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The Role of Stereotactic Radiosurgery in the Management of Benign, Atypical, and Malignant Meningiomas

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Journal of Radiosurgery

Abstract

Stereotactic radiosurgery and fractionated Stereotactic radiotherapy (SR) offer precise localization of radiation dose (Gy) for the treatment of meningioma (M). For the multimodal treatment with preservation of function, SR is complementary to both microsurgery (S) and conventional external beam radiotherapy (XRT). The role of SR in the management of atypical and malignant meningiomas, however, remains unexplored. Fifty consecutive patients with meningioma: 18 males (60.1 +/− 2.3 years) and 32 females (56.9 +/− 2.2 years) (p = NS) received SR. Thirty-one patients had surgery 69.6 +/− 13.9 months (95% CI: 53.3–98.0) prior to SR. For patients having S, the incidence of atypical or malignant versus benign meningiomas (14 versus 17 patients) increased with age (p = 0.03). Twenty patients had XRT approximately 18 months prior to SR. For antecedent XRT, the range of doses was 3600–6400 cGy (median: 5040 cGy). Following failure of S and/or XRT, patients had SR. Compared to other series, the mean tumor volumes for SR were comparatively large: 9.8 +/− 1.3 cm3 (range 0.3–37.1 cm3). The median SR dose was 3500 cGy (range 540–5400 cGy) administered in seven fractions (range 1–30). Linear regression analysis showed a consistent method for fractionation: the number of administered fractions increased (p = 0.053) and the total dose increased (p = 0.054) with tumor size. During the interval for follow–up (17.9 +/− 2.9 months), one patient with malignant meningioma required surgery for progression 8 months after SR. In the remaining patients, post-SR MRIs showed control (unchanged or smaller tumor volume) regardless of histology. These results show that SR may provide control of M regardless of grade.

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REFERENCES

  1. Cushing H, Eisenhardt L. (eds), Meningiomas: Their Classification, Regional Behavior, Life History, and Surgical End Results. Springfield, IL., Charles C Thomas, 1938

    Google Scholar 

  2. Grant FC: Intracranial meningiomas, surgical results. Surg Gynecol Obstet 85:419-431, 1947

    Google Scholar 

  3. Hoessly GF, Olivecrona H: Report on 280 cases of verified parasagittal meningiomas. J Neurosurg 12:614-626, 1955

    Google Scholar 

  4. Katsura S, Suzuki J, Wada I: A statistical study of brain tumors in the neurosurgical clinics in Japan. J Neurosurg 16:570-579, 1959

    Google Scholar 

  5. Adegbite A, Khan M, Paine K, Tan L: The recurrence of intracranial meningioma after surgical treatment. J Neurosurg 58:51-56, 1983

    Google Scholar 

  6. Carella R, Ransohoff J, Newal, J: Role of radiation therapy in the management of meningioma. Neurosurgery 10:332-338, 1982

    Google Scholar 

  7. Forbes A, Goldberg I: Radiation therapy in the treatment of meningioma: The Join Center for Radiation Therapy experience 1970 to 1982. J Clinic Oncol 2:1139-1142, 1984

    Google Scholar 

  8. Glaholm J, Bloom H, Crow J: The role of radiotherapy in the management of intracranial meningiomas: The Royal Marsden Hospital experience with 186 patients. Int J Radiat Oncol Biol Phys 18:755-761, 1990

    Google Scholar 

  9. Goldsmith BJ, Wara WM, Wilson CB, Larson DA: Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 80:195-201, 1994

    Google Scholar 

  10. Jaaskelainen J, Haltia M, Servo A: Atypical and anaplastic meningiomas: Radiation, surgery, radiotherapy, and outcome. Neurology 25:233-242, 1986

    Google Scholar 

  11. Maier H, Ofner D, Hittmair A, Kitz K, Budka H: Classic, atypical, and anaplastic meningioma: Three histopathologic subtypes of clinical relevance. J Neurosurg 77:616-623, 1992

    Google Scholar 

  12. Mirimanoff R, Dosoretz D, Linggood R, Ojemann R, Martuza R: Meningioma: Analysis of recurrence and progression following neurosurgical resection. J Neurosurg 62:18-24, 1985

    Google Scholar 

  13. Rohringer M, Sutherland G, Louw D, Sima A: Incidence and clinicopathological features of meningioma. J Neurosurg 71:665-672, 1989

    Google Scholar 

  14. Solan M, Kramer S: The role of radiotherapy in the management of intracranial meningiomas. Int J Radiat Oncol Biol Phys 11:675-677, 1985

    Google Scholar 

  15. Fabiani A, Trebini F, Favero M: The significance of atypical mitosis in malignant meningiomas. Acta Neuropath (Berl) 38:229-231, 1977

    Google Scholar 

  16. Jellinger K, Slovik F: Histologic subtypes and prognostic problems in meningioma. J Neurol 208:279-198, 1975

    Google Scholar 

  17. Zulch KJ (ed), Histological Typing of Tumors of the Central Nervous System. Geneva, World Health Organization, 1979

    Google Scholar 

  18. MacCarty CS, Taylor WF: Intracranial meningiomas: Experience at the Mayo Clinic (in Japanese, English abst). Neurol Med Chir. (Tokyo) 19:569-574, 1979

    Google Scholar 

  19. Barbaro NM, Gutin PH, Wilson CB, Sheline GE, Boldsey EB, and Wara WM: Radiation therapy in the treatment of partially resected meningiomas. Neurosurgery 20:525-528, 1987

    Google Scholar 

  20. Beks JWF, de Windt HL: The recurrence of supratentorial meningiomas after surgery. Acta Neurochir 95:3-5, 1988

    Google Scholar 

  21. Chan RC, Thompson GB: Morbidity, mortality, and quality of life following surgery for intracranial meningiomas. A retrospective study in 257 cases. J Neurosurg 60:52-60, 1984

    Google Scholar 

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

    Google Scholar 

  23. Taylor BW Jr, Marcus RB Jr, Friedman WA, Ballinger WE Jr, Million RR: The meningioma controversy: Postoperative radiation therapy. Int J Radiat Oncol Biol Phys 15:299-304, 1988

    Google Scholar 

  24. Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiat 20:22, 1957

    Google Scholar 

  25. Black P McL: Meningiomas. Neurosurgery 32:643-657, 1993

    Google Scholar 

  26. Jaaskelainen J: Seemingly complete removal of histologically benign meningioma: Late recurrence rate and factors predicting recurrence in 657 patients. Surg Neurol. 26:461-469, 1986

    Google Scholar 

  27. Borovich B, Doron Y: Recurrence of intracranial meningiomas: The role played by regional multicentricity. J Neurosurg. 64:58-63, 1986

    Google Scholar 

  28. Kinjo T, Al-Mefty O, Kanaan I: Grade zero removal of supratentorial convexity meningioma. Neurosurgery 33:394-399, 1993

    Google Scholar 

  29. Mahmood A, Caccamo D, Tomacek FJ, Malik GM: Atypical and malignant meningiomas: a clinicopathological review. Neurosurgery 33:955-963, 1993

    Google Scholar 

  30. Jaaskelainen J, Haltia M, Servo A: Atypical and malignant meningiomas: radiology, surgery, and outcome. Surg Neurol 25:233-242, 1986

    Google Scholar 

  31. Milosevic MF, Frost PJ, Lapierre NJ, Wong CS, Simpson WJ: Radiotherapy for atypical and malignant meningioma. Int J Radiat Oncol Biol Phys 34:817-822, 1996

    Google Scholar 

  32. Guthrie BL, Carabell SC, Laws ER: Radiation therapy for intracranial meningiomas, in Al-Mefty O (ed) Meningiomas. New York, Raven Press, 1991 pp. 255-262

    Google Scholar 

  33. Kondziolka D, Lunsford D, Coffey RJ, Fickinger J: Stereotactic radiosurgery for meningiomas. J Neurosurg 74:552-559, 1991

    Google Scholar 

  34. Hakim R, Alexander E, Loeffer JS, Shrieve DC, Wen P, Fallon M, Stieg, PE, Black P: Results of linear accelerator-based radiosurgery for intracranial meningiomas. Neurosurgery 42(3):446-454, 1998

    Google Scholar 

  35. Maire JP, Caudry M, Guerin J, Celerier D, Galli F, Causse N, Trouette R, Dautheribes M: Fractionated radiation therapy in the treatment of intracranial meningiomas: Local control, functional efficacy, and tolerance in 91 patients. Int J Radiat Oncol Biol Phys, 33(2):315-321, 1995

    Google Scholar 

  36. Yamashita J, Handa H, Iwaki K, Abe M: Recurrence of intracranial meningiomas with special reference to radiotherapy. Surg Neurol 14:33-40, 1980

    Google Scholar 

  37. Hudgins WR, Barker JL, Schwartz DE, Nichols TD: Gamma knife treatment of 100 consecutive meningiomas. Stereotact Funct Neurosurg 66(Suppl 1):121-8, 1996

    Google Scholar 

  38. Chang SD, Adler JR Jr: Treatment of cranial base meningiomas with linear accelerator radiosurgery. Neurosurgery. 41:1019-25, 1997

    Google Scholar 

  39. Hodes JE, Sanders M, Patel P, Patchell RA: Radiosurgical management of meningiomas. Stereotact Funct Neurosurg 66:15-8, 1996

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurological Surgery, The Johns Hopkins Hospital, Harvey 811, 600 North Wolfe Street, Baltimore, Maryland, 21287-8811

    Maciej S. Lesniak & Jeffery Williams

  2. Department of Radiation Oncology, The Johns Hopkins Hospital, Harvey 811, 600 North Wolfe Street, Baltimore, Maryland, 21287-8811

    Jeffery Williams

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  1. Maciej S. Lesniak
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  2. Jeffery Williams
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Lesniak, M.S., Williams, J. The Role of Stereotactic Radiosurgery in the Management of Benign, Atypical, and Malignant Meningiomas. Journal of Radiosurgery 2, 207–213 (1999). https://doi.org/10.1023/A:1022984925249

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