J Neurol Surg B Skull Base 2025; 86(S 01): S1-S576
DOI: 10.1055/s-0045-1803204
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Multisession Radiosurgery Alone for Treatment of Presumed Cranial Meningiomas: 10-Year Outcomes from a Single-Institution Protocol

Akrita Bhatnagar
1   Department of Radiation Medicine, Georgetown University, Washington, District of Columbia, United States
,
Michael Carrasquilla
1   Department of Radiation Medicine, Georgetown University, Washington, District of Columbia, United States
,
Monica P. Marin
2   Department of Neurology, Columbia University, New York, United States
,
Simeng Suy
1   Department of Radiation Medicine, Georgetown University, Washington, District of Columbia, United States
,
Siviero Agazzi
3   Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
,
Amjad Anaizi
4   Department of Neurosurgery, Georgetown University, Washington, District of Columbia, United States
,
Kevin McGrail
4   Department of Neurosurgery, Georgetown University, Washington, District of Columbia, United States
,
Sean P. Collins
5   Department of Radiation Oncology, Tampa General Hospital, Florida, United States
,
Brian T. Collins
5   Department of Radiation Oncology, Tampa General Hospital, Florida, United States
,
Walter C. Jean
6   Division of Neurosurgery, Lehigh Valley Fleming Neuroscience Institute, Allentown, Pennsylvania, United States
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Purpose: Cranial meningiomas are routinely treated with surgery. Single-fraction radiosurgery is an alternative treatment option with well-established long-term outcomes data. Multisession radiosurgery is a novel treatment option with promising early results. However, mature outcomes literature does not yet exist. In this study, we report 10-year results on the efficacy and safety of five-fraction radiosurgery alone for radiographically diagnosed progressing meningiomas.

Materials/Methods: Between 2005 and 2015, all newly diagnosed patients who completed treatment on a single-institution protocol utilizing five-fraction robotic radiosurgery alone for the treatment of progressing intracranial radiographically diagnosed meningiomas were eligible for inclusion. Local control was calculated using the Kaplan–Meier method.

Results: Forty-four consecutive predominately female patients (84%) ranging in age from 33 to 85 (median: 59) with relatively small tumors that did not require surgery were included in the present study. Median gross tumor volume (GTV) was 4.05 mm3 (range: 0.94–15.4 mm3) and most tumors were located at the base of skull (66%). A median dose of 25 Gy (range: 25–35 Gy) was delivered to the GTV over a median of 7 days (range: 5–11 days). The median prescription isodose line was 82% (range: 70–90%). The median follow-up for surviving patients was 10.3 years. The 10-year local control rate was 90%. Of 16 patients (38%) who presented with a cranial nerve deficit, symptom improvement was noted in 11 patients (69%). No chronic treatment-related toxicity was noted in our small cohort.

Conclusion: The treatment of radiographically diagnosed progressing meningiomas with five-fraction robotic radiosurgery alone provides excellent local control at 10 years. Furthermore, in patients with symptomatic base of skull tumors, such treatment appears to enhance cranial nerve recovery relative to historical single fraction radiosurgery outcomes. Additional prospective research is planned to confirm these preliminary findings.



Publication History

Article published online:
07 February 2025

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