Skip to main content

Advertisement

Log in

Patterns of failure after stereotactic radiotherapy of intracranial meningioma

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

Abstract

The aim of this work is to evaluate patterns of failure in patients with recurrent meningioma after stereotactic radiotherapy. Of 411 patients with intracranial meningioma treated with radiotherapy at our institution, 22 patients with local tumor progression diagnosed by magnetic resonance imaging (MRI) after radiotherapy (RT) were identified and further investigated. The histologic grade of the meningiomas was World Health Organization (WHO) grade I in 54.5%, WHO grade II in 27.3%, and WHO grade III in 9.1% of cases. Fourteen patients had received fractionated stereotactic RT; five patients underwent intensity-modulated RT. The median total dose was 57.6 Gy at 1.8 Gy/fraction, five times weekly. Local recurrences were divided into the dosimetric categories “central” (“in-field”) and “marginal” (“out-field”). Median follow-up was 59.5 months. Eleven local failures were found to be central, and 11 were marginal. Recurrence-free survival (P < 0.05) and site of local recurrence (P < 0.05) depended statistically significantly on histology. Median recurrence-free survival was 46 months for patients with benign meningioma (WHO grade I) and 31.5 months for patients with higher-grade meningioma (WHO grade II/III). In the WHO grade I group, three recurrences were central and nine were marginal, whereas in the WHO grade II/III group seven recurrences were central and one was marginal. Median time to local tumor progression and site of local recurrence significantly depended on histological grade of meningioma. Regarding site of failure, improvement of dose coverage for benign meningiomas and dose escalation for high-grade tumors might further improve therapy outcome.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Marosi C, Hassler M, Roessler K, Reni M, Sant M, Mazza E, Vecht C (2008) Meningioma. Crit Rev Oncol Hematol 67:153–171

    Article  PubMed  Google Scholar 

  2. Longstreth WT, Dennis LK, McGuire VM, Drangsholt MT, Koepsell TT (1993) Epidemiology of intracranial meningioma. Cancer 72:639–648

    Article  PubMed  Google Scholar 

  3. Louis DN, Scheithauer BW, Budka H, von Deimling A, Kepes JJ (2000) Meningiomas. In: Kleihues P, Cavenee WK (eds) Pathology and genetics. Tumors of the nervous system, WHO classification of tumors. IARC, Lyon, pp 176–184

  4. Bartolomei M, Bodei L, De Cicco C, Grana CM, Cremonesi M, Botteri E, Baio SM, Aricò D, Sansovini M, Paganelli G (2009) Peptide receptor radionuclide therapy with (90)Y-DOTATOC in recurrent meningioma. Eur J Nucl Med Mol Imaging 36(9):1407–1416

    Article  CAS  PubMed  Google Scholar 

  5. O’Sullivan MG, Van Loveren HR, Tew JM (1997) The surgical resectability of meningiomas of the cavernous sinus. Neurosurgery 40:238–245

    Article  PubMed  Google Scholar 

  6. Colli BO, Assirati JA Jr, Deriggi DJ, Neder L, dos Santos AC, Carlotti CG Jr (2008) Tentorial meningiomas: follow-up review. Neurosurg Rev 31(4):421–430

    Article  PubMed  Google Scholar 

  7. Debus J, Wuendrich M, Pirzkall A, Hoess A, Schlegel W, Zuna I, Engenhart-Cabillic R, Wannenmacher M (2001) High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results. J Clin Oncol 19(15):3547–3553

    CAS  PubMed  Google Scholar 

  8. Pirzkall A, Debus J, Haering P, Rhein B, Grosser KH, Höss A, Wannenmacher M (2003) Intensity modulated radiotherapy (IMRT) for recurrent, residual, or untreated skull-base meningiomas: preliminary clinical experience. Int J Radiat Oncol Biol Phys 55(2):362–372

    PubMed  Google Scholar 

  9. Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL (1985) Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 62:18–24

    Article  CAS  PubMed  Google Scholar 

  10. Milker-Zabel S, Zabel A, Schulz-Ertner D, Schlegel W, Wannenmacher M, Debus J (2005) Fractionated stereotactic radiotherapy in patients with benign or atypical intracranial meningioma: long-term experience and prognostic factors. Int J Radiat Oncol Biol Phys 61(3):809–816

    PubMed  Google Scholar 

  11. Milker-Zabel S, Zabel-du Bois A, Huber P, Schlegel W, Debus J (2007) Intensity-modulated radiotherapy for complex-shaped meningioma of the skull base: long-term experience of a single institution. Int J Radiat Oncol Biol Phys 68(3):858–863

    PubMed  Google Scholar 

  12. Milker-Zabel S, Zabel-du Bois A, Huber P, Schlegel W, Debus J (2006) Fractionated stereotactic radiation therapy in the management of benign cavernous sinus meningiomas. Strahlenther Onkol 182:635–640

    Article  PubMed  Google Scholar 

  13. Menke M, Hirschfeld F, Mack T, Pastyr O, Sturm V, Schlegel W (1994) Photogrammetic accuracy measurements of head holder systems used for fractionated radiotherapy. Int J Radiat Oncol Biol Phys 29(5):1147–1155

    CAS  PubMed  Google Scholar 

  14. Preiser K, Bortfeld T, Hartwig K, Schlegel W, Stein J (1998) Inverse radiotherapy planning for intensity modulated photon fields. Radiologe 38(3):228–234

    Article  CAS  PubMed  Google Scholar 

  15. Keller-Reichenbecher MA, Bortfeld T, Levegrün S, Stein J, Preiser K, Schlegel W (1999) Intensity modulation with the “step and shoot” technique using a commercial MLC: a planning study. Multileaf collimator. Int J Radiat Oncol Biol Phys 45(5):1315–1324

    Article  CAS  PubMed  Google Scholar 

  16. Vendrely V, Maire JP, Darrouzet V, Bonichon N, San Galli F, Celerier D, Causse N, Demeaux H, Trouette R, Dahan O, Recaldini L, Guerin J, Caudry M (1999) Fractionated radiotherapy of intracranial meningiomas: 15 years’ experience at the Bordeaux University Hospital Center. Cancer Radiother 3(4):311–317

    CAS  PubMed  Google Scholar 

  17. Nutting C, Brada M, Brazil L, Sibtain F, Westbury C, Moore A, Thomas DG, Traish D, Ashley S (1999) Radiotherapy in the treatment of benign meningioma of the skull base. J Neurosurg 90(5):823–827

    Article  CAS  PubMed  Google Scholar 

  18. Hamm K, Henzel M, Gross MW, Surber G, Kleinert G, Engenhart-Cabillic R (2008) Radiosurgery/stereotactic radiotherapy in the therapeutical concept for skull base meningiomas. Zantralbl Neurochir 69(1):14–21

    Article  CAS  Google Scholar 

  19. Brown JM (2007) Tumor hypoxia in cancer therapy. Methods Enzymol 435:297–321

    CAS  PubMed  Google Scholar 

Download references

Conflict of interest statement

All authors disclose any financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Stefanie Milker-Zabel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Askoxylakis, V., Zabel-du Bois, A., Schlegel, W. et al. Patterns of failure after stereotactic radiotherapy of intracranial meningioma. J Neurooncol 98, 367–372 (2010). https://doi.org/10.1007/s11060-009-0084-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-009-0084-1

Keywords

Navigation