Limits...
Fractionated stereotactic conformal radiotherapy for large benign skull base meningiomas.

Minniti G, Clarke E, Cavallo L, Osti MF, Esposito V, Cantore G, Cappabianca P, Enrici RM - Radiat Oncol (2011)

Bottom Line: Hypopituitarism was the most commonly reported late complication, with a new hormone pituitary deficit occurring in 10 (19%) of patients.Clinically significant late neurological toxicity was observed in 3 (5.5%) patients consisting of worsening of pre-existing cranial deficits.Longer follow-up is required to assess long term efficacy and toxicity, particularly in terms of potential reduction of treatment-related late toxicity.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Sant' Andrea Hospital, Università degli Studi di Roma La Sapienza, Rome, Italy. giuseppe.minniti@ospedalesantandrea.it

ABSTRACT

Purpose: To assess the safety and efficacy of fractionated stereotactic radiotherapy (FSRT) for large skull base meningiomas.

Methods and materials: Fifty-two patients with large skull base meningiomas aged 34-74 years (median age 56 years) were treated with FSRT between June 2004 and August 2009. All patients received FSRT for residual or progressive meningiomas more than 4 centimeters in greatest dimension. The median GTV was 35.4 cm3 (range 24.1-94.9 cm3), and the median PTV was 47.6 cm3 (range 33.5-142.7 cm3). Treatment volumes were achieved with 5-8 noncoplanar beams shaped using a micromultileaf collimator (MLC). Treatment was delivered in 30 daily fractions over 6 weeks to a total dose of 50 Gy using 6 MV photons. Outcome was assessed prospectively.

Results: At a median follow-up of 42 months (range 9-72 months) the 3-year and 5-year progression-free survival (PFS) rates were 96% and 93%, respectively, and survival was 100%. Three patients required further debulking surgery for progressive disease. Hypopituitarism was the most commonly reported late complication, with a new hormone pituitary deficit occurring in 10 (19%) of patients. Clinically significant late neurological toxicity was observed in 3 (5.5%) patients consisting of worsening of pre-existing cranial deficits.

Conclusion: FSRT as a high-precision technique of localized RT is suitable for the treatment of large skull base meningiomas. The local control is comparable to that reported following conventional external beam RT. Longer follow-up is required to assess long term efficacy and toxicity, particularly in terms of potential reduction of treatment-related late toxicity.

Show MeSH

Related in: MedlinePlus

Kaplan-Meier analysis of tumor control (red line) and overall survival (blue line) rates after FSRT of 52 large benign skull base meningiomas.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3094366&req=5

Figure 1: Kaplan-Meier analysis of tumor control (red line) and overall survival (blue line) rates after FSRT of 52 large benign skull base meningiomas.

Mentions: Fifty-two patients with large benign skull base meningioma were treated with FSRT. At the time of analysis in December 2010, three patients had tumor progression 18, 30 and 42 months after FSRT and required surgery. After a median follow-up of 42 months (range from 12 months to 72 months), the actuarial tumor control was 96% at 3 years and 93% at 5 years, and respective survival 100% (Figure 1). Local control was similar for patients treated with FSRT as a part of their primary treatment or at the time of recurrence. MRI showed on serial imaging no changes in 37 (71%) and reduction in tumor size in 12 patients (23%), however without reaching conventional partial response criteria. Univariate analysis showed no significant tumor control between 23 meningiomas larger than 40 cm3 and 29 meningiomas smaller than or equal to 40 cm3 (P = 0.16) (Figure 2). Similarly, tumor location, sex, and age were not correlated with tumor control.


Fractionated stereotactic conformal radiotherapy for large benign skull base meningiomas.

Minniti G, Clarke E, Cavallo L, Osti MF, Esposito V, Cantore G, Cappabianca P, Enrici RM - Radiat Oncol (2011)

Kaplan-Meier analysis of tumor control (red line) and overall survival (blue line) rates after FSRT of 52 large benign skull base meningiomas.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3094366&req=5

Figure 1: Kaplan-Meier analysis of tumor control (red line) and overall survival (blue line) rates after FSRT of 52 large benign skull base meningiomas.
Mentions: Fifty-two patients with large benign skull base meningioma were treated with FSRT. At the time of analysis in December 2010, three patients had tumor progression 18, 30 and 42 months after FSRT and required surgery. After a median follow-up of 42 months (range from 12 months to 72 months), the actuarial tumor control was 96% at 3 years and 93% at 5 years, and respective survival 100% (Figure 1). Local control was similar for patients treated with FSRT as a part of their primary treatment or at the time of recurrence. MRI showed on serial imaging no changes in 37 (71%) and reduction in tumor size in 12 patients (23%), however without reaching conventional partial response criteria. Univariate analysis showed no significant tumor control between 23 meningiomas larger than 40 cm3 and 29 meningiomas smaller than or equal to 40 cm3 (P = 0.16) (Figure 2). Similarly, tumor location, sex, and age were not correlated with tumor control.

Bottom Line: Hypopituitarism was the most commonly reported late complication, with a new hormone pituitary deficit occurring in 10 (19%) of patients.Clinically significant late neurological toxicity was observed in 3 (5.5%) patients consisting of worsening of pre-existing cranial deficits.Longer follow-up is required to assess long term efficacy and toxicity, particularly in terms of potential reduction of treatment-related late toxicity.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Sant' Andrea Hospital, Università degli Studi di Roma La Sapienza, Rome, Italy. giuseppe.minniti@ospedalesantandrea.it

ABSTRACT

Purpose: To assess the safety and efficacy of fractionated stereotactic radiotherapy (FSRT) for large skull base meningiomas.

Methods and materials: Fifty-two patients with large skull base meningiomas aged 34-74 years (median age 56 years) were treated with FSRT between June 2004 and August 2009. All patients received FSRT for residual or progressive meningiomas more than 4 centimeters in greatest dimension. The median GTV was 35.4 cm3 (range 24.1-94.9 cm3), and the median PTV was 47.6 cm3 (range 33.5-142.7 cm3). Treatment volumes were achieved with 5-8 noncoplanar beams shaped using a micromultileaf collimator (MLC). Treatment was delivered in 30 daily fractions over 6 weeks to a total dose of 50 Gy using 6 MV photons. Outcome was assessed prospectively.

Results: At a median follow-up of 42 months (range 9-72 months) the 3-year and 5-year progression-free survival (PFS) rates were 96% and 93%, respectively, and survival was 100%. Three patients required further debulking surgery for progressive disease. Hypopituitarism was the most commonly reported late complication, with a new hormone pituitary deficit occurring in 10 (19%) of patients. Clinically significant late neurological toxicity was observed in 3 (5.5%) patients consisting of worsening of pre-existing cranial deficits.

Conclusion: FSRT as a high-precision technique of localized RT is suitable for the treatment of large skull base meningiomas. The local control is comparable to that reported following conventional external beam RT. Longer follow-up is required to assess long term efficacy and toxicity, particularly in terms of potential reduction of treatment-related late toxicity.

Show MeSH
Related in: MedlinePlus