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Published on: March 6, 2012
High-precision radiotherapy for meningiomas : Long-term results and patient-reported outcome (PRO)
Kerstin A Kessel1,2, Hanna Fischer3,4, Markus Oechnser3
1Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany. Kerstin.Kessel@tum.de.
Objective:
To evaluate long-term outcome after high-precision radiotherapy (RT) of meningioma patients in terms of survival and side effects.
Methods:
We analyzed 275 meningioma cases: 147 low-grade and 43 high-grade meningiomas (WHO II: n = 40, III: n = 3). In all, 85 patients had no pathologically confirmed histology but were determined as low-grade based on multimodal imaging. Surgery was performed in 183 cases. RT was delivered as either radiosurgery (RS, n = 16), fractionated stereotactic radiotherapy (FSRT, n = 241), or intensity-modulated radiation therapy (IMRT, n = 18). Of 218 patients contacted for patient-reported-outcome (PRO), 207 responded (95%).
Results:
Median follow-up was 7.2 years. For low-grade meningioma the survival rate (OS) was 97% at 3 years, 85% at 10 years, and 64% at 15 years, for atypical meningioma 91% at 3 years, 62% at 10 years, and 50% at 15 years. Local control rate (PFS) for low-grade meningioma was 91% at 3 years, 87% at 5 years, and 86% at 10 years, for atypical cases 67% at 3 years and 55% at 5 years. Of all, 3.0% of patients reported worsened or new symptoms grade ≥3 during RT and the first 6 months thereafter; 17.5% reported a deterioration after more than 2 years. We found the prognostic factors tumor volume and age significantly influencing OS and PFS.
Conclusion:
Complemented by PRO, we found long-term low toxicity rates in addition to excellent local control. Thus, due to the beneficial risk-benefit profile of benign and high-risk meningiomas, RT should be performed as adjuvant treatment and should not be postponed until tumor progression.
Insights
High-precision radiotherapy (RT) for meningioma offers excellent local control and low long-term toxicity. This treatment is recommended as adjuvant therapy, even for benign tumors, rather than delaying until progression.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Oncology
Background:
- Meningiomas are tumors arising from the meninges.
- High-precision radiotherapy (RT) is a treatment modality for meningioma.
- Long-term outcomes and side effects of RT for meningioma require evaluation.
Purpose of the Study:
- To assess the long-term survival and side effect profile of meningioma patients treated with high-precision RT.
- To determine the efficacy of RT in terms of local tumor control.
- To correlate patient-reported outcomes (PRO) with clinical data.
Main Methods:
- Analysis of 275 meningioma cases (147 low-grade, 43 high-grade).
- Treatment modalities included radiosurgery (RS), fractionated stereotactic radiotherapy (FSRT), and intensity-modulated radiation therapy (IMRT).
- Patient-reported outcomes (PRO) were collected from 207 patients (95% response rate).
Main Results:
- Overall survival (OS) rates at 15 years were 64% for low-grade and 50% for atypical meningioma.
- Progression-free survival (PFS) at 10 years was 86% for low-grade and 55% for atypical meningioma.
- Low incidence of severe side effects (≥3%) during RT and early post-RT period; 17.5% reported deterioration after 2 years. Tumor volume and age were significant prognostic factors.
Conclusions:
- High-precision RT demonstrates excellent local control and favorable long-term toxicity for meningioma.
- RT is beneficial as adjuvant treatment for both benign and high-risk meningiomas.
- Treatment should not be postponed until tumor progression due to the positive risk-benefit profile.
