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Stereotactic LINAC radiosurgery for incompletely resected or recurrent atypical and anaplastic meningiomas

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Abstract

Background

The optimal management of subtotally resected or recurrent malignant meningiomas remains controversial. We evaluated the efficacy of linear accelerator (LINAC) radiosurgery for atypical and anaplastic meningiomas after incomplete resection or treatment of recurrences.

Methods

Between August 1990 and December 2003, 16 patients with 28 meningiomas WHO II and III were treated by stereotactic LINAC radiosurgery at our institution. The median radiological follow-up was 60.3 months, respectively (range: 7.2–173.9 months). Fourteen tumors in nine patients were classified as WHO II and 14 tumors in seven patients as WHO III. The median surface dose was 14 Gy (range: 10–15 Gy) with a median tumor volume of 4.8 ml (range: 0.51–51.4 ml).

Results

Clinical condition improved in four patients, remained unchanged in nine and deteriorated in one. Tumor shrinkage was seen in eight of 28 meningiomas and a stable disease in 12. Eight of 28 meningiomas showed local tumor progression. The overall tumor control rate (TCR) was 84%, 70%, 70% after 3, 5, 10 years. According to grading the corresponding TCR after 3, 5, 10 years was 91%, 81%, 81% for grade II and 77%, 60%, 60% for grade III meningiomas. Overall progression-free survival (PFS) was 74%, 67%, 58% after 3, 5, 10 years. According to grading the PFS after 3, 5, 10 years was 88%, 75%, 75% for grade II meningiomas and 57%, 57%, 43% for grade III meningiomas.

Conclusion

Our results show the efficacy and safety of LINAC radiosurgery for incompletely resected or recurrent malignant meningiomas with a relatively high local tumor control and low morbidity.

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References

  1. Aghi MK, Carter BS, Cosgrove GR, Ojemann RG, Amin-Hanjani S, Martuza RL, Curry WT Jr, Barker FG 2nd (2009) Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation. Neurosurgery 64:56–60, discussion 60

    Article  PubMed  Google Scholar 

  2. Al-Mefty O, Kersh JE, Routh A, Smith RR (1990) The long-term side effects of radiation therapy for benign brain tumors in adults. J Neurosurg 73:502–512

    Article  PubMed  CAS  Google Scholar 

  3. Goyal LK, Suh JH, Mohan DS, Prayson RA, Lee J, Barnett GH (2000) Local control and overall survival in atypical meningioma: a retrospective study. Int J Radiat Oncol Biol Phys 46:57–61

    Article  PubMed  CAS  Google Scholar 

  4. Harris AE, Lee JY, Omalu B, Flickinger JC, Kondziolka D, Lunsford LD (2003) The effect of radiosurgery during management of aggressive meningiomas. Surg Neurol 60:298–305, discussion 305

    Article  PubMed  Google Scholar 

  5. Jaaskelainen J, Haltia M, Servo A (1986) Atypical and anaplastic meningiomas: radiology, surgery, radiotherapy, and outcome. Surg Neurol 25:233–242

    Article  PubMed  CAS  Google Scholar 

  6. Kallio M, Sankila R, Hakulinen T, Jaaskelainen J (1992) Factors affecting operative and excess long-term mortality in 935 patients with intracranial meningioma. Neurosurgery 31:2–12

    Article  PubMed  CAS  Google Scholar 

  7. Kano H, Takahashi JA, Katsuki T, Araki N, Oya N, Hiraoka M, Hashimoto N (2007) Stereotactic radiosurgery for atypical and anaplastic meningiomas. J Neurooncol 84:41–47

    Article  PubMed  Google Scholar 

  8. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114:97–109

    Article  PubMed  Google Scholar 

  9. Maarouf M, Runge M, Kocher M, Zahringer M, Treuer H, Sturm V (2004) Radiosurgery for cerebral arteriovenous malformations in hereditary hemorrhagic telangiectasia. Neurology 63:367–369

    PubMed  CAS  Google Scholar 

  10. Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280

    PubMed  CAS  Google Scholar 

  11. Milker-Zabel S, Zabel A, Schulz-Ertner D, Schlegel W, Wannenmacher M, Debus J (2005) Fractionated stereotactic radiotherapy in patients with benign or atypical intracranial meningioma: long-term experience and prognostic factors. Int J Radiat Oncol Biol Phys 61:809–816

    Article  PubMed  Google Scholar 

  12. Modha A, Gutin PH (2005) Diagnosis and treatment of atypical and anaplastic meningiomas: a review. Neurosurgery 57:538–550, discussion 538-550

    Article  PubMed  Google Scholar 

  13. Ojemann SG, Sneed PK, Larson DA, Gutin PH, Berger MS, Verhey L, Smith V, Petti P, Wara W, Park E, McDermott MW (2000) Radiosurgery for malignant meningioma: results in 22 patients. J Neurosurg 93(Suppl 3):62–67

    PubMed  Google Scholar 

  14. Palma L, Celli P, Franco C, Cervoni L, Cantore G (1997) Long-term prognosis for atypical and malignant meningiomas: a study of 71 surgical cases. J Neurosurg 86:793–800

    Article  PubMed  CAS  Google Scholar 

  15. Pasquier D, Bijmolt S, Veninga T, Rezvoy N, Villa S, Krengli M, Weber DC, Baumert BG, Canyilmaz E, Yalman D, Szutowicz E, Tzuk-Shina T, Mirimanoff RO (2008) Atypical and malignant meningioma: outcome and prognostic factors in 119 irradiated patients. A multicenter, retrospective study of the Rare Cancer Network. Int J Radiat Oncol Biol Phys 71:1388–1393

    Article  PubMed  Google Scholar 

  16. Pastyr O, Hartmann GH, Schlegel W, Schabbert S, Treuer H, Lorenz WJ, Sturm V (1989) Stereotactically guided convergent beam irradiation with a linear accelerator: localization-technique. Acta Neurochir (Wien) 99:61–64

    Article  CAS  Google Scholar 

  17. Perry A, Scheithauer BW, Stafford SL, Lohse CM, Wollan PC (1999) “Malignancy” in meningiomas: a clinicopathologic study of 116 patients, with grading implications. Cancer 85:2046–2056

    PubMed  CAS  Google Scholar 

  18. Shaw E, Scott C, Souhami L, Dinapoli R, Kline R, Loeffler J, Farnan N (2000) Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys 47:291–298

    Article  PubMed  CAS  Google Scholar 

  19. Stafford SL, Pollock BE, Foote RL, Link MJ, Gorman DA, Schomberg PJ, Leavitt JA (2001) Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients. Neurosurgery 49:1029–1037, discussion 1037-1028

    PubMed  CAS  Google Scholar 

  20. Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW (2008) Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. J Neurol Neurosurg Psychiatry 79:574–580

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpenerstraße 62, 50937, Cologne, Germany

    Mustapha El-Khatib, Faycal El Majdoub, Mauritius Hoevels, Volker Sturm & Mohammad Maarouf

  2. Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany

    Mustapha El-Khatib & Hans-Jakob Steiger

  3. Department of Radiation Oncology, University of Cologne, Cologne, Germany

    Martin Kocher & Rolf-Peter Müller

Authors
  1. Mustapha El-Khatib
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  2. Faycal El Majdoub
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  3. Mauritius Hoevels
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  4. Martin Kocher
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  5. Rolf-Peter Müller
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  6. Hans-Jakob Steiger
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  7. Volker Sturm
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  8. Mohammad Maarouf
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Corresponding author

Correspondence to Mohammad Maarouf.

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Comment

The authors presented a small series of 16 patients who had stereotactic radiosurgery for residual or recurrent atypical or anaplastic meningiomas. They achieved impressive long-term tumour control, as shown by overall progression free survival. These are patients with rather challenging pathologies, particularly due to the widespread and multiple nature of the disease.

Their results are approximately in keeping with similar studies in the literature, although the 10-year results appear to be much better than that published elsewhere. If proven by larger studies, this paper would indicate that our therapeutic pessimism may have to be revised and focal radiosurgical treatment may be offered.

Andras Kemeny

Sheffield, UK

Mustapha El-Khatib and Faycal El Majdoub contributed equally to theis study

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El-Khatib, M., El Majdoub, F., Hoevels, M. et al. Stereotactic LINAC radiosurgery for incompletely resected or recurrent atypical and anaplastic meningiomas. Acta Neurochir 153, 1761–1767 (2011). https://doi.org/10.1007/s00701-011-1073-7

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  • DOI: https://doi.org/10.1007/s00701-011-1073-7

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