| Clinical Outcome of Gamma-Knife Radiosurgery for Large-Sized (>8,000mm3) Benign Meningioma |
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Joon Ho Byun, Doh Hoon Kwon, Do Hee Lee, Jeong Hoon Kim, Chang Jin Kim |
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Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea |
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| Abstract |
Introduction: Meningiomas, which account for 15% of intracranial neoplasm arising in adults, are generally benign and slow
growing tumors. The trend to treat meningiomas with lower radiation doses theoretically permits patients with larger lesions to
be considered for gamma knife radiosurgery (GKRS). We retrospectively analyze large meningioma cases for indication, radiosurgical results, and complications.
Method: A retrospective review was performed for patients with large sized meningioma (volume ＞8,000mm3
) who underwent
GKRS during December 1990 to September 2012. In total 72 patients were enrolled. With the exclusion of 5 atypical meningiomas
and 2 anaplastic meningiomas, 65 benign meningioma patients with contributing factors to tumor control (variable : gender, age,
underwent prior surgery or not, tumor location, tumor volume, radiation dose) were analyzed.
Result: There were 16 male patients and 49 female patients. Mean age was 53.6 years. There were 19 supratentorial tumors and
46 cases of skull base meningiomas. Mean tumor volume was 12,528mm3
, mean marginal radiation dose (50% isodose line)
was 13.1Gy. Mean follow up duration was 78 months. A total of 51 patients (78.4%) achieved disease control and 14 (21.5%) patients showed disease progression during follow up. The 1-, 3-, 5- year tumor control rate was 98.46%, 90.2% and 80%, respectively. Multivariate analysis found that patients who underwent surgery prior to GKRS as negative factor for tumor control
rate (hazard ratio : 3.979, 95% CI 1.07-14.75, p=0.039). Patients who underwent microsurgery prior to GKRS had a lower mean
age (47 vs. 59 years). Comparing disease control group to disease progression group, there were no significant differences noted between the disease control and disease progression groups in terms of age, sex, tumor location, tumor volume and radiation
dose. The disease progression group, however, had a significantly higher portion of patients who underwent surgery prior to
GKRS. Four cases (6.15% of total ; one of decreased visual acuity, one of facial weakness, and two of cranial nerve palsy) with
permanent complications were noted after GKRS. Four patients required a short-course of steroids to treat peritumoral edema.
Conclusion
Tumor control rate of GKRS for large-sized meningioma is favorable. Its complication rate is low. GKRS should be
considered as a possible first line treatment strategy for large sized meningioma in selected patients. |
| Key Words:
Large size, Meningioma, Gamma knife radiosurgery, Complication. |
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