Gamma Knife radiosurgery for posterior fossa meningiomas: a multicenter study
| العنوان: | Gamma Knife radiosurgery for posterior fossa meningiomas: a multicenter study |
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| المؤلفون: | Gene H. Barnett, Michelle Alonso-Basanta, Norissa Honea, James B. Yu, Peter Nakaji, Veronica Chiang, L. Dade Lunsford, Robert M. Starke, Jason P. Sheehan, Heyoung McBride, John Y K Lee, Gazanfar Rahmathulla, Wendi Evanoff, David Mathieu, Judith Hess, Hideyuki Kano |
| المصدر: | Journal of Neurosurgery. 122:1479-1489 |
| بيانات النشر: | Journal of Neurosurgery Publishing Group (JNSPG), 2015. |
| سنة النشر: | 2015 |
| مصطلحات موضوعية: | Adult, Male, Adolescent, medicine.medical_treatment, Radiosurgery, Skull Base Neoplasms, Meningioma, Young Adult, Sex Factors, medicine, Humans, Child, Aged, Aged, 80 and over, Foramen magnum, business.industry, Hazard ratio, Middle Aged, Neurovascular bundle, medicine.disease, Cerebellopontine angle, Radiation therapy, Treatment Outcome, medicine.anatomical_structure, Cranial Fossa, Posterior, Tumor progression, Female, business, Nuclear medicine |
| الوصف: | OBJECT Posterior fossa meningiomas represent a common yet challenging clinical entity. They are often associated with neurovascular structures and adjacent to the brainstem. Resection can be undertaken for posterior fossa meningiomas, but residual or recurrent tumor is frequent. Stereotactic radiosurgery (SRS) has been used to treat meningiomas, and this study evaluates the outcome of this approach for those located in the posterior fossa. METHODS At 7 medical centers participating in the North American Gamma Knife Consortium, 675 patients undergoing SRS for a posterior fossa meningioma were identified, and clinical and radiological data were obtained for these cases. Females outnumbered males at a ratio of 3.8 to 1, and the median patient age was 57.6 years (range 12–89 years). Prior resection was performed in 43.3% of the patient sample. The mean tumor volume was 6.5 cm3, and a median margin dose of 13.6 Gy (range 8–40 Gy) was delivered to the tumor. RESULTS At a mean follow-up of 60.1 months, tumor control was achieved in 91.2% of cases. Actuarial tumor control was 95%, 92%, and 81% at 3, 5, and 10 years after radiosurgery. Factors predictive of tumor progression included age greater than 65 years (hazard ratio [HR] 2.36, 95% CI 1.30–4.29, p = 0.005), prior history of radiotherapy (HR 5.19, 95% CI 1.69–15.94, p = 0.004), and increasing tumor volume (HR 1.05, 95% CI 1.01–1.08, p = 0.005). Clinical stability or improvement was achieved in 92.3% of patients. Increasing tumor volume (odds ratio [OR] 1.06, 95% CI 1.01–1.10, p = 0.009) and clival, petrous, or cerebellopontine angle location as compared with petroclival, tentorial, and foramen magnum location (OR 1.95, 95% CI 1.05–3.65, p = 0.036) were predictive of neurological decline after radiosurgery. After radiosurgery, ventriculoperitoneal shunt placement, resection, and radiation therapy were performed in 1.6%, 3.6%, and 1.5%, respectively. CONCLUSIONS Stereotactic radiosurgery affords a high rate of tumor control and neurological preservation for patients with posterior fossa meningiomas. Those with a smaller tumor volume and no prior radiation therapy were more likely to have a favorable response after radiosurgery. Rarely, additional procedures may be required for hydrocephalus or tumor progression. |
| تدمد: | 1933-0693 0022-3085 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::af67d18154097b64fb13d1931c955cbfTest https://doi.org/10.3171/2014.10.jns14139Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....af67d18154097b64fb13d1931c955cbf |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19330693 00223085 |
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