Five fraction image-guided radiosurgery for primary and recurrent meningiomas

Area of Science:

• Neurosurgery
• Radiation Oncology
• Oncology

Background:

• Benign meningiomas pose treatment challenges due to size and critical structure proximity.
• Single fraction radiosurgery risks symptomatic peritumoral edema.
• Image-guided radiosurgery offers a precise treatment modality.

Purpose of the Study:

• To evaluate the efficacy and safety of five fraction image-guided radiosurgery for benign meningiomas.
• To assess treatment outcomes including tumor response and toxicity.
• To identify risk factors for post-treatment complications.

Main Methods:

• Retrospective review of 38 patients treated with five fraction radiosurgery.
• Utilized CyberKnife, a frameless robotic image-guided radiosurgery system.
• Median total dose of 25 Gy (range, 25-35 Gy) delivered over five fractions.

Main Results:

• Median follow-up of 20 months with minimal acute toxicity.
• Neurological symptoms resolved in 58.3% of patients; 64% of tumors remained stable, 36% regressed.
• Post-treatment peritumoral edema occurred in 13.2% of patients; pre-existing edema and proximity to large veins were risk factors.

Conclusions:

• Five fraction image-guided radiosurgery is well-tolerated for benign meningiomas.
• Achieved a comparable neurologic symptom response rate to standard treatments.
• Low rates of peritumoral edema and cranial nerve deficits observed; longer follow-up needed.