Exploring the Role of Radiosurgery for Atypical Meningiomas: Addressing Suboptimal Local Control in High-Risk Patients
Purpose: Despite recent advancements in the treatment of atypical meningioma, control rates in high-risk patients continue to be suboptimal. Stereotactic radiosurgery (SRS) offers the ability to achieve improved local control (LC) with a low toxicity profile. However, available data are limited. We...
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| Format: | Article |
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Elsevier
2025-03-01
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| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109424002720 |
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| author | Sanjeev Sreenivasan, MD, MCh Salem Najjar, BA Daniel Ma, MD Sabrina L. Begley, BS Yen-Ruh Wuu, MD Zaker Rana, MD Emile Gogineni, DO Michael Schulder, MD Anuj Goenka, MD |
| author_facet | Sanjeev Sreenivasan, MD, MCh Salem Najjar, BA Daniel Ma, MD Sabrina L. Begley, BS Yen-Ruh Wuu, MD Zaker Rana, MD Emile Gogineni, DO Michael Schulder, MD Anuj Goenka, MD |
| author_sort | Sanjeev Sreenivasan, MD, MCh |
| collection | DOAJ |
| description | Purpose: Despite recent advancements in the treatment of atypical meningioma, control rates in high-risk patients continue to be suboptimal. Stereotactic radiosurgery (SRS) offers the ability to achieve improved local control (LC) with a low toxicity profile. However, available data are limited. We aimed to conduct a comprehensive review of a consecutive cohort of patients diagnosed with high-risk atypical meningioma who underwent SRS, either as a single-fraction SRS or in the hypofractionated SRS (hf-SRS), and evaluate the LC rates (LCR) with a specific emphasis on patterns of treatment failure. Methods and Materials: We identified consecutive patients diagnosed with high-risk World Health Organization grade 2 meningioma treated with SRS at a single institution between 2014 and 2021. High-risk meningioma was defined as a residual disease or recurrence after initial gross total resection. Follow-up data were analyzed to evaluate LCRs and patterns of treatment failure. We defined local failure as tumor recurrence wthin the prescription isodose line, marginal failure as recurrence within 5 mm but outside the prescription isodose line, and distant/regional failure as recurrence beyond 5 mm of the prescription isodose line but within 2 cm of the surgical cavity. Results: We identified 45 pathologically confirmed atypical meningiomas in 25 patients. Thirty-three tumors underwent single-fraction SRS, and 12 tumors received hf-SRS. The median follow-up was 36 months (range, 2-86 months). The 3-year LCR was 84.6%, and overall survival was 96.0%. Four patients with a total of 7 tumors experienced treatment failure. Failures were either local (3 patients and 3 lesions) or marginal (3 patients and 4 lesions). Patients treated with hf-SRS did not exhibit local, marginal, or distant failures. Conclusions: Our institutional data on atypical patients with meningioma treated with radiosurgery compare favorably to existing literature using fractionated radiation therapy. SRS offers a promising strategy to improve LC in this patient population, and the occurrence of marginal failure plays a role in creating clinical target volume margins. |
| format | Article |
| id | doaj-art-90050cc40df043f385937bc00c940a79 |
| institution | Kabale University |
| issn | 2452-1094 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj-art-90050cc40df043f385937bc00c940a792025-01-31T05:12:08ZengElsevierAdvances in Radiation Oncology2452-10942025-03-01103101709Exploring the Role of Radiosurgery for Atypical Meningiomas: Addressing Suboptimal Local Control in High-Risk PatientsSanjeev Sreenivasan, MD, MCh0Salem Najjar, BA1Daniel Ma, MD2Sabrina L. Begley, BS3Yen-Ruh Wuu, MD4Zaker Rana, MD5Emile Gogineni, DO6Michael Schulder, MD7Anuj Goenka, MD8Northwell Health Physician Partners Internal Medicine at Lake Success, Lake Success, New York; Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New YorkDepartment of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New YorkNorthwell Health Physician Partners Internal Medicine at Lake Success, Lake Success, New York; Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New YorkDepartment of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New YorkNorthwell Health Physician Partners Internal Medicine at Lake Success, Lake Success, New York; Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New YorkNorthwell Health Physician Partners Internal Medicine at Lake Success, Lake Success, New York; Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New YorkNorthwell Health Physician Partners Internal Medicine at Lake Success, Lake Success, New York; Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New YorkNorthwell Health Physician Partners Internal Medicine at Lake Success, Lake Success, New York; Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New YorkNorthwell Health Physician Partners Internal Medicine at Lake Success, Lake Success, New York; Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; Corresponding author: Anuj Goenka, MDPurpose: Despite recent advancements in the treatment of atypical meningioma, control rates in high-risk patients continue to be suboptimal. Stereotactic radiosurgery (SRS) offers the ability to achieve improved local control (LC) with a low toxicity profile. However, available data are limited. We aimed to conduct a comprehensive review of a consecutive cohort of patients diagnosed with high-risk atypical meningioma who underwent SRS, either as a single-fraction SRS or in the hypofractionated SRS (hf-SRS), and evaluate the LC rates (LCR) with a specific emphasis on patterns of treatment failure. Methods and Materials: We identified consecutive patients diagnosed with high-risk World Health Organization grade 2 meningioma treated with SRS at a single institution between 2014 and 2021. High-risk meningioma was defined as a residual disease or recurrence after initial gross total resection. Follow-up data were analyzed to evaluate LCRs and patterns of treatment failure. We defined local failure as tumor recurrence wthin the prescription isodose line, marginal failure as recurrence within 5 mm but outside the prescription isodose line, and distant/regional failure as recurrence beyond 5 mm of the prescription isodose line but within 2 cm of the surgical cavity. Results: We identified 45 pathologically confirmed atypical meningiomas in 25 patients. Thirty-three tumors underwent single-fraction SRS, and 12 tumors received hf-SRS. The median follow-up was 36 months (range, 2-86 months). The 3-year LCR was 84.6%, and overall survival was 96.0%. Four patients with a total of 7 tumors experienced treatment failure. Failures were either local (3 patients and 3 lesions) or marginal (3 patients and 4 lesions). Patients treated with hf-SRS did not exhibit local, marginal, or distant failures. Conclusions: Our institutional data on atypical patients with meningioma treated with radiosurgery compare favorably to existing literature using fractionated radiation therapy. SRS offers a promising strategy to improve LC in this patient population, and the occurrence of marginal failure plays a role in creating clinical target volume margins.http://www.sciencedirect.com/science/article/pii/S2452109424002720 |
| spellingShingle | Sanjeev Sreenivasan, MD, MCh Salem Najjar, BA Daniel Ma, MD Sabrina L. Begley, BS Yen-Ruh Wuu, MD Zaker Rana, MD Emile Gogineni, DO Michael Schulder, MD Anuj Goenka, MD Exploring the Role of Radiosurgery for Atypical Meningiomas: Addressing Suboptimal Local Control in High-Risk Patients Advances in Radiation Oncology |
| title | Exploring the Role of Radiosurgery for Atypical Meningiomas: Addressing Suboptimal Local Control in High-Risk Patients |
| title_full | Exploring the Role of Radiosurgery for Atypical Meningiomas: Addressing Suboptimal Local Control in High-Risk Patients |
| title_fullStr | Exploring the Role of Radiosurgery for Atypical Meningiomas: Addressing Suboptimal Local Control in High-Risk Patients |
| title_full_unstemmed | Exploring the Role of Radiosurgery for Atypical Meningiomas: Addressing Suboptimal Local Control in High-Risk Patients |
| title_short | Exploring the Role of Radiosurgery for Atypical Meningiomas: Addressing Suboptimal Local Control in High-Risk Patients |
| title_sort | exploring the role of radiosurgery for atypical meningiomas addressing suboptimal local control in high risk patients |
| url | http://www.sciencedirect.com/science/article/pii/S2452109424002720 |
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