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Multisession radiosurgery for perioptic meningiomas: medium-to-long term results from a CyberKnife cooperative study

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Abstract

Purpose

Most recent literature has confirmed the efficacy of single-session radiosurgery (sRS) in the treatment of intracranial meningioma. Unfortunately, sRS is not always applicable due to large tumor volume and the proximity of the tumor to critical structures. When sRS is not recommended, multi-session radiosurgery (mRS) can be the solution. The best treatment schedule for mRS, however, is not well established. The aim of the present retrospective study is to validate the effectiveness of one approach, 25 Gy delivered in 5 fractions in 5 consecutive days, to treat skull base meningiomas.

Methods

This is a retrospective multicenter study. Patients with an anterior or a medium skull base meningioma that could not be treated by sRS due to large volume or proximity to the anterior optic pathways (AOPs) underwent 5-fraction mRS. Only patients with at least 36 months follow-up were included in the analysis. Local control and visual outcomes were investigated.

Results

One-hundred-sixty-seven patients were included in the analysis. One-hundred-one patients underwent RS as a primary indication and 66 were treated after a previous surgery. The median follow-up period was 51 months (range 36–129 months). Progression-free survival at 3, 5 and 8 years were, respectively, 98%, 94% and 90%. Excluding the progressive disease patients, the visual worsening rate was 3.7%. The 42% of the patients with a pre-treatment visual deficit experienced improvement in vision.

Conclusion

25 Gy delivered in 5 fractions is an effective modality for meningiomas that are near the AOP or are too large to be treated by sRS. The treatment schedule controlled the tumors while sparing visual function.

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Acknowledgements

The authors thank David Schaal, PhD, of Accuray Incorporated for English reviewing and Cecilia Iezzoni PsyD, Fondazione IRCCS Istituto Neurologico C.Besta for editorial assistance.

Funding

The study is partially funded by Accuray Europe (statistical analysis fee).

Author information

Authors and Affiliations

  1. Radiotherapy Unit, Dept. of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Via Celoria 11, 20133, Milan, Italy

    Marcello Marchetti, Valentina Pinzi & Laura Fariselli

  2. Dept. of Neurosurgery, University of Messina, AOU “Policlinico G. Martino”, Messina, Italy

    Alfredo Conti

  3. CyberKnife Center, Centro Diagnostico Italiano, Milan, Italy

    Giancarlo Beltramo

  4. Dept of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy

    Irene Tramacere

  5. Dept. of Neurosurgery, Charité Universitaetmedizin, Berlin, Germany

    Alfredo Conti

  6. Dept. of Radiation Oncology, University of Messina, Messina, Italy

    Antonio Pontoriero & Stefano Pergolizzi

  7. Dept. of Radiation Oncology, Charité Universitaetmedizin, Berlin, Germany

    Carolin Senger

Authors
  1. Marcello Marchetti
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  2. Alfredo Conti
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  4. Valentina Pinzi
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  9. Laura Fariselli
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Corresponding author

Correspondence to Marcello Marchetti.

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Conflict of interest

Marcello Marchetti, Alfredo Conti and Laura Fariselli have received Grants Congress Participation and Honoraria from Accuray Europe and AB Medica, unrelated to the present study. The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Foundation IRCCS Neurological Institute Carlo Besta Ethical Committee, Reference Number 201/2011, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Marchetti, M., Conti, A., Beltramo, G. et al. Multisession radiosurgery for perioptic meningiomas: medium-to-long term results from a CyberKnife cooperative study. J Neurooncol 143, 597–604 (2019). https://doi.org/10.1007/s11060-019-03196-x

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  • DOI: https://doi.org/10.1007/s11060-019-03196-x

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