BACKGROUND:: Radiosurgery is the main alternative to microsurgical resection for benign meningiomas. OBJECTIVE:: To assess the long-term efficacy and safety of radiosurgery for meningiomas with respect to tumour growth and prevention of associated neurological deterioration. Medium to long-term outcomes have been widely reported, but no large multicentre series with long-term follow-up have been published. METHODS:: From 15 participating centers we performed a retrospective observational analysis of 4565 consecutive patients harbouring 5300 benign meningiomas. All were treated with Gamma-Knife radiosurgery at least five years prior to assessment for this study. Clinical and imaging data were retrieved from each center and uniformly entered into a database by one author (AS). RESULTS:: Median tumour-volume was 4.8cc and median dose to tumour margin was 14Gy. All tumours with imaging follow-up less than 24 months were excluded. Detailed results from 3768 meningiomas (71\%) were analyzed. Median imaging follow-up was 63 months. The volume of treated tumours decreased in 2187 (58\%), remained unchanged in 1300 (34.5\%), and increased in 281 lesions (7.5\%), giving a control rate of 92.5\%. Only 84 (2.2\%) enlarging tumours required further treatment. Five and ten years progression-free-survival (PFS) rates were 95.2\% and 88.6\%, respectively. Tumour-control was higher for imaging defined tumours vs. Grade-I meningiomas (p<0.0001), for females vs. males (p<0.0001), for sporadic vs. multiple meningiomas (p<0.0001) and for skull-base vs. convexity tumours (p<0.0001). Permanent morbidity rate was 6.6\% at last follow-up. CONCLUSION:: Radiosurgery is a safe and effective method for treating benign meningiomas even in the medium to long-term.
Long term tumour control of benign intracranial meningiomas after radiosurgery in a series of 4565 patients.
LUPIDI, Francesco;
2012-01-01
Abstract
BACKGROUND:: Radiosurgery is the main alternative to microsurgical resection for benign meningiomas. OBJECTIVE:: To assess the long-term efficacy and safety of radiosurgery for meningiomas with respect to tumour growth and prevention of associated neurological deterioration. Medium to long-term outcomes have been widely reported, but no large multicentre series with long-term follow-up have been published. METHODS:: From 15 participating centers we performed a retrospective observational analysis of 4565 consecutive patients harbouring 5300 benign meningiomas. All were treated with Gamma-Knife radiosurgery at least five years prior to assessment for this study. Clinical and imaging data were retrieved from each center and uniformly entered into a database by one author (AS). RESULTS:: Median tumour-volume was 4.8cc and median dose to tumour margin was 14Gy. All tumours with imaging follow-up less than 24 months were excluded. Detailed results from 3768 meningiomas (71\%) were analyzed. Median imaging follow-up was 63 months. The volume of treated tumours decreased in 2187 (58\%), remained unchanged in 1300 (34.5\%), and increased in 281 lesions (7.5\%), giving a control rate of 92.5\%. Only 84 (2.2\%) enlarging tumours required further treatment. Five and ten years progression-free-survival (PFS) rates were 95.2\% and 88.6\%, respectively. Tumour-control was higher for imaging defined tumours vs. Grade-I meningiomas (p<0.0001), for females vs. males (p<0.0001), for sporadic vs. multiple meningiomas (p<0.0001) and for skull-base vs. convexity tumours (p<0.0001). Permanent morbidity rate was 6.6\% at last follow-up. CONCLUSION:: Radiosurgery is a safe and effective method for treating benign meningiomas even in the medium to long-term.
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