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Tumor Shrinkage Assessed by Volumetric MRI in the Long-Term Follow-Up after Stereotactic Radiotherapy of Meningiomas

Volumetrisch nachgewiesene Größenreduktion von Meningeomen in der längerfristigen Nachbeobachtung nach stereotaktischer Strahlentherapie

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Abstract

Purpose:

To evaluate tumor volume reduction in the follow-up of meningiomas after fractionated stereotactic radiotherapy (FSRT) or linac radiosurgery (RS) by using magnetic resonance imaging (MRI).

Patients and Methods:

In 59 patients with skull base meningiomas, gross tumor volume (GTV) was outlined on contrast-enhanced MRI before and median 50 months (range 11–92 months) after stereotactic radiotherapy. MRI was performed as an axial three-dimensional gradient-echo T1-weighted sequence at 1.6 mm slice thickness without gap (3D-MRI). Results were compared to the reports of diagnostic findings.

Results:

Mean tumor size of all 59 meningiomas was 13.9 ml (0.8–62.9 ml) before treatment. There was shrinkage of the treated meningiomas in all but one patient. Within a median volumetric follow-up of 50 months (11–95 months), an absolute mean volume reduction of 4 ml (0–18 ml) was seen. The mean relative size reduction compared to the volume before radiotherapy was 27% (0–73%). Shrinkage measured by 3D-MRI was greater at longer time intervals after radiotherapy. The mean size reduction was 17%, 23%, and 30% (at < 24 months, 24–48 months, and 48–72 months).

Conclusion:

By using 3D-MRI in almost all patients undergoing radiotherapy of a meningioma, tumor shrinkage is detected. The data presented here demonstrate that volumetric assessment from 3D-MRI provides additional information to routinely used radiologic response measurements. After FSRT or RS, a mean size reduction of 25–45% can be expected within 4 years.

Zusammenfassung

Ziel:

Evaluation der Volumenreduktion von Meningeomen in der Nachbeobachtung nach fraktionierter stereotaktischer Strahlentherapie oder Linac-Radiochirurgie mit Hilfe der Magnetresonanztomographie (MRT).

Patienten und Methodik:

Bei 59 Patienten mit Schädelbasismeningeomen wurde das Tumorvolumen auf den kontrastmittelverstärkten MRT-Aufnahmen vor und im Median 50 Monate (11–92 Monate) nach stereotaktischer Strahlentherapie konturiert. Die MRT wurde als axiale dreidimensionale Gradientenecho-T1-Sequenz mit 1,6 mm Schichtdicke ohne Abstand durchgeführt (3D-MRT). Die Ergebnisse wurden mit den radiologischen Befunden verglichen.

Ergebnisse:

Die mittlere Tumorgröße aller 59 Meningeome betrug vor Strahlentherapie 13,9 ml (0,8–62,9 ml). Mit einer Ausnahme zeigte sich bei allen behandelten Meningeomen eine Größenreduktion. Innerhalb einer medianen Nachbeobachtung von 50 Monaten (11–95 Monate) konnte eine mittlere Volumenreduktion von 4 ml (0–18 ml) gemessen werden. Die mittlere relative Größenreduktion im Vergleich zum Ausgangsvolumen vor Strahlentherapie lag bei 27% (0–73%). Die relative, mittels 3D-MRT gemessene Tumorverkleinerung nahm mit längerem Zeitintervall nach Strahlentherapie zu. Die mittlere Größenreduktion betrug 17%, 23% und 30% (< 24 Monate, 24–48 Monate und 48–72 Monate).

Schlussfolgerung:

Durch die Verwendung der 3D-MRT kann in nahezu allen Meningeomen nach stereotaktischer Strahlentherapie eine Größenreduktion beobachtet werden. In der vorliegenden Arbeit konnte gezeigt werden, dass die volumetrische Bestimmung anhand der 3D-MRT zusätzliche Informationen zur in der Routine eingesetzten Messung des radiologischen Ansprechens bietet. Nach fraktionierter stereotaktischer Strahlentherapie oder Radiochirurgie ist innerhalb von 4 Jahren eine mittlere Größenreduktion von 25–45% zu erwarten.

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Correspondence to Sabrina T. Astner MD.

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Astner, S.T., Theodorou, M., Dobrei-Ciuchendea, M. et al. Tumor Shrinkage Assessed by Volumetric MRI in the Long-Term Follow-Up after Stereotactic Radiotherapy of Meningiomas. Strahlenther Onkol 186, 423–429 (2010). https://doi.org/10.1007/s00066-010-2138-x

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  • DOI: https://doi.org/10.1007/s00066-010-2138-x

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