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Exploring the Role of Radiosurgery for Atypical Meningiomas: Addressing Suboptimal Local Control in High-Risk
Sanjeev Sreenivasan1,2, Salem Najjar2, Daniel Ma1,3
1Northwell Health Physician Partners Internal Medicine at Lake Success, Lake Success, New York.
Advances in Radiation Oncology
|February 14, 2025
Summary
Stereotactic radiosurgery (SRS) shows promise for treating high-risk atypical meningiomas, achieving an 84.6% 3-year local control rate. Hypofractionated SRS demonstrated no treatment failures in this patient group.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Oncology
Background:
- High-risk atypical meningioma treatment remains challenging with suboptimal control rates.
- Stereotactic radiosurgery (SRS) offers a precise approach with a favorable toxicity profile.
- Limited data exist on SRS efficacy for high-risk atypical meningiomas.
Purpose of the Study:
- To evaluate local control rates (LCR) in high-risk atypical meningioma patients treated with SRS.
- To analyze patterns of treatment failure after SRS for atypical meningioma.
- To compare single-fraction SRS and hypofractionated SRS (hf-SRS) outcomes.
Main Methods:
- Retrospective review of consecutive high-risk World Health Organization grade 2 meningioma patients treated with SRS (2014-2021).
- High-risk definition: residual disease or recurrence post-gross total resection.
- Analysis of local, marginal, and distant/regional failure patterns.
Main Results:
- 45 tumors in 25 patients were analyzed; 33 received single-fraction SRS, 12 received hf-SRS.
- The 3-year LCR was 84.6%; overall survival was 96.0%.
- Failures occurred locally (3 patients) or marginally (3 patients); no failures were observed in the hf-SRS group.
Conclusions:
- SRS is a promising strategy for improving local control in high-risk atypical meningiomas.
- Institutional SRS data compare favorably with fractionated radiation therapy outcomes.
- Understanding marginal failure patterns is crucial for defining clinical target volume margins.
