Experience with hypofractionated stereotactic radiosurgery in a series of patients with skull base tumors

Abstract

Introduction and objective

Although the effectiveness of single-fraction brain stereotactic radiosurgery has been extensively demonstrated, recent evidence is suggesting that when skull base lesions are the targets, radiation near critical structures (e.g., optic nerves, and brainstem) should be reduced to avoid radiotoxic effects, with the risk of treatment inefficacy. Hence, in these tumors, hypofractionated stereotactic radiosurgery (HSRS) would offer a therapeutical opportunity. Here, we present our experience with this modality in the management of patients with skull base tumors.

Methods

A series of patients with skull base tumors was retrospectively analyzed to evaluate the treatment with HSRS. The primary endpoint was tumor control in post-treatment imaging. Age, sex, tumor histology, tumor volume, type of radiation protocol, pre-treatment Karnofsky performance status (KPS), previous neurosurgery, and prior radiotherapy were analyzed.

Results

A total of 84 patients were treated between January/2009 to January/2017. Median age: 51.5 years. Female gender: 53.6%. There was 92.7% of non-progression after HSRS, with a median f/u of 36 months. Main tumors treated were pituitary adenomas, acoustic schwannomas, and skull base meningioma. Most of the patients were treated with a 5-day fraction scheme of a 25 Gy total dose. No late radiotoxicity was observed. In multivariate analysis, a high KPS was associated with non-progression.

Conclusions

In our series of patients, the high incidence of non-progression of tumors indicated that HSRS could be a therapeutic option in some cases of skull base lesions, mainly residuals or tumoral recurrences of pituitary adenomas, schwannomas, and meningiomas.

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Notes

  1. 1.

    Hormone-secreting pituitary adenomas were excluded given that the appropriate outcome, in this case, is not the tumor non-progression, but the biochemical normalization of hormone secretion.

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Correspondence to Diego Aldo Hernández.

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Our Institutional Review Board approved the execution of the study.

Conflict of interest

Author Diego A. Hernández declares that he has no conflict of interest. Author Juan M Zaloff Dakoff declares that he has no conflict of interest. Author Cynthia Auad declares that she has no conflict of interest. Author Victor E. Derechinsky declares that he has no conflict of interest. Author Roberto Rosler declares that he has no conflict of interest. Author Julio García declares that he has no conflict of interest. Author Luisa Rafailovici declares that she has no conflict of interest. Author María L. Filomia declares that she has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with human or animal subjects performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study. During the processing of data at the time of analysis, the patient’s identity remained anonymous.

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Hernández, D.A., Zaloff Dakoff, J.M., Auad, C. et al. Experience with hypofractionated stereotactic radiosurgery in a series of patients with skull base tumors. J Radiat Oncol 7, 307–315 (2018). https://doi.org/10.1007/s13566-018-0365-4

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Keywords

  • Stereotactic radiosurgery
  • Skull base tumors
  • LINAC
  • Hypofractionation