• Neurosurgery · Jan 2012

    Long-term tumor control of benign intracranial meningiomas after radiosurgery in a series of 4565 patients.

    • Antonio Santacroce, Maja Walier, Jean Régis, Roman Liščák, Enrico Motti, Christer Lindquist, Andras Kemeny, Klaus Kitz, Bodo Lippitz, Martínez ÁlvarezRobertoR, Paal-Henning Pedersen, Shoji Yomo, Francesco Lupidi, Karlheinz Dominikus, Philip Blackburn, Thomas Mindermann, Otto Bundschuh, A T C J van Eck, Rolf Fimmers, and Gerhard A Horstmann.
    • Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany. antoniosantacroce@msn.com
    • Neurosurgery. 2012 Jan 1; 70 (1): 32-9; discussion 39.

    BackgroundRadiosurgery is the main alternative to microsurgical resection for benign meningiomas.ObjectiveTo assess the long-term efficacy and safety of radiosurgery for meningiomas with respect to tumor growth and prevention of associated neurological deterioration. Medium- to long-term outcomes have been widely reported, but no large multicenter series with long-term follow-up have been published.MethodsFrom 15 participating centers, we performed a retrospective observational analysis of 4565 consecutive patients harboring 5300 benign meningiomas. All were treated with Gamma Knife radiosurgery at least 5 years before assessment for this study. Clinical and imaging data were retrieved from each center and uniformly entered into a database by 1 author (A.S.).ResultsMedian tumor volume was 4.8 cm³, and median dose to tumor margin was 14 Gy. All tumors with imaging follow-up < 24 months were excluded. Detailed results from 3768 meningiomas (71%) were analyzed. Median imaging follow-up was 63 months. The volume of treated tumors decreased in 2187 lesions (58%), remained unchanged in 1300 lesions (34.5%), and increased in 281 lesions (7.5%), giving a control rate of 92.5%. Only 84 (2.2%) enlarging tumors required further treatment. Five- and 10-year progression-free survival rates were 95.2% and 88.6%, respectively. Tumor control was higher for imaging defined tumors vs grade I meningiomas (P < .001), for female vs male patients (P < .001), for sporadic vs multiple meningiomas (P < .001), and for skull base vs convexity tumors (P < .001). Permanent morbidity rate was 6.6% at the last follow-up.ConclusionRadiosurgery is a safe and effective method for treating benign meningiomas even in the medium to long term.

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