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Single Dose versus Fractionated Stereotactic Radiotherapy for Meningiomas

  • Simon S. Lo (a1), Kwan H. Cho (a1), Walter A. Hall (a1) (a2), Ronald J. Kossow (a1), Wilson L. Hernandez (a1), Kim K. McCollow (a1), Bruce J. Gerbi (a1), Patrick D. Higgins (a1), Chung K. Lee (a1) and Kathryn E. Dusenbery (a1)...
  • Please note a correction has been issued for this article.

Abstract

Objective:

To evaluate the safety and efficacy of stereotactic radiosurgery (SRS) compared to fractionated stereotactic radiation therapy (FSRT) for meningiomas treated over a seven year period.

Methods and materials:

Of the 53 patients (15 male and 38 female) with 63 meningiomas, 35 were treated with SRS and the 18 patients with tumors adjacent to critical structures or with large tumors were treated with FSRT. The median doses for the SRS and the FSRT groups were 1400 cGy (500- 4500 cGy) and 5400 cGy (4000-6000 cGy) respectively. Median target volumes for SRS and FSRT were 6.8 ml and 8.8 ml respectively. The median follow-up for the SRS and FSRT groups were 38 months (4.1-97 months) and 30.5 months (6.0-63 months) respectively.

Results:

The five-year tumor control probability (TC) for benign versus atypical meningiomas were 92.7% vs. 31% (P=.006). The three-year TC were 92.7% vs. 93.3% for SRS vs. FSRT groups respectively (P=.62). For benign meningiomas, the three-year TC were 92.9% vs. 92.3% for the SRS group (29 patients) vs. FSRT group (14 patients) respectively (P=.77). Two patients in the SRS group and one in the FSRT group developed late complications.

Conclusion:

Preliminary data suggest that SRS is a safe and effective treatment for patients with benign meningiomas. Fractionated stereotactic radiation therapy with conventional fractionation appeared to be an effective and safe treatment alternative for patients not appropriate for SRS. A longer follow-up is required to determine the long-term efficacy and the toxicity of these treatment modalities.

RÉSUMÉ: Objectif:

Évaluer la sécurité et l.efficacité de la radiochirurgie stéréotaxique (RCS) comparée à la radiothérapie stétéotaxique fractionnée (RTSF) dans le traitement des méningiomes sur une période de sept ans.

Méthodes et matériels:

Parmi les 53 patients (15 hommes et 38 femmes) atteints de 63 méningiomes, 35 ont été traités par RCS et 18, dont la tumeur était adjacente à des structures critiques ou était volumineuse, ont été traités par RTSF. Les doses médianes pour le groupe RCS et le groupe RTSF étaient de 1400 cGy (500 à 4500 cGy) et 5400 cGy (4000 à 6000 cGy) respectivement. Les volumes cibles médians pour les groupes RCS et RTSF étaient de 6,8 ml et 8,8 ml respectivement. Le suivi médian pour les groupes RCS et RTSF étaient de 38 (4,1 à 97) mois et 30,5 (6,0 à 63) mois respectivement.

Résultats:

La probabilité de contrôle tumoral (CT) à cinq ans, s.il s.agissait de méningiomes bénins plutôt qu.atypiques, était de 92,7% versus 31% (P = 0,006). Le CT à trois ans était de 92,7% versus 93,3% pour les groupes RCS et RTSF respectivement (P = 0,62). Pour les méningiomes bénins, le CT à trois ans était de 92,9% pour le groupe RCS (29 patients) versus 92,3% pour le groupe RTSF (14 patients) (P = 0,77). Deux patients du groupe RCS et un patient du groupe RTSF ont présenté des complications tardives.

Conclusions:

Les données préliminaires suggèrent que la RCS est un mode de traitement sûr et efficace pour les patients porteurs de méningiomes bénins. La RTSF avec fractionnement conventionnel semble être un traitement alternatif efficace et sûr pour les patients chez qui la RCS n.est pas appropriée. Un suivi plus long est nécessaire pour déterminer l.efficacité à long terme et la toxicité de ces modalités de traitement.

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