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Stereotactic radiosurgery in the management of petroclival meningiomas: a systematic review and meta-analysis of treatment outcomes of primary and adjuvant radiosurgery

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Abstract

Purpose

To summarize the clinical features and outcomes of petroclival meningioma patients treated with stereotactic radiosurgery (SRS) as either a primary or an adjuvant modality.

Methods

Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane. A systematic review and meta-analysis of treatment outcomes comparing primary and adjuvant SRS was conducted.

Results

Seven articles comprising 722 cases were included. The mean tumor marginal dose was 13.5 Gy. After SRS, symptoms improved in 28.7%, remained unchanged in 61.3%, and worsened in 10.0% of the cohort. Tumor control was achieved in 94.8% of patients. The mean tumor volume change was −6.4 cm3. The 5-year and 10-year progression-free survival (PFS) rates were 91–100% and 69.6–89.9%, respectively. Overall, 61.9% of patients underwent primary radiosurgery, and 38.1% had adjuvant radiosurgery. Patients who had primary SRS reported higher rates of tumor control (94.3% vs. 88.2%) and fewer SRS-related complications (3.7% vs. 10.3%) than those who received adjuvant SRS (not accounting for microsurgical complications). The functional status of patients who had primary SRS was more likely to improve or remain unchanged, with an effect size of 1.12 (95% CI 1.1–1.25; I2 = 0). Neither group displayed superiority in worsening functional outcomes or tumor control rate.

Conclusion

SRS of petroclival meningiomas was associated with excellent long-term PFS and local tumor control rates. Primary SRS was highly effective for patients with smaller volume lesions without clinically symptomatic mass effect. In patients who warrant initial resection, adjuvant radiosurgery remains an important modality to prevent regrowth while maintaining postresection function.

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Data availability

All authors confirm the appropriateness of all dataset and software used for supporting the conclusion. All data generated or analyzed during this study are included in this published article (and its supplementary information files).

Code availability

Not applicable.

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Acknowledgements

We thank Kristin Kraus, MSc, for her editorial assistance.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Othman Bin Alamer

  2. Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy

    Paolo Palmisciano

  3. Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, Pittsburgh, PA, 15213, USA

    Arka N. Mallela, Paul A. Gardner, L. Dade Lunsford & Hussam Abou-Al-Shaar

  4. Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA

    Mohamed A. Labib

  5. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA

    William T. Couldwell

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Contributions

Conception and design: OBA, HA. Literature search, articles screen, and data extraction: OBA, PP, ANM, HA. Data analysis: OBA, PP, ANM, HA, MAL. Manuscript draft: OBA, HA. All authors critically revised and edited the first draft and commented on all versions of the manuscript. The project was supervised by PAG, WTC, LDL, HA. All authors read and approved the final manuscript.

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Correspondence to Hussam Abou-Al-Shaar.

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Bin Alamer, O., Palmisciano, P., Mallela, A.N. et al. Stereotactic radiosurgery in the management of petroclival meningiomas: a systematic review and meta-analysis of treatment outcomes of primary and adjuvant radiosurgery. J Neurooncol 157, 207–219 (2022). https://doi.org/10.1007/s11060-021-03934-0

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