Abstract
Purpose
Data on the efficacy and safety of stereotactic radiosurgery (SRS) for treatment of radiation-induced meningiomas (RIMs) are limited.
Methods
A single institution database of Cobalt-60 SRS cases from 08/1999 to 10/2020 was reviewed. Radiation-induced meningiomas were identified using Cahan’s criteria. Endpoints included overall survival (OS), progression free survival (PFS), local control (LC), treatment failure, and treatment toxicity. Univariate and multivariate analyses were performed using cox proportional hazard models.
Results
A total of 29 patients with 86 RIM lesions were identified. Median follow-up after SRS was 59 months. The median dose prescribed to the 50% isodose line was 14 Gy (range 12–20 Gy). The actuarial 5-yr OS and PFS were 96% and 68%, respectively. Patients treated for recurrent RIMs had a significantly lower PFS (45% vs 94% at 3 yr, p < 0.005) than patients treated in the upfront setting. Patients with presumed or WHO grade I RIMs had a significantly greater PFS (3-year PFS 96% vs 20%) than patients with WHO grade II RIMs (p < 0.005). On a per-lesion basis, local control (LC) at 1-, 3-, and 5-yrs was 82%, 76%, 74%, respectively. On multivariate analysis, female gender was associated with improved LC (p < 0.001), while marginal doses > 14 Gy were associated with worse local control (p < 0.001). Grade I-III toxicity following treatment was 9.0%.
Conclusions
Stereotactic radiosurgery is a safe and effective treatment option for radiographic RIMs, WHO grade I RIMs, or lesions treated in the upfront setting. WHO grade II lesions and recurrent lesions are at increased risk for disease progression.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Niema B. Razavian, Corbin A. Helis, Michael D. Chan, and Christina Cristina K. Cramer. The first draft of the manuscript was written by Niema B. Razavian and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The authors have no relevant financial or non-financial interests to disclose. The views expressed in this article are those of the authors and do not reflect the official policy or position of Fort Belvoir Community Hospital, the Defense Health Agency, Department of Defense, or the U.S. Government. Reference to any commercial products within this publication does not create or imply any endorsement by Fort Belvoir Community Hospital, the Defense Health Agency, Department of Defense, or U.S. Government.
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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Wake Forest School of Medicine approved this study.
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Razavian, N.B., Helis, C.A., Laxton, A. et al. Outcomes of radiation-induced meningiomas treated with stereotactic radiosurgery. J Neurooncol 161, 259–266 (2023). https://doi.org/10.1007/s11060-022-04156-8
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DOI: https://doi.org/10.1007/s11060-022-04156-8