Impact of Fractionation Regimen on Local Control Following Frameless Linear Accelerator-Based Image-Guided...

Area of Science:

• Neurosurgery
• Radiation Oncology
• Oncology

Background:

• Stereotactic radiosurgery (SRS) is a primary treatment for intracranial meningioma.
• Tumor size and critical structure proximity can limit SRS applicability.
• Fractionated radiotherapy (RT) offers an alternative for complex cases.

Purpose of the Study:

• To compare local control (LC) outcomes of three stereotactic techniques for benign intracranial meningioma.
• To evaluate the efficacy of SRS, fractionated SRS, and conventionally fractionated stereotactic radiotherapy (FSRT).

Main Methods:

• Retrospective review of 543 patients with 613 meningiomas treated between 2008-2021.
• Comparison of SRS (n=211), fractionated SRS (n=170), and FSRT (n=232).
• Analysis of definitive or postoperative treatment settings, including recurrent disease.

Main Results:

• Overall 5/10/14-year LC was 97.4%/86.8%/86.8%.
• No significant difference in LC was observed between SRS, fractionated SRS, and FSRT regimens.
• Factors associated with inferior LC included skull base location, tumor volume ≥5 cc, and recurrent disease.

Conclusions:

• Stereotactic radiotherapy provides durable long-term local control for intracranial meningioma.
• Fractionation regimen did not significantly impact LC outcomes.
• Treatment decisions can be guided by clinical factors without compromising efficacy.