Predictors of response to Gamma Knife radiosurgery for intracranial meningiomas

被引:18
作者
Mansouri, Alireza [1 ,2 ]
Larjani, Soroush [1 ]
Klironomos, George [1 ,2 ]
Laperriere, Normand [3 ]
Cusimano, Michael [2 ,4 ]
Gentili, Fred [1 ,2 ]
Schwartz, Michael [2 ,5 ]
Zadeh, Gelareh [1 ,2 ]
机构
[1] Univ Hlth Network, Toronto Western Hosp, Div Neurosurg, Toronto, ON, Canada
[2] Univ Toronto, Div Neurosurg, Toronto, ON, Canada
[3] Univ Toronto, Univ Hlth Network, Princess Margaret Canc Ctr, Dept Radiat Oncol, Toronto, ON M5S 1A1, Canada
[4] St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr, Toronto, ON M5B 1W8, Canada
[5] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Surg Neurosurg, Toronto, ON M5S 1A1, Canada
关键词
adverse event; meningioma; predictor; stereotactic radiosurgery; CAVERNOUS SINUS MENINGIOMAS; SKULL BASE MENINGIOMAS; LOCAL TUMOR-CONTROL; LONG-TERM OUTCOMES; STEREOTACTIC RADIOSURGERY; BENIGN MENINGIOMAS; PERITUMORAL EDEMA; PARASAGITTAL MENINGIOMAS; CRANIAL NERVES; COMPLICATIONS;
D O I
10.3171/2014.12.JNS141687
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECT In this paper, the authors' aim was to determine short-term volumetric and diametric tumor growth and identify clinical, radiological, and dosimetric predictors of adverse radiation events (AREs) following stereotactic radiosurgery (SRS) for intracranial WHO Grade I meningiomas. METHODS This is a retrospective review of all WHO Grade I meningiomas that were treated with SRS (primary or adjuvant) between December 2005 and June 2012 at the University Health Network. Seventy-five patients had at least 24 months of both clinical and radiological follow-up and were, therefore, included in this study. Tumor growth was defined as any volumetric or diametric change greater than 10% per year. Any variation less than +10% was considered growth stability. Volumetric measurements were made using T1-weighted gadolinium-enhanced 3-T MRI scans and ITK-SNAP software. Tumor growth rates were calculated using the specific growth rate (SGR). Univariate statistics were used to identify predictors of post-SRS AREs. All statistical analyses were performed using IBM SPSS. RESULTS Women accounted for 69.3% of patients, and the mean treatment age was 58.6 years. Median follow-up was 36.2 months. Twenty-one (28%) patients had undergone prior resection. Two (3%) patients required salvage surgical intervention following SRS. The majority of the lesions (56%) were skull base tumors. Median tumor volume and diameter were 5.2 cm(3) and 27.5 mm, respectively. The absence of tumor growth was observed in 39 cases (52%) based on the volumetric measurements, while the absence of tumor growth was observed in 69 cases (92%) based on the diametric measurements. Twenty-six patients (34.6%) experienced new-onset AREs, including headache (17.3%), cranial neuropathy (10.6%), speech impairment (2.7%), tremors (2.7%), and ataxia (1.3%). Fourteen patients (18.7%) experienced new-onset edema, and 4 of these patients were symptomatic. A lower conformity index (1.24 vs 1.4) was significantly associated with the development of edema (p < 0.001 power > 0.8). Patients with meningiomas that had growth rates of more than 10% per year were more likely to experience long-term headaches after SRS (p = 0.022). CONCLUSIONS Volume-based reporting of SRS outcomes for meningiomas may be a more accurate method given the complex morphology of some lesions. The conformity index was identified as a predictor of edema following radiosurgery.
引用
收藏
页码:1294 / 1300
页数:7
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