PC3 - 141 Long-Term Results of Stereotactic Radiosurgery for Skull Base Meningiomas

Abstract

Gamma knife radiosurgery (GKRS) is well-established in the management of inaccessible, recurrent, or residual benign skull base meningiomas. Most series report clinical outcome parameters and complications in the short -intermediate period after radiosurgery. Reports of long-term tumor control and neurological status are still lacking. Objective: We report the presentation, treatment, and long-term outcome of skull base meningiomas after GKRS. Methods: From a prospectively collected IRB approved database, we selected patients with a WHO grade I skull base meningioma treated with a single-session GKRS and a minimum of 60 months follow up. 135 patients, 54.1% males (n=73) form the cohort. Median age was 54 years (19-80). Median tumor volume was 4.7 cm3 (0.5-23). Median margin dose was 15 Gy (7.5-36). Median follow up was 102.5 months (60.1-235.4). Patient and tumor characteristics were assessed to determine predictors of neurological function and tumor progression. Results: At last follow up, tumor volume control was achieved in 88.1% (n=119). Post-GKRS clinical improvement or stability was reported in 61.5%. The 5, 10, and 15 years actuarial progression free survival rates are 100%, 95.4%, and 68.8%, respectively. Favorable outcome (both tumor control and clinical preservation/improvement) was attained in 60.8% (n=79). Pre-GKRS performance status (KPS) was shown to influence tumor progression (p=0.0001) and post-GKRS clinical improvement / preservation (p=0.003). Conclusion: GKRS offers a highly durable rate of tumor control for WHO-I skull base meningiomas, with an acceptably low incidence of neurological deficits. KPS at the time of radiosurgery serves as a reliable long-term predictor of overall outcome.