Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-23T22:31:00.189Z Has data issue: false hasContentIssue false
  • English
  • Français

Patterns of recurrence in patients receiving conformal radiation for intracranial meningioma: a single-institution experience

Published online by Cambridge University Press:  15 July 2020

B. Rajkrishna Open the ORCID record for B. Rajkrishna [Opens in a new window] ,
Balakrishnan Rajesh ,
Sebastian Patricia  and
B. Selvamani
B. Rajkrishna*
Affiliation:
Department of Radiation Oncology, Ida B Scudder Cancer Centre, Christian Medical College, Vellore, India
Balakrishnan Rajesh
Affiliation:
Department of Radiation Oncology, Ida B Scudder Cancer Centre, Christian Medical College, Vellore, India
Sebastian Patricia
Affiliation:
Department of Radiation Oncology, Ida B Scudder Cancer Centre, Christian Medical College, Vellore, India
B. Selvamani
Affiliation:
Department of Radiation Oncology, Ida B Scudder Cancer Centre, Christian Medical College, Vellore, India
*
Author for correspondence: Dr Rajkrishna B, Assistant Professor, Department of Radiation Oncology, Ida B Scudder Cancer Centre, Christian Medical College, Vellore632004, India. Tel: +91 9626947477. E-mails: [email protected], [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim:

To evaluate the patterns of recurrence following postoperative conformal radiotherapy (RT) for intracranial meningioma.

Materials and methods:

Eighty-six patients who received conformal RT for intracranial meningiomas from 2014 to 2017 were retrospectively analysed. For documented recurrences, recurrence imaging was deformably co-registered to planning CT scan. In-field recurrence was defined as recurrence within the 90% isodose line, and out-of-field recurrences were those that occurred outside the 90% isodose line. We present the demographic details, surgical and RT details, outcomes and patterns of recurrence.

Results:

The median age was 46 years (range 17–72); 82·6% underwent surgery [46·5% had subtotal resection (STR), 43·7% gross tumour resection (GTR), 5·6% biopsy] and 17·4% had no surgery. Among these, 53·5% were WHO grade 2; 27·9% grade 1; and 1·2% grade 3 meningioma. Fifty per cent received stereotactic RT (SRT), 46·5% 3D conformal RT (3DCRT) and 3·5% intensity-modulated RT (IMRT). The mean clinical target volume (CTV) and planning target volume (PTV) margins were 4·5 mm (range 0–15) and 3·9 mm (range 1–5), respectively. The doses ranged from 54 to 59·4 Gy. The median follow-up after RT was 1·7 years (range 0·2–4·7). 17·4% were lost to follow-up, 5·4% had recurrence, and the median time to recurrence after completion of RT was 2 years (range 0·7–2·9). The 3-year recurrence-free rate was 81·5%. Three patients had in-field and two had in-field and out-of-field recurrence. Among the cases with recurrence, three received SRT, one 3DCRT and one IMRT. Four were grade 2 and one was grade 3 tumour, and the CTV margin ranged from 0 to 5 mm, and the PTV margin ranged from 3 to 5 mm.

Conclusion:

Local recurrence was seen in grade 2 and 3 meningiomas. SRT probably had more recurrence as they had lesser CTV margin. Increased CTV margin, escalated dose up to 59·4 Gy and 3DCRT/IMRT may be helpful in preventing local recurrences in grade 2 and grade 3 meningiomas.

Keywords

CTV marginsmeningiomaradiotherapyrecurrence patterns
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 20 , Issue 4 , December 2021 , pp. 406 - 412
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Louis, D N, Perry, A, Reifenberger, G et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 2016; 131 (6): 803–820.CrossRefGoogle ScholarPubMed
Longstreth, W T, Dennis, L K, McGuire, V M, Drangsholt, M T, Koepsell, T D. Epidemiology of intracranial meningioma. Cancer 1993; 72 (3): 639–648.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
Stafford, S L, Perry, A, Suman, V J et al. Primarily resected meningiomas: outcome and prognostic factors in 581 Mayo Clinic patients, 1978 through 1988. Mayo Clin Proc 1998; 73 (10): 936–942.CrossRefGoogle Scholar
Condra, K S, Buatti, J M, Mendenhall, W M, Friedman, W A, Marcus, R B, Rhoton, A L. Benign meningiomas: primary treatment selection affects survival. Int J Radiat Oncol Biol Phys 1997; 39 (2): 427–436.CrossRefGoogle ScholarPubMed
Aghi, M K, Carter, B S, Cosgrove, G R et al. Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation. Neurosurgery 2009; 64 (1): 56–60; discussion 60.CrossRefGoogle ScholarPubMed
Yang, S-Y, Park, C-K, Park, S-H, Kim, D G, Chung, Y S, Jung, H-W. Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. J Neurol Neurosurg Psychiatry 2008; 79 (5): 574–580.CrossRefGoogle ScholarPubMed
Milosevic, M F, Frost, P J, Laperriere, N J, Wong, C S, Simpson, W J. Radiotherapy for atypical or malignant intracranial meningioma. Int J Radiat Oncol Biol Phys 1996; 34 (4): 817–822.CrossRefGoogle ScholarPubMed
Hug, E B, Devries, A, Thornton, A F et al. Management of atypical and malignant meningiomas: role of high-dose, 3D-conformal radiation therapy. J Neurooncol 2000; 48 (2): 151–160.CrossRefGoogle ScholarPubMed
Dziuk, T W, Woo, S, Butler, E B et al. Malignant meningioma: an indication for initial aggressive surgery and adjuvant radiotherapy. J Neurooncol 1998; 37 (2): 177–188.CrossRefGoogle ScholarPubMed
Henzel, M, Gross, M W, Hamm, K et al. Stereotactic radiotherapy of meningiomas: symptomatology, acute and late toxicity. Strahlenther Onkol 2006; 182 (7): 382–388.CrossRefGoogle ScholarPubMed
Goldsmith, B J, Wara, W M, Wilson, C B, Larson, D A. Postoperative irradiation for subtotally resected meningiomas: a retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 1994; 80 (2): 195–201.CrossRefGoogle ScholarPubMed
Perry, A, Scheithauer, B W, Stafford, S L, Lohse, C M, Wollan, P C. “Malignancy” in meningiomas: a clinicopathologic study of 116 patients, with grading implications. Cancer 1999; 85 (9): 2046–2056.Google ScholarPubMed
Press, R H, Prabhu, R S, Appin, C L et al. Patterns of failure for grade 2/3 meningioma treated with reduced margin intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 2013; 87 (2): S158.CrossRefGoogle Scholar
Kumar, N, Kumar, R, Khosla, D, Salunke, P S, Gupta, S K, Radotra, B D. Survival and failure patterns in atypical and anaplastic meningiomas: a single-center experience of surgery and postoperative radiotherapy. J Cancer Res Ther 2015; 11 (4): 735–739.CrossRefGoogle ScholarPubMed
Zollner, B, Ganswindt, U, Maihöfer, C et al. Recurrence pattern analysis after [68Ga]-DOTATATE-PET/CT-planned radiotherapy of high-grade meningiomas. Radiat Oncol 2018; 13 (1): 110. Published 2018 Jun 14. doi: 10.1186/s13014-018-1056-4 CrossRefGoogle Scholar
Rogers, L, Zhang, P, Vogelbaum, M A et al. Intermediate-risk meningioma: initial outcomes from NRG Oncology RTOG 0539. J Neurosurg 2018; 129 (1): 35–47.CrossRefGoogle ScholarPubMed
Rogers, C L, Won, M, Vogelbaum, M A et al. High-risk meningioma: initial outcomes from NRG Oncology/RTOG 0539. Int J Radiat Oncol Biol Phys. 2020; 106 (4): 790–799.CrossRefGoogle ScholarPubMed
Debus, J, Wuendrich, M, Pirzkall, A et al. High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results. J Clin Oncol 2001; 19 (15): 3547–3553.CrossRefGoogle ScholarPubMed
Hanft, S, Canoll, P, Bruce, J N. A review of malignant meningiomas: diagnosis, characteristics, and treatment. J Neurooncol 2010; 99 (3): 433–443.CrossRefGoogle Scholar
Goldbrunner, R, Minniti, G, Preusser, M et al. EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol 2016; 17 (9): e383–e391.CrossRefGoogle ScholarPubMed
Rogers, L, Gilbert, M, Vogelbaum, M A. Intracranial meningiomas of atypical (WHO grade II) histology. J Neurooncol 2010; 99 (3): 393–405.CrossRefGoogle ScholarPubMed
Ohba, S, Kobayashi, M, Horiguchi, T et al. Long-term surgical outcome and biological prognostic factors in patients with skull base meningiomas. J Neurosurg 2011; 114 (5): 1278–1287.CrossRefGoogle ScholarPubMed
Combs, S E, Schulz-Ertner, D, Debus, J, von Deimling, A, Hartmann, C. Improved correlation of the neuropathologic classification according to adapted world health organization classification and outcome after radiotherapy in patients with atypical and anaplastic meningiomas. Int J Radiat Oncol Biol Phys 2011; 81 (5): 1415–1421.CrossRefGoogle ScholarPubMed
Vendrely, V, Maire, J P, Darrouzet, V et al. [Fractionated radiotherapy of intracranial meningiomas: 15 years’ experience at the Bordeaux University Hospital Center]. Cancer Radiother 1999; 3 (4): 311–317.CrossRefGoogle Scholar
Park, H J, Kang, H-C, Kim, I H et al. The role of adjuvant radiotherapy in atypical meningioma. J Neurooncol 2013; 115 (2): 241–247.CrossRefGoogle ScholarPubMed
Vernooij, M W, Ikram, M A, Tanghe, H L et al. Incidental findings on brain MRI in the general population. N Engl J Med 2007; 357 (18): 1821–1828.CrossRefGoogle ScholarPubMed
Chamberlain, MC. Intracerebral Meningiomas. Curr Treat Options Neurol 2004; 6 (4): 297–305.CrossRefGoogle ScholarPubMed
Kumar, R, Kumar, N, Khosla, D, Gupta, S K, Radotra, B D, Sharma, S C. Long term outcome analysis of role of radiotherapy in Grade I meningiomas: a single centre experience from North India. Int J Appl Basic Med Res 2015; 5 (2): 128–132.CrossRefGoogle Scholar
Cohen-Inbar, O, Tata, A, Moosa, S, Lee, C-C, Sheehan, J P. Stereotactic radiosurgery in the treatment of parasellar meningiomas: long-term volumetric evaluation. J Neurosurg 2018; 128 (2): 362–372.CrossRefGoogle ScholarPubMed
Kreil, W, Luggin, J, Fuchs, I, Weigl, V, Eustacchio, S, Papaefthymiou, G. Long term experience of gamma knife radiosurgery for benign skull base meningiomas. J Neurol Neurosurg Psychiatry 2005; 76 (10): 1425–1430.CrossRefGoogle ScholarPubMed
Pollock, B E, Stafford, S L, Link, M J, Garces, Y I, Foote, R L. Single-fraction radiosurgery for presumed intracranial meningiomas: efficacy and complications from a 22-year experience. Int J Radiat Oncol Biol Phys 2012; 83 (5): 1414–1418.CrossRefGoogle ScholarPubMed
Starke, R M, Williams, B J, Hiles, C, Nguyen, J H, Elsharkawy, M Y, Sheehan, J P. Gamma knife surgery for skull base meningiomas. J Neurosurg 2012; 116 (3): 588–597.CrossRefGoogle ScholarPubMed
Unger, K R, Lominska, C E, Chanyasulkit, J et al. Risk factors for posttreatment edema in patients treated with stereotactic radiosurgery for meningiomas. Neurosurgery 2012; 70 (3): 639–645.CrossRefGoogle ScholarPubMed
Huffmann, B C, Reinacher, P C, Gilsbach, J M. Gamma knife surgery for atypical meningiomas. J Neurosurg 2005;102 (Suppl): 283–286.CrossRefGoogle ScholarPubMed
Choi, C Y H, Soltys, S G, Gibbs, I C et al. Cyberknife stereotactic radiosurgery for treatment of atypical (WHO grade II) cranial meningiomas. Neurosurgery 2010; 67 (5): 1180–1188.CrossRefGoogle ScholarPubMed
Attia, A, Chan, M D, Mott, R T et al. Patterns of failure after treatment of atypical meningioma with gamma knife radiosurgery. J Neurooncol 2012; 108 (1): 179–185.CrossRefGoogle ScholarPubMed
Rogers, L, Zhang, P, Vogelbaum, M A et al. Low-Risk Meningioma: Initial Outcomes from NRG Oncology/RTOG 0539. Int J Radiat Oncol Biol Phys 2016; 96 (5): 939–940.CrossRefGoogle Scholar
Sheehan, J P, Starke, R M, Kano, H et al. Gamma Knife radiosurgery for posterior fossa meningiomas: a multicenter study. J Neurosurg 2015; 122 (6): 1479–1489.CrossRefGoogle ScholarPubMed
Jalali, R, Loughrey, C, Baumert, B et al. High precision focused irradiation in the form of fractionated stereotactic conformal radiotherapy (SCRT) for benign meningiomas predominantly in the skull base location. Clin Oncol (R Coll Radiol) 2002; 14 (2): 103–109.CrossRefGoogle ScholarPubMed
Jang, C K, Jung, H H, Chang, J H, Chang, J W, Park, Y G, Chang, W S. Long-term results of gamma knife radiosurgery for intracranial meningioma. Brain Tumor Res Treat 2015; 3 (2): 103–107.CrossRefGoogle ScholarPubMed
Korah, M P, Nowlan, A W, Johnstone, P A S, Crocker, I R. Radiation therapy alone for imaging-defined meningiomas. Int J Radiat Oncol Biol Phys 2010; 76 (1): 181–186.CrossRefGoogle ScholarPubMed