Skip to main content

Efficacy of stereotactic radiosurgery for radiation-induced meningiomas

Abstract

Purpose

Stereotactic radiosurgery is an established treatment option for sporadic meningiomas, though limited data exists for radiation-induced lesions.

Methods

Patients treated with cobalt-60 radiosurgery between October 2005 and December 2018 in an institutional registry were reviewed. Single fraction treatments were prescribed to the 50% isodose line. Lesions were deemed to be radiation-induced according to standard criteria previously established by Cahan et al.

Results

A total of 37 patients with 72 lesions were analysed. Median follow up per patient was 44 months (range, 1.4–150.7 months). Median age at initial radiotherapy was 5 years (4 months–48 years), and at radiosurgery was 38 years. Of the 72 lesions, 62 were grade 1 (n = 4) or radiologically-diagnosed (n = 58), six were grade 2 and four were grade 3. Median lesion volume was 2.13 cc (0.04–13.8 cc), while the median radiosurgery margin dose was 13 Gy. Local control, on a per lesion basis, was 88.6% at 5 years (95% confidence interval [CI] 72.3–95.6). For grade 1 or radiologically-diagnosed lesions, local control was 96.6% at 5 years (95% CI 77.9–99.5), whereas those with grade 2 or higher lesions had a local control of 40% at 5 years (95% CI 5.2–75.3, p = 0.005). Radiologic oedema developed in 17 lesions (23.6%) and was symptomatic in 12 patients (16.7%). Doses above 12 Gy were not associated with local control probability (p = 0.292).

Conclusion

Radiosurgery is an effective treatment option for grade 1 or radiologically-diagnosed radiation-induced meningiomas, with 12 Gy appearing to be a sufficient dose.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Data availability

Yes.

References

  1. Banerjee J, Pääkkö E, Harila M, Herva R, Tuominen J, Koivula A, Lanning M, Harila-Saari A (2009) Radiation-induced meningiomas: a shadow in the success story of childhood leukemia. Neuro Oncol 11(5):543–549

    Article  Google Scholar 

  2. Remes TM, Suo-Palosaari MH, Heikkilä VP, Sutela AK, Koskenkorva PKT, Toiviainen-Salo SM, Porra L, Arikoski PM, Lähteenmäki PM, Pokka TM, Arola MO, Riikonen VP, Sirkiä KH, Lönnqvist TRI, Rantala HMJ, Ojaniemi MK, Harila-Saari AH (2019) Radiation-induced meningiomas after childhood brain tumor: a magnetic resonance imaging screening study. J Adolesc Young Adult Oncol 8(5):593–601

    Article  Google Scholar 

  3. Co JL, Swain M, Murray LJ, Ahmed S, Laperriere NJ, Tsang DS, Yu E, Pintilie M, Weiss J, Hodgson DC (2019) Meningioma screening with MRI in childhood leukemia survivors treated with cranial radiation. Int J Radiat Oncol Biol Phys 104(3):640–643

    Article  Google Scholar 

  4. Cahan WG, Woodard HQ, Higinbotham NL, Stewart FW, Coley BL (1998) Sarcoma arising in irradiated bone: report of eleven cases. Cancer 82(1):8–34

    CAS  Article  Google Scholar 

  5. Shah AH, Jusue-Torres I, Kuchakulla M, Ivan ME, Benveniste RJ, Morcos JJ, Komotar RJ (2018) Radiation-induced meningiomas: a case-control study at single center institution. J Neurol Sci 387:205–209

    Article  Google Scholar 

  6. Al-Mefty O, Topsakal C, Pravdenkova S, Sawyer JR, Harrison MJ (2004) Radiation-induced meningiomas: clinical, pathological, cytokinetic, and cytogenetic characteristics. J Neurosurg 100(6):1002–1013

    Article  Google Scholar 

  7. Kondziolka D, Patel AD, Kano H, Flickinger JC, Lunsford LD (2016) Long-term outcomes after gamma knife radiosurgery for meningiomas. Am J Clin Oncol 39(5):453–457

    Article  Google Scholar 

  8. Jensen AW, Brown PD, Pollock BE, Stafford SL, Link MJ, Garces YI, Foote RL, Gorman DA, Schomberg PJ (2005) Gamma knife radiosurgery of radiation-induced intracranial tumors: local control, outcomes, and complications. Int J Radiat Oncol Biol Phys 62(1):32–37

    Article  Google Scholar 

  9. Kuhn EN, Chan MD, Tatter SB, Ellis TL (2012) Gamma knife stereotactic radiosurgery for radiation-induced meningiomas. Stereotact Funct Neurosurg 90(6):365–369. discussion 469-70

    Article  Google Scholar 

  10. Kondziolka D, Kano H, Kanaan H, Madhok R, Mathieu D, Flickinger JC, Lunsford LD (2009) Stereotactic radiosurgery for radiation-induced meningiomas. Neurosurgery 64(3):463–469

    Article  Google Scholar 

  11. Park KJ, Kano H, Iyer A, Liu X, Tonetti DA, Lehocky C, Faramand A, Niranjan A, Flickinger JC, Kondziolka D, Lunsford LD (2018) Gamma Knife stereotactic radiosurgery for cavernous sinus meningioma: long-term follow-up in 200 patients. J Neurosurg 130(6):1799–1808

    Article  Google Scholar 

  12. Shoshan Y, Chernova O, Juen SS, Somerville RP, Israel Z, Barnett GH, Cowell JK (2000) Radiation-induced meningioma: a distinct molecular genetic pattern? J Neuropathol Exp Neurol 59(7):614–620

    CAS  Article  Google Scholar 

  13. Umansky F, Shoshan Y, Rosenthal G, Fraifeld S, Spektor S (2008) Radiation-induced meningioma. Neurosurg Focus 24(5):E7

    Article  Google Scholar 

  14. Sadetzki S, Flint-Richter P, Ben-Tal T, Nass D (2002) Radiation-induced meningioma: a descriptive study of 253 cases. J Neurosurg 97(5):1078–1082

    Article  Google Scholar 

  15. Huo M, Shultz D, Laperriere N, Payne D, Cusimano M, Berlin A, Hodaie M, Millar B, Gentili F, Schwartz M, Nassiri F, Zadeh G, Tsang DS (2019) Stereotactic radiosurgery for meningiomas: effect of dose on local control. Int J Radiat Oncol Biol Phys 105(1):E66

    Article  Google Scholar 

Download references

Funding

Not applicable.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael Huo.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethics approval

Obtained via University Health Network Research Ethics Board.

Informed consent

Yes.

Additional information

Publisher's Note

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

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Huo, M., Laperriere, N., van Prooijen, M. et al. Efficacy of stereotactic radiosurgery for radiation-induced meningiomas. J Neurooncol 148, 299–305 (2020). https://doi.org/10.1007/s11060-020-03515-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-020-03515-7

Keywords

  • Radiation-induced meningioma
  • Meningioma
  • Radiosurgery
  • Stereotactic
  • Radiotherapy