen Meningeomen. Die niedrige Anzahl der verabreichten Fraktionen mit hFSRT verringerte die behandlungsbedingten Beschwerden der Patienten. WHO-Grad-II-Tumoren und vorausgegangene Operationen waren negative Prognosefaktoren.

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Affiliations

  1. Radiotherapy Oncology Centre, “S. Maria” Hospital, Via T. di Joannuccio, 1, 05100, Terni, Italy

    Ernesto Maranzano M.D., Lorena Draghini M.D., Michelina Casale Ph. D., Fabio Arcidiacono M.D., Paola Anselmo M.D., Fabio Trippa M.D. & Cesare Giorgi M.D.

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  1. Ernesto Maranzano M.D.
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  2. Lorena Draghini M.D.
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  3. Michelina Casale Ph. D.
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  5. Paola Anselmo M.D.
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  6. Fabio Trippa M.D.
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  7. Cesare Giorgi M.D.
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Corresponding author

Correspondence to Ernesto Maranzano M.D..

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Conflict of interest

E. Maranzano, L. Draghini, M. Casale, F. Arcidiacono, P. Anselmo, F. Trippa, C. Giorgi state that there are no conflicts of interest.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its most recently amended version). Informed consent was obtained from all patients included in the study.

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Maranzano, E., Draghini, L., Casale, M. et al. Long-term outcome of moderate hypofractionated stereotactic radiotherapy for meningiomas. Strahlenther Onkol 191, 953–960 (2015). https://doi.org/10.1007/s00066-015-0915-2

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Keywords

  • Prognosis
  • Survival
  • Stereotactic radiotherapy
  • Hypofractionated radiotherapy
  • Neoplasms, nerve tissue

Schlüsselwörter

  • Prognose
  • Überleben
  • Stereotaktische Strahlentherapie
  • Hypofraktionierte Strahlentherapie
  • Neoplasien, Nervengewebe