Long-term Results of Treatment of Meningiomas with Leksell Gamma Knife

Czech version

Authors: A. Kollová ¹; R. Liščák ²; J. Šemnická ³; G. Šimonová ²; V. Vladyka ²; D. Urgošík ²
Authors‘ workplace: Neurochirurgická klinika LF UPJŠ a FN L. Pasteura Košice ¹; Oddělení stereotaktické a radiační neurochirurgie, Nemocnice Na Homolce, Praha ²; Oddělení lékařské fyziky, Nemocnice Na Homolce Praha ³
Published in: Cesk Slov Neurol N 2010; 73/106(4): 415-421
Category: Short Communication

Overview

Objective:
The evaluation of the results of treatment of meningioma, a slow-growing tumour, requires long-term follow-up. This study analyzes a cohort of 226 patients harbouring 249 meningiomas, treated between 1992 and 1997 at Na Homolce Hospital, Prague. Methods: The cohort of patients for analysis consisted of 179 women (79.2%) and 47 men (20.8%) with a mean age of 61 years (18–84 years). Tumour volume ranged between 0.1 and 44.9 cm³ (median 4.37 cm³). Radiation dose to the tumour margin was between 6.5 and 24 Gy (median 12.9 Gy), usually at 50% isodose. Follow-up records of 217 of the patients, with 239 meningiomas, were available for final analysis. Results: Follow-up ranged from one to 168 months, median 96. The ten-year tumour control rate was observed in 94.7% of cases. Partial regression of the tumour was recorded in 163 (68.2%), stabilization in 70 (29.3%) and progression in 6 (2.5%). Improvement of symptoms occurred in 89 patients (41%). Temporary morbidity occurred in 30 (13.8%), permanent morbidity in 14 (6.4%) of the patients treated. Conclusion: Stereotactic radiosurgery is a safe and effective treatment of meningioma from a long term perspective. However, the decision on treatment options has to be assessed on a patient-by-patient basis.

Key words:
meningioma – gamma knife – stereotactic radiosurgery – long term results

Sources

1. DeMonte F, Marmor E, Al-Mefty O. Meningiomas. In: Kaye AH, Laws ER jr (eds). Brain tumors. London: Churchill Livingstone 2000: 719–750.

2. Sanson M, Cornu P. Biology of menigiomas. Acta Neurochir 2000; 142(5): 493–505.

3. Whittle IR, Smith C, Navoo P, Collie D. Meningiomas. Lancet 2004; 363(9420): 1535–1543.

4. Sheehan J, Yen CP, Steiner L. Gamma knife surgery-induced meningioma. Report of two cases and review of the literature. J Neurosurg 2006; 105(2): 325–329.

5. Couldwell WT, Fukushima T, Giannotta SL, Weiss MH. Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 1996; 84(1): 20–28.

6. Cudlip SA, Wilkins PR, Johnston FG, Moore AJ, Marsh HT, Bell BA. Posterior fossa meningiomas: surgical experience in 52 cases. Acta Neurochir (Wien) 1998; 140(10): 1007–1012.

7. Kotapka M, Kalia KK, Martinez AJ, Sekhar LN. Infiltration of the carotid artery by cavernous sinus meningioma. J Neurosurg 1994; 81(2): 252–255.

8. Larson JJ, van Loveren HR, Balko MG, Tew JM jr. Evidence of meningioma infiltration into cranial nerves: clinical implications for cavernous sinus meningiomas. J Neurosurg 1995; 83(4): 596–599.

9. Sindou MP, Alaywan M. Most intracranial meningiomas are not cleavable tumors: anatomic-surgical evidence and angiographic predictibility. Neurosurgery 1998; 42(3): 476–480.

10. Chang SD, Adler JR jr. Treatment of cranial base meningiomas with linear accelerator radiosurgery. Neurosurgery 1997; 41(5): 1019–1025.

11. DiBiase SJ, Kwork Y, Yovino S, Arena C, Naqvi S, Temple R et al. Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 2004; 60(5): 1515–1519.

12. Iwai Y, Yamanaka K, Yasui T, Komiyama M, Nishikawa M, Nakajima H et al. Gamma knife surgery for skull base meningiomas. The effectiveness of low-dose treatment. Surg Neurol 1999; 52(1): 40–45.

13. Kenai H, Yamashita M, Nakamura T, Asano T, Sainoh M, Nagatomi H. Tolerance dose in gamma knife surgery of lesions extending to the anterior visual pathway. J Neurosurg 2005; 102 (Supp): 230–233.

14. Kollová A, Liščák R, Novotný J jr , Vladyka V, Šimonová G, Janoušková L. Gamma Knife surgery for benign meningioma. J Neurosurg 2007; 107(2): 325–336.

15. Kondziolka D, Flickinger JC, Perez B. Gamma Knife Meningioma Study Group. Judicious Resection and/or radiosurgery for parasagittal meningiomas: outcomes from a multicenter review. Neurosurgery 1998; 43(3): 405–414.

16. Lee JY, Niranjan A, McInerney J, Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery providing long term tumor control of cavernous sinus meningiomas. J Neurosurg 2002; 97(1): 65–72.

17. Nicolato A, Gioretti P, Foroni R, Grigolato D, Pasquin IP, Zuffante M et al. Gamma knife radiosurgery in skull base meningiomas: a possible relationship between somatostatin receptor decrease and early neurological improvement without tumor shrinkage at short term imaging follow up. Acta Neurochir (Wien) 2005; 147(4): 367–375.

18. Roche PH, Pellet W, Fuentes S, Thomassin JM, Régis J. Gamma knife radiosurgical management of petroclival meningiomas result and indications. Acta Neurochir 2003; 145(10): 883–888.

19. Shafron DH, Friedman WA, Buatti JM, Bova FJ, Mendenhall WM. Linac radiosurgery for benign meningiomas. Int J Radiat Oncol Biol Phys 1999; 43(2): 321–327.

20. Spiegelmann R, Nissim O, Menhel J, Alezra D, Pfeffer MR. Linear accelerator radiosurgery for meningiomas in and around the cavernous sinus. Neurosurgery 2002; 51(6): 1373–1380.

21. Stafford SL, Pollock BE, Foote RL, Link MJ, Gorman DA, Schomberg PJ et al. Meningioma radiosurgery: tumor control, outcomes and complications among 190 consecutive patients. Neurosurgery 2001; 49(5): 1029–1037.

22. Subach BR, Lunsford LD, Kondziolka D, Maitz AH, Flickinger JC. Management of petroclival meningiomas by stereotactic radiosurgery. Neurosurgery 1998; 42(3): 437–443.

23. Tischler RB, Leoffler JS, Lunsford LD, Duma C, Alexander E 3rd, Kooy HM et al. Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 1993; 27(2): 215–221.

24. Morita A, Coffey RJ, Foote RL, Schiff D, Gorman D. Risk of injury to cranial nerves after gamma knife radiosurgery for skull base meningiomas: experience in 88 patients. J Neurosurg 1999; 90(1): 42–49.

25. Ganz JC, Reda WA, Abdelkarim K. Adverse radiation effects after Gamma Knife Surgery in relation to dose and volume. Acta Neurochir (Wien) 2009; 151(1): 9–19.

26. Pollock BE. Stereotactic radiosurgery for intracranial meningiomas: indications and results. Neurosurg Focus 2003; 14(5): e4.

27. Aichholzer M, Bertalanffy A, Dietrich W, Roessler K, Pfisterer W, Ungersboeck K et al: Gamma knife radiosurgery of skull base meningiomas. Acta Neurochir (Wien) 2000; 142(6): 647–653.

28. Hakim R, Alexander E 3rd, Loeffler JS, Shrieve DC, Wen P, Fallon MP et al. Results of linear accelerator-based radiosurgery for intracranial meningiomas. Neurosurgery 1998; 42(3): 446–454.

29. Niiro M, Yatsushiro K, Nakamura K, Kawahara Y, Kuratsu J. Natural history of elderly patients with asymptomatic meningiomas. J Neurol Neurosurg Psychiatry 2000; 68(1): 25–28.

30. Aaslid R, Gröger U, Patlak CS, Fenstermacher JD, Huber P, Reulen HJ. Fluid flow rates in human peritumoral oedema. Acta Neurochir Suppl 1990; 51: 152–154.

31. Yoshioka H, Hama S, Taniguchi E, Sugiyama K, Arita K, Kurisu K. Peritumoral brain edema associated with meningioma: influence of vascular endothelial growth factor expression and vascular blood supply. Cancer 1999; 85(4): 936–944.

32. Liščák R, Kollová A, Vladyka V, Šimonová G, Novotný J jr. Gamma knife radiosurgery of skull base meningiomas. Acta Neurochir Suppl 2004; 91: 65–74.

33. Pendl G, Schröttner, Eustacchio S, Feichtinger K, Ganz J. Stereotactic radiosurgery of skull base meningiomas. Minim Invasive Neurosurg 1997; 40(3): 87–90.

34. Kim DG, Kim CH, Chung HT, Paek SH, Jeong SS, Han DH et al. Gamma knife surgery of superficially located meningioma. J Neurosurg 2005; 102 (Suppl): 255–258.

35. Patil CG, Hoang S, Borchers DJ 3rd, Sakamoto G, Soltys SG, Gibbs IC et al. Predictors of peritumoral edema after stereotactic radiosurgery of supratentorial meningiomas. Neurosurgery 2008; 63(3): 435–440.

36. Chen CH, Shen CC, Sun MH, Ho WL, Huang CF, Kwan PC. Histopathology of radiation necrosis with severe peritumoral edema after gamma knife radiosurgery for parasagittal meningioma. A report of 2 cases. Stereotact Funct Neurosurg 2007; 85(6): 292–295.

37. Girvigian MR, Chen JC, Rahimian J, Miller MJ, Tome M. Comparison of early complications for patients with convexity and parasagittal meningiomas treated with either stereotactic radiosurgery or fractionated stereotactic radiotherapy. Neurosurgery 2008; 62 (Suppl 5): A19–A27.

38. Lang DA, Neil-Dwyer G, Garfield J. Outcome after complex neurosurgery: the caregiver’s burden is forgotten. J Neurosurg 1999; 91(3): 359–363.