Radiosurgery Case History #2 - Intracranial Meningiomas
- The problem: Meningiomas are benign intracranial tumors that can slowly grow to produce neurologic deficit or death. Chemotherapy is not effective. Surgery is a mainstay of treatment, but total resection can be difficult and recurrence/residual tumor after resection is common.
The question: Can radiosurgery provide durable local control of meningiomas? How do the results of resection compare with those of radiosurgery?
The studies: Many studies report the efficacy of radiosurgery for meningiomas.
For example:
- A comparison of 136 patients treated with resection vs. 62 treated with Gamma Knife radiosurgery (mean follow-up 5.3 years) showed that recurrence after radiosurgery was lower than after surgery (2% vs. 12%)1.
- A report of 85 patients showed a local control rate of 93% with a 10 year median follow-up.Tumor shrinkage was seen in 53% and morbidity was 4%2.
- A report of 36 patients with skull base meningiomas showed a local control rate of 94% with a mean follow-up of 8.6 years. Tumor shrinkage was seen in 33% and neurologic deficit seen in 4%3.
- A comparison of 38 patients with cavernous sinus meningiomas treated with conformal radiotherapy vs. 36 treated with radiosurgery (median follow-up of 7.4 and 5.3 years, respectively) showed more tumor shrinkage (53% vs. 29%) and lower morbidity (0% vs. 3%) in the radiosurgery group4.
Advantages of radiosurgery. Radiosurgery is an outpatient procedure that is used to treat primary or recurrent/residual meningiomas after resection. Control rates rival or surpass those of resection, and morbidity is significantly less than that of resection when the tumor involves cranial nerves, large vessels or the venous sinuses. Radiosurgery is often an option when surgery is contraindicated.
Risks of radiosurgery. The risk of severe complications is usually less than 5%. Tumors adjacent to the chiasm cannot be treated aggressively without risk of visual impairment. Radiation induced malignancies are extremely rare but should be considered when treating these benign tumors in young patients.
Conclusion. Radiosurgery can provide durable local control of meningiomas that equals or surpasses that of resection. Morbidity is low. Some centers avoid the risk of total resection of difficult meningiomas by strategic combinations of surgery and radiosurgery.
(1) Pollock et. al. Int J Rad Oncol Biol Phys, 2003
(2) Kondziolka et. al., Neurosurgery, 2003
(3) Zachenhofer et. al., Neurosurgery, 2006
(4) Metellus et.al., Neurosurgery, 2005
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Radiosurgery Case History #1 - Metastatic Non-small Cell Lung Cancer
