2025 Proffered Presentations
S190: MULTISESSION RADIOSURGERY ALONE FOR TREATMENT OF PRESUMED CRANIAL MENINGIOMAS: 10-YEAR OUTCOMES FROM A SINGLE INSTITUTION PROTOCOL
Akrita Bhatnagar, MD, PhD1; Michael Carrasquilla, MD1; Monica P Marin, MD2; Simeng Suy1; Siviero Agazzi, MD3; Amjad Anaizi, MD4; Kevin McGrail, MD4; Sean P Collins, MD, PhD5; Brian T Collins, MD5; Walter C Jean, MD6; 1Department of Radiation Medicine, Georgetown University, Washington, DC.; 2Department of Neurology, Columbia University, New York; 3Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida; 4Department of Neurosurgery, Georgetown University, Washington, DC.; 5Department of Radiation Oncology, Tampa General Hospital, Florida; 6Division of Neurosurgery, Lehigh Valley Fleming Neuroscience Institute, Allentown, Pennsylvania.
Purpose: Cranial meningiomas are routinely treated with surgery. Single-fraction radiosurgery is an alternative treatment option with well-established long-term outcomes data. Multisession radiosurgery is a novel treatment option with promising early results. However, mature outcomes literature does not yet exist. In this study, we report 10-year results on the efficacy and safety of 5-fraction radiosurgery alone for radiographically diagnosed progressing meningiomas.
Materials/Methods: Between 2005-2015 all newly diagnosed patients who completed treatment on a single institution protocol utilizing 5-fraction robotic radiosurgery alone for the treatment of progressing intracranial radiographically diagnosed meningiomas were eligible for inclusion. Local control was calculated using the Kaplan-Meier Method.
Results: Forty-four consecutive predominately female patients (84%) ranging in age from 33-85 (median: 59) with relatively small tumors that did not require surgery were included in the present study. Median gross tumor volume (GTV) was 4.05 mm3 (range: 0.94-15.4 mm3) and most tumors were located at the base of skull (66%). A median dose of 25Gy (range: 25Gy-35Gy), was delivered to the GTV over a median of 7 days (range: 5-11 days). The median prescription isodose line was 82% (range: 70%-90%). The median follow-up for surviving patients was 10.3 years. The 10-year local control rate was 90% (Figure 1). Of 16 patients (38%) who presented with a cranial nerve deficit, symptom improvement was noted in 11 patients (69%). No chronic treatment related toxicity was noted in our small cohort.
Conclusions: The treatment of radiographically diagnosed progressing meningiomas with 5-fraction robotic radiosurgery alone provides excellent local control at 10 years. Furthermore, in patients with symptomatic base of skull tumors, such treatment appears to enhance cranial nerve recovery relative to historical single fraction radiosurgery outcomes. Additional prospective research is planned to confirm these preliminary findings.
Figures
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Figure 1. 5-year local control was 90% at a median follow-up of 10 years