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Stereotactic radiosurgery of petroclival meningiomas: a multicenter study

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Abstract

Petroclival meningiomas are difficult to treat due to their intimate location with critical structures, and complete microsurgical resection is often associated with significant morbidity. In this study, we evaluate the outcomes of petroclival meningiomas treated with Gamma Knife radiosurgery (GKRS) as an adjunct to microsurgery or a primary treatment modality. A multicenter study of 254 patients with a benign petroclival meningioma was conducted through the North American Gamma Knife Consortium. One hundred and forty patients were treated with upfront radiosurgery, and 114 following surgery. Multivariate analysis was used to determine predictors of favorable defined as no tumor progression following radiosurgery and the absence of any new or worsening neurological function. At mean follow up of 71 months (range 6–252), tumor volumes increased in 9 % of tumors, remained stable in 52 %, and decreased in 39 %. Kaplan–Meier actuarial progression free survival rates at 3, 5, 8, 10, and 12 years were 97, 93, 87, 84, and 80 % respectively. At last clinical follow-up, 93.6 % of patients demonstrated no change or improvement in their neurological condition whereas 6.4 % of patients experienced progression of symptoms. Favorable outcome was achieved in 87 % of patients and multivariate predictors of favorable outcome included smaller tumor volume (OR = 0.92; 95 % CI 0.87–0.97, p = 0.003), female gender (OR 0.37; 95 % CI 0.15–0.89, p = 0.027), no prior radiotherapy (OR 0.03; 95 % CI 0.01–0.36, p = 0.006), and decreasing maximal dose (OR 0.92; 95 % CI 0.96–0.98, p = 0.010). GKRS of petroclival meningiomas achieves neurological preservation in most patients and with a high rate of tumor control.

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Abbreviations

GKRS:

Gamma Knife radiosurgery

SRS:

Stereotactic radiosurgery

MR:

Magnetic resonance

CT:

Computed tomography

IMRT:

Tintensity-modulated radiotherapy

FSRT:

Fractionated stereotactic radiotherapy

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Conflict of interest

Dr. Lunsford is a consultant for and stockholder in Elekta AB.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, 22908, USA

    Robert Starke, Dale Ding & Jason P. Sheehan

  2. University of Pittsburgh, Pittsburgh, PA, USA

    Hideyuki Kano & L. Dade Lunsford

  3. University of Pennsylvania, Philadelphia, PA, USA

    John Y. K. Lee & Michelle Alonso-Basanta

  4. University of Sherbrooke, Sherbrooke, QC, Canada

    David Mathieu

  5. Cleveland Clinic, Cleveland, OH, USA

    Gene H. Barnett, Gazanfar Rahmathulla & Wendi A. Evanoff

  6. Yale University, New Haven, CT, USA

    Veronica Chiang, James B. Yu & Judith Hess

  7. Barrow Neurological Institute, Phoenix, AZ, USA

    Peter Nakaji, Heyoung L. McBride & Norissa Honea

Authors
  1. Robert Starke
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  2. Hideyuki Kano
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  3. Dale Ding
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  4. Peter Nakaji
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  5. Gene H. Barnett
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  6. David Mathieu
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  7. Veronica Chiang
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  8. James B. Yu
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  9. Judith Hess
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  15. Michelle Alonso-Basanta
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  16. L. Dade Lunsford
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  17. Jason P. Sheehan
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Correspondence to Jason P. Sheehan.

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Starke, R., Kano, H., Ding, D. et al. Stereotactic radiosurgery of petroclival meningiomas: a multicenter study. J Neurooncol 119, 169–176 (2014). https://doi.org/10.1007/s11060-014-1470-x

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  • DOI: https://doi.org/10.1007/s11060-014-1470-x

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