Hypofractionated stereotactic radiosurgery for large-sized skull base meningiomas
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CLINICAL STUDY
Hypofractionated stereotactic radiosurgery for large‑sized skull base meningiomas Hyuk‑Jin Oh1 · Young Hyun Cho2,3 · Jeong Hoon Kim2 · Chang Jin Kim2,3 · Do Hoon Kwon2,3 · Doheui Lee3 · KyoungJun Yoon3 Received: 10 May 2020 / Accepted: 24 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Although stereotactic radiosurgery (SRS) has been proven to be effective and safe for treating intracranial meningiomas, concerns have been raised about the use of SRS for large-sized tumors involving the skull base that frequently encroach onto adjacent critical neural structures. The purpose of this study was to investigate the role of hypofractionated SRS as a therapeutic option for large-sized skull base meningiomas. Methods Thirty-one consecutive patients (median age: 55 years, 9 men and 22 women) who had been treated with hypofractionated SRS using CyberKnife for large-sized skull base meningiomas (> 10 c m3 in volume, median of 18.9 c m3, range 11.6–58.2 cm3) were enrolled. All patients harbored middle or posterior skull base tumors, most frequently of cavernous sinus (n = 7, 22.6%), petroclival (n = 6, 19.4%), or tentorial edge (n = 6, 19.4%) locations. SRS was delivered in five daily fractions (range 3–5 fractions) with a median cumulative dose of 27.8 Gy (range 22.6–27.8 Gy). Results With a median follow-up of 57 months (range 9–98 months), tumor control was achieved for 28 (90.3%) of 31 patients. Treatment response on MRI included partial response (volume decrease > 20%) in 17 (54.8%) patients, stable in 11 (35.5%), and progression (volume increase > 20%) in 3 (9.7%). Of 21 patients with cranial neuropathy, 20 (95.2%) showed improved neurological status. Conclusions Our current results suggest a promising role of hypofractionated SRS for large-sized skull base megningiomas in terms of tumor control and neurological outcomes. It is a reasonable therapeutic option for select patients. Keywords Meningioma · Radiosurgery · Skull base · Brain neoplasm
Introduction Skull base meningiomas account for almost 30% of all intracranial meningiomas [1]. They pose a great challenge for surgical treatment because they often require complicated surgical approaches with considerable risks of morbidity and mortality (as high as 18–76% and 4–9%, respectively) [2–5]. Over the past decades, stereotactic radiosurgery (SRS) typically delivered in a single fraction has been established as * Young Hyun Cho [email protected] 1
Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
2
Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
3
Radiosurgery Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
a preferred therapeutic alternative in treating intracranial meningiomas with favorable tumor control rates (> 90% at 5 to 10 years of follow-up) as well as functional outcomes, usually for small tumors [6]. However, concerns have been raised about th
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