Fractionated stereotactic conformal radiotherapy for large benign skull base meningiomas.

Abstract

PURPOSE:

To assess the safety and efficacy of fractionated stereotactic radiotherapy (FSRT) for large skull base meningiomas.

METHODS AND MATERIALS:

Fifty-two patients with large skull base meningiomas aged 34-74 years (median age 56 years) were treated with FSRT between June 2004 and August 2009. All patients received FSRT for residual or progressive meningiomas more than 4 centimeters in greatest dimension. The median GTV was 35.4 cm3 (range 24.1-94.9 cm3), and the median PTV was 47.6 cm3 (range 33.5-142.7 cm3). Treatment volumes were achieved with 5-8 noncoplanar beams shaped using a micromultileaf collimator (MLC). Treatment was delivered in 30 daily fractions over 6 weeks to a total dose of 50 Gy using 6 MV photons. Outcome was assessed prospectively.

RESULTS:

At a median follow-up of 42 months (range 9-72 months) the 3-year and 5-year progression-free survival (PFS) rates were 96% and 93%, respectively, and survival was 100%. Three patients required further debulking surgery for progressive disease. Hypopituitarism was the most commonly reported late complication, with a new hormone pituitary deficit occurring in 10 (19%) of patients. Clinically significant late neurological toxicity was observed in 3 (5.5%) patients consisting of worsening of pre-existing cranial deficits.

CONCLUSION:

FSRT as a high-precision technique of localized RT is suitable for the treatment of large skull base meningiomas. The local control is comparable to that reported following conventional external beam RT. Longer follow-up is required to assess long term efficacy and toxicity, particularly in terms of potential reduction of treatment-related late toxicity.

• Authors: Giuseppe Minniti, Enrico Clarke, Luigi Cavallo, Mattia Falchetto Osti, Vincenzo Esposito, Gianpaolo Cantore, Paolo Cappabianca, Riccardo Maurizi Enrici
• Journal: Radiation oncology (London, England) (Radiat Oncol) Vol. 6 Pg. 36 (Apr 12 2011) ISSN: 1748-717X [Electronic] England
• PMID: 21486436 (Publication Type: Clinical Trial, Journal Article)

Topics

• Adult
• Aged
• Dose Fractionation, Radiation
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Meningioma (mortality, radiotherapy)
• Middle Aged
• Radiosurgery (adverse effects)
• Radiotherapy, Conformal (adverse effects)
• Skull Base Neoplasms (mortality, radiotherapy)
• Treatment Outcome