image: (a) The prescription dose was 12 Gy, delivered to an isodose line of 50.0%. (b) At the six-month follow-up, the tumor shrank significantly. (c) However, a new tumor developed and was treated with a prescription dose of 14 Gy, delivered to the 52% isodose line using GKRS. (d) The second tumor shrank significantly at the 27-month follow-up after the initial GKRS. (e) Simultaneously, a new tumor was treated with the third GKRS at a prescription dose of 13 Gy, delivered to the 50% isodose line. (f) At the 35-month follow-up after the initial GKRS, the third tumor had increased in size, while the first tumor remained under control. EBRT, external beam radiotherapy; GKRS, gamma knife radiosurgery.
Credit: Shibin Sun, Enmeng Bao
Background and objectives
The role of radiosurgery in the treatment of grade 2 meningioma remains unclear. This study aimed to evaluate the long-term outcomes of gamma knife radiosurgery (GKRS) in patients with grade 2 meningiomas and to identify factors influencing tumor control and survival.
Methods
In this retrospective study, seventy patients underwent GKRS for grade 2 meningioma between 2007 and 2016. Tumor recurrence was categorized as local, marginal, or distant. Survival curves were estimated using the Kaplan-Meier method, while the log-rank test and Cox proportional hazards model were employed to analyze potential risk factors.
Results
The median follow-up period was 48 months (range: 8 to 132 months). The one-year, three-year, and five-year local control rates were 92%, 73%, and 65%, respectively. The one-, three-, and three-year progression-free survival rates were 87%, 51%, and 44%, respectively. Multiple lesions and multiple prior recurrences were identified as negative predictors of marginal control and progression-free survival. Similarly, multiple lesions and marginal doses ≤13 Gy were associated with poor local control. Serious complications related to gamma knife use occurred in 4% of patients.
Conclusions
Our results support the use of GKRS as a reasonable treatment option in the management of grade 2 meningiomas. A higher margin dose should be considered to achieve better local control. Outfield progression (marginal and/or distant recurrence) was common, particularly in patients with multiple prior recurrences and/or multiple lesions. More aggressive treatment strategies should be explored for patients with these risk factors.
Full text:
https://www.xiahepublishing.com/3067-6150/NSSS-2024-00002
The study was recently published in the Neurosurgical Subspecialties.
Neurosurgical Subspecialties (NSSS) is the official scientific journal of the Department of Neurosurgery at Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. NSSS aims to provide a forum for clinicians and scientists in the field, dedicated to publishing high-quality and peer-reviewed original research, reviews, opinions, commentaries, case reports, and letters across all neurosurgical subspecialties. These include but are not limited to traumatic brain injury, spinal and spinal cord neurosurgery, cerebrovascular disease, stereotactic radiosurgery, neuro-oncology, neurocritical care, neurosurgical nursing, neuroendoscopy, pediatric neurosurgery, peripheral neuropathy, and functional neurosurgery.
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Journal
Neurosurgical Subspecialties
Article Title
The Role of Gamma Knife Radiosurgery in the Management of Grade 2 Meningioma
Article Publication Date
17-Dec-2024