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Background <p>Stereotactic radiosurgery (SRS) for the management of small and medium-sized intracranial meningiomas is well defined. However, limited studies evaluating long-term outcomes following SRS for large-volume meningiomas (LVMs) exist. Here, we report a large single-institution experience in using upfront single-session SRS to manage LVMs.</p> Methods <p>This retrospective review included 112 patients (83 female, 74%) managed with single-session SRS for LVMs (&gt; 10&#xa0;cc) between 1987 and 2022. Exclusion criteria consisted of prior meningioma surgical resection or follow-up &lt; 2 years. Tumors were classified as supratentorial (35%) or skull-base (65%). The median tumor volume was 13&#xa0;cc (range: 10-24.7), and the median margin dose was 12&#xa0;Gy (range: 10–15). Overall, 101 (90%) patients were neurologically symptomatic at SRS.</p> Results <p>The median follow-up was 106 months (range: 24–307). Sixteen (14%) LVMs demonstrated tumor progression at a median time of 43 months (range: 7-181) following SRS. Local tumor control (LTC) rates at 3-years, 5-years, and 10-years were 98% (95%CI: 91–99), 97% (95% CI: 94–100) and 88% (95% CI: 80–96), respectively. Tumor volume &gt; 17&#xa0;cc (HR: 3.26, 95% CI: 1.17–9.08, <i>p</i> = 0.023) was significantly associated with worsened LTC. Seven (6%) patients developed peritumoral edema adverse radiation effects (AREs) at a median time of 35 months (range: 4-182) following SRS. Meningiomas located in supratentorial regions (OR: 1.11, 95% CI: 1.01–1.22, <i>p</i> = 0.031), as compared to skull base tumors, had a significantly greater risk of peritumoral edema ARE development.</p> Conclusions <p>In this select patient cohort, upfront single-session SRS provides durable long-term LTC and minimizes ARE risk for patients with LVMs.</p>

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Long-term outcomes following upfront single-session gamma knife stereotactic radiosurgery for large volume meningiomas

  • 期刊论文

  • 发表日期：

    2025年3月31日

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  • Suchet Taori,
  • Zhishuo Wei,
  • Constantinos G. Hadjipanayis,
  • Ajay Niranjan,
  • L. Dade Lunsford

摘要

Background

Stereotactic radiosurgery (SRS) for the management of small and medium-sized intracranial meningiomas is well defined. However, limited studies evaluating long-term outcomes following SRS for large-volume meningiomas (LVMs) exist. Here, we report a large single-institution experience in using upfront single-session SRS to manage LVMs.

Methods

This retrospective review included 112 patients (83 female, 74%) managed with single-session SRS for LVMs (> 10 cc) between 1987 and 2022. Exclusion criteria consisted of prior meningioma surgical resection or follow-up < 2 years. Tumors were classified as supratentorial (35%) or skull-base (65%). The median tumor volume was 13 cc (range: 10-24.7), and the median margin dose was 12 Gy (range: 10–15). Overall, 101 (90%) patients were neurologically symptomatic at SRS.

Results

The median follow-up was 106 months (range: 24–307). Sixteen (14%) LVMs demonstrated tumor progression at a median time of 43 months (range: 7-181) following SRS. Local tumor control (LTC) rates at 3-years, 5-years, and 10-years were 98% (95%CI: 91–99), 97% (95% CI: 94–100) and 88% (95% CI: 80–96), respectively. Tumor volume > 17 cc (HR: 3.26, 95% CI: 1.17–9.08, p = 0.023) was significantly associated with worsened LTC. Seven (6%) patients developed peritumoral edema adverse radiation effects (AREs) at a median time of 35 months (range: 4-182) following SRS. Meningiomas located in supratentorial regions (OR: 1.11, 95% CI: 1.01–1.22, p = 0.031), as compared to skull base tumors, had a significantly greater risk of peritumoral edema ARE development.

Conclusions

In this select patient cohort, upfront single-session SRS provides durable long-term LTC and minimizes ARE risk for patients with LVMs.