Radiosurgery for large-volume (> 10 cm3) benign meningiomas

Jonathan M. Bledsoe, Michael J. Link, Scott L. Stafford, Paul J. Park, Bruce E. Pollock

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Object. Stereotactic radiosurgery (SRS) has proven to be a safe and effective treatment for many patients with intracranial meningiomas. Nevertheless, the morbidity associated with radiosurgery of larger meningiomas is poorly understood. Methods. The authors performed a retrospective review of 116 patients who underwent SRS for meningiomas (WHO Grade I) > 10 cm 3 between 1990 and 2007, with a minimum follow-up of 12 months. Patients with atypical or malignant meningiomas and those who received prior radiotherapy were excluded. The average tumor volume was 17.5 cm3 (range 10.1-48.6 cm3); the average tumor margin dose was 15.1 Gy (range 12-18 Gy); and the mean follow-up duration was 70.1 months (range 12-199 months). Results. Tumor control was 99% at 3 years and 92% at 7 years after radiosurgery. Thirty complications after radiosurgery were noted in 27 patients (23%), including 7 cases of seizures, 6 cases of hemiparesis, 5 cases of trigeminal injury, 4 cases of headaches, 3 cases of diplopia, 2 cases each of cerebral infarction and ataxia, and 1 case of hearing loss. Patients with supratentorial tumors experienced a higher complication rate compared with patients with skull base tumors (44% compared with 18%) (hazard ratio 2.9, 95% CI 1.3-6.7, p = 0.01). Conclusions. The morbidity associated with SRS for patients with benign meningiomas > 10 cm3 is greater for supratentorial tumors compared with skull base tumors. Whereas radiosurgery is relatively safe for patients with large-volume skull base meningiomas, resection should remain the primary disease management for the majority of patients with large-volume supratentorial meningiomas.

Original languageEnglish (US)
Pages (from-to)951-956
Number of pages6
JournalJournal of Neurosurgery
Volume112
Issue number5
DOIs
StatePublished - May 2010

Fingerprint

Radiosurgery
Meningioma
Skull Base
Supratentorial Neoplasms
Neoplasms
Morbidity
Diplopia
Cerebral Infarction
Paresis
Ataxia
Disease Management
Tumor Burden
Hearing Loss
Headache
Seizures
Radiotherapy
Wounds and Injuries

Keywords

  • Complication
  • Meningioma
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Bledsoe, J. M., Link, M. J., Stafford, S. L., Park, P. J., & Pollock, B. E. (2010). Radiosurgery for large-volume (> 10 cm3) benign meningiomas. Journal of Neurosurgery, 112(5), 951-956. https://doi.org/10.3171/2009.8.JNS09703

Radiosurgery for large-volume (> 10 cm3) benign meningiomas. / Bledsoe, Jonathan M.; Link, Michael J.; Stafford, Scott L.; Park, Paul J.; Pollock, Bruce E.

In: Journal of Neurosurgery, Vol. 112, No. 5, 05.2010, p. 951-956.

Research output: Contribution to journalArticle

Bledsoe, JM, Link, MJ, Stafford, SL, Park, PJ & Pollock, BE 2010, 'Radiosurgery for large-volume (> 10 cm3) benign meningiomas', Journal of Neurosurgery, vol. 112, no. 5, pp. 951-956. https://doi.org/10.3171/2009.8.JNS09703
Bledsoe JM, Link MJ, Stafford SL, Park PJ, Pollock BE. Radiosurgery for large-volume (> 10 cm3) benign meningiomas. Journal of Neurosurgery. 2010 May;112(5):951-956. https://doi.org/10.3171/2009.8.JNS09703
Bledsoe, Jonathan M. ; Link, Michael J. ; Stafford, Scott L. ; Park, Paul J. ; Pollock, Bruce E. / Radiosurgery for large-volume (> 10 cm3) benign meningiomas. In: Journal of Neurosurgery. 2010 ; Vol. 112, No. 5. pp. 951-956.
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abstract = "Object. Stereotactic radiosurgery (SRS) has proven to be a safe and effective treatment for many patients with intracranial meningiomas. Nevertheless, the morbidity associated with radiosurgery of larger meningiomas is poorly understood. Methods. The authors performed a retrospective review of 116 patients who underwent SRS for meningiomas (WHO Grade I) > 10 cm 3 between 1990 and 2007, with a minimum follow-up of 12 months. Patients with atypical or malignant meningiomas and those who received prior radiotherapy were excluded. The average tumor volume was 17.5 cm3 (range 10.1-48.6 cm3); the average tumor margin dose was 15.1 Gy (range 12-18 Gy); and the mean follow-up duration was 70.1 months (range 12-199 months). Results. Tumor control was 99{\%} at 3 years and 92{\%} at 7 years after radiosurgery. Thirty complications after radiosurgery were noted in 27 patients (23{\%}), including 7 cases of seizures, 6 cases of hemiparesis, 5 cases of trigeminal injury, 4 cases of headaches, 3 cases of diplopia, 2 cases each of cerebral infarction and ataxia, and 1 case of hearing loss. Patients with supratentorial tumors experienced a higher complication rate compared with patients with skull base tumors (44{\%} compared with 18{\%}) (hazard ratio 2.9, 95{\%} CI 1.3-6.7, p = 0.01). Conclusions. The morbidity associated with SRS for patients with benign meningiomas > 10 cm3 is greater for supratentorial tumors compared with skull base tumors. Whereas radiosurgery is relatively safe for patients with large-volume skull base meningiomas, resection should remain the primary disease management for the majority of patients with large-volume supratentorial meningiomas.",
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AU - Pollock, Bruce E.

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N2 - Object. Stereotactic radiosurgery (SRS) has proven to be a safe and effective treatment for many patients with intracranial meningiomas. Nevertheless, the morbidity associated with radiosurgery of larger meningiomas is poorly understood. Methods. The authors performed a retrospective review of 116 patients who underwent SRS for meningiomas (WHO Grade I) > 10 cm 3 between 1990 and 2007, with a minimum follow-up of 12 months. Patients with atypical or malignant meningiomas and those who received prior radiotherapy were excluded. The average tumor volume was 17.5 cm3 (range 10.1-48.6 cm3); the average tumor margin dose was 15.1 Gy (range 12-18 Gy); and the mean follow-up duration was 70.1 months (range 12-199 months). Results. Tumor control was 99% at 3 years and 92% at 7 years after radiosurgery. Thirty complications after radiosurgery were noted in 27 patients (23%), including 7 cases of seizures, 6 cases of hemiparesis, 5 cases of trigeminal injury, 4 cases of headaches, 3 cases of diplopia, 2 cases each of cerebral infarction and ataxia, and 1 case of hearing loss. Patients with supratentorial tumors experienced a higher complication rate compared with patients with skull base tumors (44% compared with 18%) (hazard ratio 2.9, 95% CI 1.3-6.7, p = 0.01). Conclusions. The morbidity associated with SRS for patients with benign meningiomas > 10 cm3 is greater for supratentorial tumors compared with skull base tumors. Whereas radiosurgery is relatively safe for patients with large-volume skull base meningiomas, resection should remain the primary disease management for the majority of patients with large-volume supratentorial meningiomas.

AB - Object. Stereotactic radiosurgery (SRS) has proven to be a safe and effective treatment for many patients with intracranial meningiomas. Nevertheless, the morbidity associated with radiosurgery of larger meningiomas is poorly understood. Methods. The authors performed a retrospective review of 116 patients who underwent SRS for meningiomas (WHO Grade I) > 10 cm 3 between 1990 and 2007, with a minimum follow-up of 12 months. Patients with atypical or malignant meningiomas and those who received prior radiotherapy were excluded. The average tumor volume was 17.5 cm3 (range 10.1-48.6 cm3); the average tumor margin dose was 15.1 Gy (range 12-18 Gy); and the mean follow-up duration was 70.1 months (range 12-199 months). Results. Tumor control was 99% at 3 years and 92% at 7 years after radiosurgery. Thirty complications after radiosurgery were noted in 27 patients (23%), including 7 cases of seizures, 6 cases of hemiparesis, 5 cases of trigeminal injury, 4 cases of headaches, 3 cases of diplopia, 2 cases each of cerebral infarction and ataxia, and 1 case of hearing loss. Patients with supratentorial tumors experienced a higher complication rate compared with patients with skull base tumors (44% compared with 18%) (hazard ratio 2.9, 95% CI 1.3-6.7, p = 0.01). Conclusions. The morbidity associated with SRS for patients with benign meningiomas > 10 cm3 is greater for supratentorial tumors compared with skull base tumors. Whereas radiosurgery is relatively safe for patients with large-volume skull base meningiomas, resection should remain the primary disease management for the majority of patients with large-volume supratentorial meningiomas.

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