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Hypofractionated stereotactic radiation therapy in skull base meningiomas

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Abstract

To investigate the role of hypo-fractionated stereotactic radiation treatment (HSRT) in the management of skull base meningioma. Twenty-six patients were included in the study and treated with a dose of 30 Gy in 5 fractions with volumetric modulated arc therapy (RapidArc). Eighteen patients were symptomatic before treatment. Endpoints were local toxicity and relief from symptoms. Tumors were located in anterior skull base in 4/27 cases, in middle skull base in 12/27 and in posterior skull base in 11/27. HSRT was performed as first treatment in 17 (65 %) patients, in 9 (35 %) patients it followed a previous partial resection. Median follow up was 24.5 months (range 5–57 months). clinical remission of symptoms, complete or partial, was obtained in the vast majority of patients after treatment. Out of the 18 symptomatic patients, partial remission occurred in 9 (50 %) patients and complete remission in 9 (50 %). All asymptomatic patients retained their status after treatment. No severe neurologic toxicity grade III–IV was recorded. No increase of meningioma in the same site of treatment occurred; 16 (62 %) patients had stable disease and 9 (38 %) patients had tumor reduction. The mean tumor volume after treatment was 10.8 ± 17.8 cm3 compared with 13.0 ± 19.1 cm3 before treatment (p = 0.02). The mean actuarial OS was 54.4 ± 2.8 months. The 1- and 2-years OS was 92.9 ± 0.7 %. HSRT proved to be feasible for these patients not eligible to full surgery or to ablative radiation therapy. Local control and durability of results suggest for a routine application of this approach in properly selected cases.

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Ethical standards

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.

Conflict of interest

L. Cozzi acts as Scientific Advisor to Varian Medical Systems and is Clinical Research Scientist at Humanitas Cancer Center. All other co-authors have no conflicts of interest.

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Authors and Affiliations

  1. Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center Rozzano Milano, Via Manzoni 56, 20089, Rozzano, Milano, Italy

    Pierina Navarria, Luca Cozzi, Elena Clerici, Elisa Villa, Anna Maria Ascolese, Fiorenza De Rose, Tiziana Comito, Ciro Franzese, Giuseppe D’Agostino, Francesca Lobefalo, Antonella Fogliata, Giacomo Reggiori, Stefano Tomatis & Marta Scorsetti

  2. Neurosurgery Department, Humanitas Research Hospital, Milan, Italy

    Federico Pessina, Maurizio Fornari & Lorenzo Bello

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  1. Pierina Navarria
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  2. Federico Pessina
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  3. Luca Cozzi
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  4. Elena Clerici
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  5. Elisa Villa
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  15. Stefano Tomatis
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  16. Lorenzo Bello
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Correspondence to Luca Cozzi.

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Navarria, P., Pessina, F., Cozzi, L. et al. Hypofractionated stereotactic radiation therapy in skull base meningiomas. J Neurooncol 124, 283–289 (2015). https://doi.org/10.1007/s11060-015-1838-6

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  • DOI: https://doi.org/10.1007/s11060-015-1838-6

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