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Analysis the causes of radiosurgical failure in intracranial meningiomas treated with radiosurgery
- Source :
- Clinical neurology and neurosurgery. 154
- Publication Year :
- 2016
-
Abstract
- Objectives Surgical resection is a primary indication for intracranial meningioma. Radiosurgery is also an excellent treatment modality for postoperative residual tumors, or tumors in high-risk locations, such as the skull base. Despite multimodality treatments, there are some cases in which radiosurgery fails and surgical resection or re-radiosurgery is required. However, there has not been a comprehensive study focusing on the causes of secondary treatment for local recurrence or a new mass that develops outside the target area after radiosurgery. Hence, we analyzed the causes of radiosurgical failure in patients with meningioma. Methods From 2000 to 2015, we retrospectively reviewed 1086 patients who underwent gamma knife radiosurgery (GKRS) for intracranial meningioma at the Asan Medical Center. Multiple meningiomas or tumors with a volume greater than 7000mm 3 were excluded. All patients had a minimum follow-up of 12 months. Finally, 771 patients were enrolled in this study. Clinical symptoms and brain MRI findings were assessed by neurosurgeons. When the tumor size increased and was accompanied by newly developed neurological symptoms, further management was considered (e.g. microsurgical resection and stereotactic radiosurgery). Histological analyses of the resected tumors were performed by neuropathologists. Results Among the 771 patients, tumor growth was observed in 60 patients (7.78%). Seven patients showed transient tumor growth after GKRS. These patients have been under close observation without any further treatment. Thirty patients (3.89%) underwent re-radiosurgery for tumor control. Another 23 patients underwent procedures other than re-radiosurgery; 8 underwent microsurgical resection, 3 underwent cyber knife radiosurgery (CKRS), 1 underwent radiation therapy, and 8 were closely followed-up. Three patients visited other clinics or were lost to follow-up. Of the remaining 30 patients, 22 (group 1) underwent microsurgical resection prior to their initial course of GKRS and the other 8 (group 2) were treated only with re-radiosurgery. In group 1, recurrence rates after radiosurgery were 2.47% (n=19) and 0.39% (n=3) for local and distant recurrence, respectively. In group 2, recurrence rates after radiosurgery were 0.52% (n=4) and 0.52% (n=4) for local and distant recurrence, respectively. An analysis was performed to determine the factors that may result in differences between the two groups. Of the many variables, local recurrence ( p =0.0331, Fisher's exact test) was the only significant factor. Conclusion We analyzed the causes of radiosurgical failure in meningioma patients and observed that microsurgery before radiosurgery was significantly associated with a high local recurrence rate compared with primary radiosurgery. Furthermore, the percentage of local recurrence cases that required secondary radiosurgery was as low as 2.98%. This result is comparable with that of microsurgical resection, which is the mainstay of treatment for meningioma.
- Subjects :
- Adult
Male
Reoperation
medicine.medical_specialty
Microsurgery
medicine.medical_treatment
Gamma knife radiosurgery
Radiosurgery
Meningioma
03 medical and health sciences
Young Adult
0302 clinical medicine
medicine
Meningeal Neoplasms
Humans
Tumor growth
Treatment Failure
Aged
medicine.diagnostic_test
business.industry
Magnetic resonance imaging
General Medicine
Middle Aged
medicine.disease
Surgery
Radiation therapy
Exact test
Outcome and Process Assessment, Health Care
030220 oncology & carcinogenesis
Female
Neurology (clinical)
Neoplasm Recurrence, Local
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 18726968
- Volume :
- 154
- Database :
- OpenAIRE
- Journal :
- Clinical neurology and neurosurgery
- Accession number :
- edsair.doi.dedup.....ecbb3226c4fdd3e5af716f1e2f041152