Öz
Aim: Innovations in radiotherapy have paved the way for alternative approaches for the treatment of meningioma, and in this context, radiosurgery has begun to be used in the treatment of meningioma. This study aimed to examine the clinical results of radiosurgery in the treatment of meningioma and to show whether it achieves the main goals, especially in terms of the possibility of tumor control and the success of preventing progression.
Materials and Methods: Primary, residual, and recurrent meningioma treated with stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) between 2013 and 2020 were evaluated retrospectively. Study endpoints were overall survival (OS), progression free survival (PFS), and local control (LC).
Results: 73 patients and 81 lesions were analyzed. The median duration of the follow-up period was 49 months (range, 7–138 months). 5- and 7-y OS and PFS were 87.6%, 78.9%; 82.9% and 82.9%, respectively. The tumor control rate was 94.6%. In univariate analysis, gender (p=0.007), radiosurgery for recurrence (p=0.011) and number of lesions (p=0.030) were found to be factors affecting OS, and number of lesions (p<0.001), grade (p=0.048) and tumor size (p=0.047) were found to be factors affecting PFS. Number of lesions (p=0.022) was remained prognostic factor for PFS in the multivariate analysis.
Conclusion: Since SRS/SRT can provide high tumor control in the management of meningioma, it can be preferred as an alternative treatment method, especially in patients who are diagnosed radiologically, who are not candidates for surgery or who refuse surgical treatment, as well as in cases of residual and recurrence in the post-surgical period.
Anahtar Kelimeler
meningioma Stereotactic Radiosurgery Stereotactic Radiotherapy
Kaynakça
- 1. Kohler BA, Ward E, McCarthy BJ et al. Annual report to the nation on the status of cancer, 1975-2007, featuring tumors of the brain and other nervous system. J Natl Cancer Inst 2011;103(9):714-36. doi: 10.1093/jnci/djr077.
- 2. Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 1957;20(1):22-39. doi: 10.1136/jnnp.20.1.22.
- 3. Goldbrunner R, Stavrinou P, Jenkinson MD et al. EANO guideline on the diagnosis and management of meningiomas. Neuro Oncol. 2021;23(11):1821-34. doi: 10.1093/neuonc/noab150.
- 4. Valentino V. Radiosurgery in cerebral tumours and AVM. Acta Neurochir Suppl (Wien) 1988;42:193-7. doi: 10.1007/978-3-7091-8975-7_38.
- 5. Bir SC, Patra DP, Maiti TK, Bollam P, Minagar A, Nanda A. Direct Comparison of Gamma Knife Radiosurgery and Microsurgery for Small Size Meningiomas. World Neurosurg 2017;101:170-9. doi: 10.1016/j.wneu.2017.01.105.
- 6. DiBiase SJ, Kwok Y, Yovino S 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):1515-9. doi: 10.1016/j.ijrobp.2004.05.073.
- 7. Kondziolka D, Mathieu D, Lunsford LD et al. Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 2008;62(1):53-8; discussion 58-60. doi: 10.1227/01.NEU.0000311061.72626.0D.
- 8. Santacroce A, Walier M, Régis J et al. Long-term tumor control of benign intracranial meningiomas after radiosurgery in a series of 4565 patients. Neurosurgery 2012;70(1):32-9; discussion 39. doi: 10.1227/NEU.0b013e31822d408a.
- 9. Cohen-Inbar O, Lee CC, Sheehan JP. The Contemporary Role of Stereotactic Radiosurgery in the Treatment of Meningiomas. Neurosurg Clin N Am 2016;27(2):215-28. doi: 10.1016/j.nec.2015.11.006.
- 10. Leroy HA, Tuleasca C, Reyns N, Levivier M. Radiosurgery and fractionated radiotherapy for cavernous sinus meningioma: a systematic review and meta-analysis. Acta Neurochir (Wien) 2018;160(12):2367-78. doi: 10.1007/s00701-018-3711-9.
- 11. Ruge MI, Tutunji J, Rueß D, et al. Stereotactic radiosurgery for treating meningiomas eligible for complete resection. Radiat Oncol 2021;16(1):22. doi: 10.1186/s13014-021-01748-y.
- 12. Pou P, Biau J, Verrelle P et al. Long-Term Outcomes After Linac Radiosurgery for Benign Meningiomas. Clin Oncol (R Coll Radiol) 2020;32(7):452-8. doi: 10.1016/j.clon.2020.02.006.
- 13. NCCN.org [homepage on the Internet]. Pennysylvania: National Comprehensive Cancer Network [updated 2.2002; cited 24 February 2023]. NCCN Guidelines Version 2.2022 Meningiomas, Available from: https://www.nccn.org/professionals/physician_gls/pdf/cns.pdf
- 14. Refaat T, Gentile M, Sachdev S et al. Gamma Knife Stereotactic Radiosurgery for Grade 2 Meningiomas. J Neurol Surg B Skull Base 2017;78(4):288-94. doi: 10.1055/s-0036-1597834.
- 15. Manabe Y, Murai T, Ogino H et al. CyberKnife Stereotactic Radiosurgery and Hypofractionated Stereotactic Radiotherapy As First-line Treatments for Imaging-diagnosed Intracranial Meningiomas. Neurol Med Chir (Tokyo) 2017;57(12):627-33. doi: 10.2176/nmc.oa.2017-0115.
- 16. Bin-Alamer O, Alnefaie N, Qedair J et al. Single session versus multisession stereotactic radiosurgery for the management of intracranial meningiomas: a systematic review and meta-analysis. J Neurooncol 2022 Aug 17. doi: 10.1007/s11060-022-04112-6. Epub ahead of print. PMID: 35976546.
Öz
Amaç: Radyoterapideki yenilikler menengiom tedavisinde alternatif yaklaşımların önünü açmış ve bu bağlamda radyocerrahi menengiom tedavisinde kullanılmaya başlanmıştır. Bu çalışma, radyocerrahinin menengiom tedavisinde klinik sonuçlarını incelemek ve özellikle tümör kontrolü olasılığı ve ilerlemeyi önleme başarısı açısından ana hedeflere ulaşıp ulaşmadığını göstermeyi amaçladı.
Gereç ve Yöntem: 2013-2020 yılları arasında stereotaktik radyocerrahi (SRC) ve stereotaktik radyoterapi (SRT) ile tedavi edilen primer, rezidüel ve nüks menengiomlar retrospektif olarak değerlendirildi. Çalışma son noktaları, genel sağkalım (GS), progresyonsuz sağkalım (PS) ve lokal kontrol (LK) idi.
Bulgular: 73 hasta ve 81 lezyon analiz edildi. Medyan takip süresi 49 aydı (aralık, 7-138 ay). 5- ve 7-y GS ve PS sırasıyla %87,6, %78,9; ve %82,9, %82,9’du. Tümör kontrol oranı %94,6’ydı. Tek değişkenli analizde cinsiyet (p=0,007), nüks nedeniyle radyocerrahi (p=0,011) ve lezyon sayısı (p=0,030) GS'ı etkileyen faktörler olarak bulundu ve lezyon sayısı (p<0,001), grad (p= 0,048) ve tümör boyutu (p=0,047) PS'ı etkileyen faktörler olarak bulundu. Çok değişkenli analizde lezyon sayısı (p=0,022) PS için prognostik faktör olarak kaldı.
Sonuç: SRC/SRT menengiom tedavisinde yüksek tümör kontrolü sağlayabildiği için özellikle radyolojik olarak tanı konulan, cerrahiye aday olmayan veya cerrahi tedaviyi reddeden hastalarda, aynı zamanda ameliyat sonrası dönemde rezidüel ve nüks durumlarında alternatif bir tedavi yöntemi olarak tercih edilebilir.
Anahtar Kelimeler
Menengiom Stereotaktik Radyocerrahi Stereotaktik Radyoterapi
Kaynakça
- 1. Kohler BA, Ward E, McCarthy BJ et al. Annual report to the nation on the status of cancer, 1975-2007, featuring tumors of the brain and other nervous system. J Natl Cancer Inst 2011;103(9):714-36. doi: 10.1093/jnci/djr077.
- 2. Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 1957;20(1):22-39. doi: 10.1136/jnnp.20.1.22.
- 3. Goldbrunner R, Stavrinou P, Jenkinson MD et al. EANO guideline on the diagnosis and management of meningiomas. Neuro Oncol. 2021;23(11):1821-34. doi: 10.1093/neuonc/noab150.
- 4. Valentino V. Radiosurgery in cerebral tumours and AVM. Acta Neurochir Suppl (Wien) 1988;42:193-7. doi: 10.1007/978-3-7091-8975-7_38.
- 5. Bir SC, Patra DP, Maiti TK, Bollam P, Minagar A, Nanda A. Direct Comparison of Gamma Knife Radiosurgery and Microsurgery for Small Size Meningiomas. World Neurosurg 2017;101:170-9. doi: 10.1016/j.wneu.2017.01.105.
- 6. DiBiase SJ, Kwok Y, Yovino S 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):1515-9. doi: 10.1016/j.ijrobp.2004.05.073.
- 7. Kondziolka D, Mathieu D, Lunsford LD et al. Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 2008;62(1):53-8; discussion 58-60. doi: 10.1227/01.NEU.0000311061.72626.0D.
- 8. Santacroce A, Walier M, Régis J et al. Long-term tumor control of benign intracranial meningiomas after radiosurgery in a series of 4565 patients. Neurosurgery 2012;70(1):32-9; discussion 39. doi: 10.1227/NEU.0b013e31822d408a.
- 9. Cohen-Inbar O, Lee CC, Sheehan JP. The Contemporary Role of Stereotactic Radiosurgery in the Treatment of Meningiomas. Neurosurg Clin N Am 2016;27(2):215-28. doi: 10.1016/j.nec.2015.11.006.
- 10. Leroy HA, Tuleasca C, Reyns N, Levivier M. Radiosurgery and fractionated radiotherapy for cavernous sinus meningioma: a systematic review and meta-analysis. Acta Neurochir (Wien) 2018;160(12):2367-78. doi: 10.1007/s00701-018-3711-9.
- 11. Ruge MI, Tutunji J, Rueß D, et al. Stereotactic radiosurgery for treating meningiomas eligible for complete resection. Radiat Oncol 2021;16(1):22. doi: 10.1186/s13014-021-01748-y.
- 12. Pou P, Biau J, Verrelle P et al. Long-Term Outcomes After Linac Radiosurgery for Benign Meningiomas. Clin Oncol (R Coll Radiol) 2020;32(7):452-8. doi: 10.1016/j.clon.2020.02.006.
- 13. NCCN.org [homepage on the Internet]. Pennysylvania: National Comprehensive Cancer Network [updated 2.2002; cited 24 February 2023]. NCCN Guidelines Version 2.2022 Meningiomas, Available from: https://www.nccn.org/professionals/physician_gls/pdf/cns.pdf
- 14. Refaat T, Gentile M, Sachdev S et al. Gamma Knife Stereotactic Radiosurgery for Grade 2 Meningiomas. J Neurol Surg B Skull Base 2017;78(4):288-94. doi: 10.1055/s-0036-1597834.
- 15. Manabe Y, Murai T, Ogino H et al. CyberKnife Stereotactic Radiosurgery and Hypofractionated Stereotactic Radiotherapy As First-line Treatments for Imaging-diagnosed Intracranial Meningiomas. Neurol Med Chir (Tokyo) 2017;57(12):627-33. doi: 10.2176/nmc.oa.2017-0115.
- 16. Bin-Alamer O, Alnefaie N, Qedair J et al. Single session versus multisession stereotactic radiosurgery for the management of intracranial meningiomas: a systematic review and meta-analysis. J Neurooncol 2022 Aug 17. doi: 10.1007/s11060-022-04112-6. Epub ahead of print. PMID: 35976546.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Orjinal Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Mayıs 2023 |
| Kabul Tarihi | 2 Nisan 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 13 Sayı: 3 |
