Stereotactic radiosurgery for treatment of radiation-induced meningiomas: a multiinstitutional study

OBJECTIVERadiation-induced meningiomas (RIMs) are associated with aggressive clinical behavior. Stereotactic radiosurgery (SRS) is sometimes considered for selected RIMs. The authors investigated the effectiveness and safety of SRS for the management of RIMs.METHODSFrom 12 institutions participating in the International Radiosurgery Research Foundation, the authors pooled patients who had prior cranial irradiation and were subsequently clinically diagnosed with WHO grade I meningiomas that were managed with SRS.RESULTSFifty-two patients underwent 60 SRS procedures for histologically confirmed or radiologically suspected WHO grade I RIMs. The median ages at initial cranial radiation therapy and SRS for RIM were 5.5 years and 39 years, respectively. The most common reasons for cranial radiation therapy were leukemia (21%) and medulloblastoma (17%). There were 39 multiple RIMs (35%), the mean target volume was 8.61 ± 7.80 cm3, and the median prescription dose was 14 Gy. The median imaging follow-up duration was 48 months (range 4–195 months). RIM progressed in 9 patients (17%) at a median duration of 30 months (range 3–45 months) after SRS. Progression-free survival at 5 years post-SRS was 83%. Treatment volume ≥ 5 cm3 predicted progression (HR 8.226, 95% CI 1.028–65.857, p = 0.047). Seven patients (14%) developed new neurological symptoms or experienced SRS-related complications or T2 signal change from 1 to 72 months after SRS.CONCLUSIONSSRS is associated with durable local control of RIMs in the majority of patients and has an acceptable safety profile. SRS can be considered for patients and tumors that are deemed suboptimal, poor surgical candidates, and those whose tumor again progresses after removal.

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224 Stereotactic Radiosurgery for Intracranial Ependymomas: An International Multicenter Study

Neurosurgery ◽

10.1093/neuros/nyx417.224 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 261-261

Author(s):

Hideyuki Kano ◽

Or Cohen-Inber ◽

Jason P Sheehan ◽

David Mathieu ◽

Yan-Hua Su ◽

...

Keyword(s):

Radiation Therapy ◽

Stereotactic Radiosurgery ◽

Radiation Effects ◽

Progression Free Survival ◽

Target Volume ◽

Low Grade ◽

Intracranial Ependymoma ◽

Failed Surgery ◽

Fractionated Radiation Therapy ◽

International Multicenter Study

Abstract INTRODUCTION Stereotactic radiosurgery (SRS) is a potentially important option for patients with intracranial ependymoma. We analyzed the outcomes of intracranial ependymoma patients who underwent SRS as a part of multimodality management. METHODS Four participating centers of the International Gamma Knife Research Foundation (IGKRF) identified 74 patients who underwent SRS for 95 intracranial ependymomas. The median patient age was 21 years (range, 1.8-80). All patients had previous surgical resection of their ependymomas, 64 had previous fractionated radiation therapy, and 26 had previous chemotherapy. Forty-three patients had low-grade ependymomas (53 tumors) and 31 patients had high-grade ependymomas (42 tumors). The median radiosurgery target volume was 3.7 cc (range, 0.03-36.8) and the median margin dose was 15 Gy (range, 10–22). RESULTS >At a median follow-up of 23 months after SRS (range, 3.3-220), 37 patients died. The overall survival after SRS was 77% at 1 year, 60% at 2 years, 52% at 3 years, and 45% at 5 years. The progression-free survival after SRS was 75% at 1 year, 65% at 2 years, 53% at 3 years, and 47% at 5 years. Factors associated with better PFS included low-grade ependymoma (P = 0.021) and higher margin dose (P = 0.013). The distant tumor relapse rate after SRS was 17% at 1 year, 26% at 2 years, 37% at 3 years, and 40% at 50 years. Symptomatic adverse radiation effects developed in 9 patients (12%). CONCLUSION SRS provides another management option for patients with intracranial ependymomas that have failed surgery and radiation therapy.

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Evaluation and treatment of children with radiation-induced cerebral vasculopathy

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.7.peds19188 ◽

2019 ◽

Vol 24 (6) ◽

pp. 680-688

Author(s):

David S. Hersh ◽

Kenneth Moore ◽

Vincent Nguyen ◽

Lucas Elijovich ◽

Asim F. Choudhri ◽

...

Keyword(s):

Radiation Therapy ◽

Proton Beam ◽

Tumor Imaging ◽

Clinic Visit ◽

Surgical Patient ◽

Beam Radiation ◽

Proton Beam Radiotherapy ◽

Cranial Radiation ◽

Delayed Complication ◽

Radiation Induced

OBJECTIVEStenoocclusive cerebral vasculopathy is an infrequent delayed complication of ionizing radiation. It has been well described with photon-based radiation therapy but less so following proton-beam radiotherapy. The authors report their recent institutional experience in evaluating and treating children with radiation-induced cerebral vasculopathy.METHODSEligible patients were age 21 years or younger who had a history of cranial radiation and subsequently developed vascular narrowing detected by MR arteriography that was significant enough to warrant cerebral angiography, with or without ischemic symptoms. The study period was January 2011 to March 2019.RESULTSThirty-one patients met the study inclusion criteria. Their median age was 12 years, and 18 (58%) were male. Proton-beam radiation therapy was used in 20 patients (64.5%) and photon-based radiation therapy was used in 11 patients (35.5%). Patients were most commonly referred for workup as a result of incidental findings on surveillance tumor imaging (n = 23; 74.2%). Proton-beam patients had a shorter median time from radiotherapy to catheter angiography (24.1 months [IQR 16.8–35.4 months]) than patients who underwent photon-based radiation therapy (48.2 months [IQR 26.6–61.1 months]; p = 0.04). Eighteen hemispheres were revascularized in 15 patients. One surgical patient suffered a contralateral hemispheric infarct 2 weeks after revascularization; no child treated medically (aspirin) has had a stroke to date. The median follow-up duration was 29.2 months (IQR 21.8–54.0 months) from the date of the first catheter angiogram to last clinic visit.CONCLUSIONSAll children who receive cranial radiation therapy from any source, particularly if the parasellar region was involved and the child was young at the time of treatment, require close surveillance for the development of vasculopathy. A structured and detailed evaluation is necessary to determine optimal treatment.

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RADT-02. FACTORS ASSOCIATED WITH NEW-ONSET SEIZURES AFTER STEREOTACTIC RADIOSURGERY FOR NEWLY DIAGNOSED BRAIN METASTASES

Neuro-Oncology ◽

10.1093/neuonc/noab196.160 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi41-vi41

Author(s):

Ethan Srinivasan ◽

Emily Lerner ◽

Ryan Edwards ◽

Aden Haskell-Mendoza ◽

David Huie ◽

...

Keyword(s):

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Target Volume ◽

Newly Diagnosed ◽

Single Institution ◽

Primary Tumor Site ◽

Significant Difference ◽

Total Treatment ◽

Treatment Volume ◽

New Onset

Abstract INTRODUCTION Stereotactic radiosurgery (SRS) is a highly effective therapy for newly diagnosed brain metastases. Risk factors for new-onset seizures after SRS have not been well established. In this study, we aimed to characterize the variables predictive of seizure risk. METHODS Patients treated with SRS for newly diagnosed brain metastases were retrospectively reviewed at a single institution. Data on baseline demographics, radiation parameters, and clinical courses were collected. RESULTS 120 patients without previous seizure history were identified. Median age was 65 years (56-70.8) and baseline KPS 90 (80-90). 16 (13%) patients developed new-onset seizures within 3 months of SRS. In analyses comparing patients with and without new-onset seizures, there was no association between new-onset seizures and baseline KPS(90:80, p=0.48), prior resection (31%:28%, p=0.76), prior WBRT (6%:10%, p=1), immunotherapy or chemotherapy within 1 month (31%:21%, p=0.52 and 56%:57%, p=1), primary tumor site (p=0.07), number of lesions (2.2:3, p=0.21), cerebellar (25%:37%, p=0.41) or brainstem involvement (19%:14%, p=0.71), irradiated maximum target diameter (2.8:2.0cm p=0.191), maximum target volume (7.6:2.9 cm3 p=0.133), total dose of radiation (25:20Gy, p = 0.12), or use of fractionation (56%:35%, p=0.11). However, there was a significant difference in the total irradiated target volume (11.6 vs. 3.8 cm3, p=0.019) and a trend toward increased post-treatment seizures among patients with a total irradiated volume greater than 10cm3 (20%:9%, p=0.11, OR 2.4 [0.85-6.4]). Patients with seizures were also more likely to have received steroids (69%:34%, p=0.012) and AEDs (28%:15%, p=0.021) prior to SRS. CONCLUSIONS Our data suggest that total treatment volume is associated with new-onset seizures within 3 months of SRS. The association between seizures and exposure to steroids or AEDs prior to SRS may be a surrogate for neurologic symptoms at presentation. Patients undergoing SRS to larger volumes and necessitating prophylactic steroids or AEDs may benefit from counseling or intensification of anti-seizure therapy.

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Large Vessel Arteriopathy After Cranial Radiation Therapy in Pediatric Brain Tumor Survivors

Journal of Child Neurology ◽

10.1177/0883073818756729 ◽

2018 ◽

Vol 33 (5) ◽

pp. 359-366 ◽

Cited By ~ 9

Author(s):

Matthew Nordstrom ◽

Erin Felton ◽

Katherine Sear ◽

Benita Tamrazi ◽

Joseph Torkildson ◽

...

Keyword(s):

Radiation Therapy ◽

Brain Tumor ◽

Pediatric Brain Tumor ◽

Childhood Cancer Survivors ◽

Large Vessel ◽

Arterial Ischemic Stroke ◽

Cranial Radiation ◽

Radiation Induced ◽

Cerebral Arteriopathy ◽

Pediatric Brain

Among childhood cancer survivors, increased stroke risk after cranial radiation therapy may be caused by radiation-induced arteriopathy, but limited data exist to support this hypothesis. Herein, we assess the timing and presence of cerebral arteriopathy identified by magnetic resonance angiography (MRA) after cranial radiation therapy in childhood brain tumor survivors. In a cohort of 115 pediatric brain tumor survivors, we performed chart abstraction and prospective annual follow-up to assess the presence of large vessel cerebral arteriopathy by MRA. We identified 10 patients with cerebral arteriopathy. The cumulative incidence of arteriopathy 5 years post–cranial radiation therapy was 5.4% (CI 0.6%-10%) and 10 years was 16% (CI 4.6%-26%). One patient had an arterial ischemic stroke 2.4 years post–cranial radiation therapy in the distribution of a radiation-induced stenotic artery. We conclude that large vessel arteriopathies can occur within a few years of cranial radiation therapy and can become apparent on MRA in under a year.

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MNG-03 PD-L1 EXPRESSION, PATIENT PROGNOSIS AND INITIAL WHO GRADE IN GRADE II/III MENINGIOMA

Neuro-Oncology Advances ◽

10.1093/noajnl/vdz039.162 ◽

2019 ◽

Vol 1 (Supplement_2) ◽

pp. ii36-ii36

Author(s):

Dai Kamamoto ◽

Hikaru Sasaki ◽

Ryota Sasao ◽

Takumi Fujiyama ◽

Kazunari Yoshida

Keyword(s):

Radiation Therapy ◽

Progression Free Survival ◽

Who Grade ◽

Free Survival ◽

Specific Data ◽

Tumor Immune Evasion ◽

Significant Difference ◽

Grade Ii ◽

Patient Prognosis ◽

The Relationship

Abstract The optimal treatment for grade II/III meningioma is operation with or without radiation therapy. However, their natural course is sometimes aggressive with high recurrent rate. There is no effective treatment other than operation and radiation therapy, therefore, a new therapeutic strategy for grade II/III meningioma is urgently required.PD-1 and PD-L1 play important roles as immune-checkpoint mediators within tumor microenvironment and the antibodies to these molecules are now approved for the treatment of various kinds of cancers. In Japan, anti-PD-1 antibody and anti-CTLA-4 antibody are approved for unresectable melanoma or advanced / recurrent non-small cell lung cancer and their high effectiveness has been reported. We investigated the expression of PD-L1 (clone:28-8) in 51 cases of grade II/III meningioma by immunohistochemistry and analyzed the relationship between the expression with overall survival, progression free survival and initial WHO grade. For now, we have evaluated 25 cases of PD-L1 immunohistochemistry and PD-L1 showed positivity in 15 cases. There is no correlation observed between PD-L1 expression and patients’ prognosis. Although it does not reach a significant difference, the WHO grade at the time of initial operation tends to be high in those with high PD-L1 staining rate.Similar studies that were previously reported did not use antibodies targeting clone 28-8, which was used as a companion diagnosis for nivolumab administration, but “Correlation between PD-L1 expression and WHO grade”, or “PD-L1 expression is an independent prognostic factor” have been reported. In our investigation, which was using antibodies for companion diagnosis, PD-L1 was positive in more than half of Grade II / III meningiomas and it also related to WHO grade. These results suggest the possibility that tumor immune evasion mechanisms are also working in meningiomas. At the conference, we will report it with the specific data from all cases with a literature review.

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Repeated CyberKnife stereotactic body radiation therapy in hepatocellular carcinoma

Radiation Oncology ◽

10.1186/s13014-020-1457-z ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

Jing Sun ◽

Can Ouyang ◽

Xiaoyun Chang ◽

Aimin Zhang ◽

Quan Wang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Radiation Therapy ◽

Stereotactic Body Radiation Therapy ◽

Medical Center ◽

Survival Rates ◽

Progression Free Survival ◽

Interval Time ◽

Stereotactic Body Radiation ◽

Kaplan Meier ◽

Radiation Induced

Abstract Background To explore the survival and side effects of repeated CyberKnife stereotactic body radiation therapy (CK-SBRT) on hepatocellular carcinoma patients. Methods 24 HCC patients were collected at The Fifth Medical Center of PLA General Hospital from November 2011 to July 2016. They received second-course CK-SBRT with a prescribed dose of 50(48–55) Gy/5-8fx, and a single dose of 10 (7–11) Gy/fx. Cumulative overall survival rates (OS), progression-free survival rates (PFS) and local control rates (LC) were calculated by Kaplan-Meier method. Results All patients finished their radiotherapy plans. The 1-,2- and 3-year cumulative OS rate were 95.8,81.1 and 60.8%. The 1-,2- and 3-year LC rate were 95.5,90.7 and 90.7%, respectively. The 1-, 2- and 3-year PFS were 74.8, 49.2 and 39.4%, respectively. 16 patients complained of fatigue during second-course therapy, 2 patients showed Grade 2 gastrointestinal reaction, 1 patient was diagnosed radiation-induced liver disease and none died. PFS was significantly higher in the interval time < 12 months group than in the interval time ≥ 12 months group (p = 0.030). Conclusions It is preliminarily believed that re-CK-SBRT is an effective and safe treatment for HCC patients, but the treatment criteria should be strictly controlled.

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The role of radiosurgery in the management of WHO Grade II and III intracranial meningiomas

Neurosurgical FOCUS ◽

10.3171/2013.9.focus13364 ◽

2013 ◽

Vol 35 (6) ◽

pp. E16 ◽

Cited By ~ 24

Author(s):

Dale Ding ◽

Robert M. Starke ◽

John Hantzmon ◽

Chun-Po Yen ◽

Brian J. Williams ◽

...

Keyword(s):

Radiation Therapy ◽

Stereotactic Radiosurgery ◽

Case Reports ◽

Case Series ◽

External Beam Radiation ◽

Beam Radiation ◽

Who Grade ◽

Intracranial Meningiomas ◽

Grade Ii ◽

Grade Iii

Object WHO Grade II and III intracranial meningiomas are uncommon, but they portend a significantly worse prognosis than their benign Grade I counterparts. The mainstay of current management is resection to obtain cytoreduction and histological tissue diagnosis. The timing and benefit of postoperative fractionated external beam radiation therapy and stereotactic radiosurgery remain controversial. The authors review the stereotactic radiosurgery outcomes for Grade II and III meningiomas. Methods A comprehensive literature search was performed using PubMed to identify all radiosurgery series reporting the treatment outcomes for Grade II and III meningiomas. Case reports and case series involving fewer than 10 patients were excluded. Results From 1998 to 2013, 19 radiosurgery series were published in which 647 Grade II and III meningiomas were treated. Median tumor volumes were 2.2–14.6 cm3. The median margin doses were 14–21 Gy, although generally the margin doses for Grade II meningiomas were 16–20 Gy and the margin doses for Grade III meningiomas were 18–22 Gy. The median 5-year PFS was 59% for Grade II tumors and 13% for Grade III tumors, which may have been affected by patient age, prior radiation therapy, tumor volume, and radiosurgical dose and timing. The median complication rate following radiosurgery was 8%. Conclusions The current data for radiosurgery suggest that it has a role in the management of residual or recurrent Grade II and III meningiomas. However, better studies are needed to fully define this role. Due to the relatively low prevalence of these tumors, it is unlikely that prospective studies will be feasible. As such, well-designed retrospective analyses may improve our understanding of the effect of radiosurgery on tumor recurrence and patient survival and the incidence and impact of treatment-induced complications.

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Indications and Efficacy of Gamma Knife Stereotactic Radiosurgery for Recurrent Glioblastoma: 2 Decades of Institutional Experience

Neurosurgery ◽

10.1227/neu.0000000000001344 ◽

2016 ◽

Vol 80 (1) ◽

pp. 129-139 ◽

Cited By ~ 14

Author(s):

Brandon S. Imber ◽

Ishan Kanungo ◽

Steve Braunstein ◽

Igor J. Barani ◽

Shannon E. Fogh ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Gamma Knife ◽

Proportional Hazards ◽

Symptomatic Treatment ◽

Target Volume ◽

Recurrent Glioblastoma ◽

Target Range ◽

Kaplan Meier ◽

Treatment Volume ◽

Gamma Knife Stereotactic Radiosurgery

Abstract BACKGROUND: The role of stereotactic radiosurgery (SRS) for recurrent glioblastoma and the radionecrosis risk in this setting remain unclear. OBJECTIVE: To perform a large retrospective study to help inform proper indications, efficacy, and anticipated complications of SRS for recurrent glioblastoma. METHODS: We retrospectively analyzed patients who underwent Gamma Knife SRS between 1991 and 2013. We used the partitioning deletion/substitution/addition algorithm to identify potential predictor covariate cut points and Kaplan-Meier and proportional hazards modeling to identify factors associated with post-SRS and postdiagnosis survival. RESULTS: One hundred seventy-four glioblastoma patients (median age, 54.1 years) underwent SRS a median of 8.7 months after initial diagnosis. Seventy-five percent had 1 treatment target (range, 1-6), and median target volume and prescriptions were 7.0 cm3 (range, 0.3-39.0 cm3) and 16.0 Gy (range, 10-22 Gy), respectively. Median overall survival was 10.6 months after SRS and 19.1 months after diagnosis. Kaplan-Meier and multivariable modeling revealed that younger age at SRS, higher prescription dose, and longer interval between original surgery and SRS are significantly associated with improved post-SRS survival. Forty-six patients (26%) underwent salvage craniotomy after SRS, with 63% showing radionecrosis or mixed tumor/necrosis vs 35% showing purely recurrent tumor. The necrosis/mixed group had lower mean isodose prescription compared with the tumor group (16.2 vs 17.8 Gy; P = .003) and larger mean treatment volume (10.0 vs 5.4 cm3; P = .009). CONCLUSION: Gamma Knife may benefit a subset of focally recurrent patients, particularly those who are younger with smaller recurrences. Higher prescriptions are associated with improved post-SRS survival and do not seem to have greater risk of symptomatic treatment effect.

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Long-term effects of cranial irradiation for childhood malignancy on sleep in adulthood

Acta Endocrinologica ◽

10.1530/eje.0.1500503 ◽

2004 ◽

pp. 503-510 ◽

Cited By ~ 32

Author(s):

EJ Van Someren ◽

J Swart-Heikens ◽

E Endert ◽

PH Bisschop ◽

DF Swaab ◽

...

Keyword(s):

Radiation Therapy ◽

Brain Tumours ◽

Cranial Irradiation ◽

High Dose ◽

Serum Concentrations ◽

Healthy Individuals ◽

Long Term Effects ◽

Cranial Radiation ◽

Serum Gh

BACKGROUND: Cranial radiation therapy (CRT) is required for successful treatment of a variety of brain tumours in childhood. OBJECTIVE: To investigate whether childhood CRT leads to altered sleep-wakefulness organization in adulthood, and to identify the determinants of such alterations. SUBJECTS AND METHODS: Subjective (questionnaires) and objective (actigraphy) measures of circadian rhythmicity and sleep were assessed in 25 individuals, 8-29 years after CRT for medulloblastoma (n=17) or other intracranial tumours (n=8), and in a group of 34 age-matched healthy individuals. Serum GH peak during insulin-induced hypoglycaemia and serum concentrations of prolactin and leptin (expressed per fat mass) were determined in the CRT group. RESULTS: The CRT group showed a markedly increased sleep duration (8.66 h, compared with 7.66 h in controls). In addition, the sleep-wake rhythm showed greater amplitude and less fragmentation, and less tolerance for alterations in the timing of sleep. Regression analysis showed both radiation dosage and neuroendocrine status to be determinants of sleep changes, suggesting that some of the alterations may be normalized with hormone supplementation. CONCLUSION: The present study shows that high-dose cranial radiation therapy in childhood is associated with objective and subjective changes in the sleep-wake rhythm in adulthood.

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Stereotactic Radiosurgery for Intracranial Noncavernous Sinus Benign Meningioma: International Stereotactic Radiosurgery Society Systematic Review, Meta-Analysis and Practice Guideline

Neurosurgery ◽

10.1093/neuros/nyaa169 ◽

2020 ◽

Vol 87 (5) ◽

pp. 879-890 ◽

Cited By ~ 3

Author(s):

Marcello Marchetti ◽

Arjun Sahgal ◽

Antonio A F De Salles ◽

Marc Levivier ◽

Lijun Ma ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Meta Analysis ◽

Progression Free Survival ◽

Intracranial Meningioma ◽

Evidence Based ◽

Cochrane Central Register ◽

Benign Meningioma ◽

Central Register ◽

Prescription Dose ◽

Level I

Abstract BACKGROUND Stereotactic radiosurgery (SRS) for benign intracranial meningiomas is an established treatment. OBJECTIVE To summarize the literature and provide evidence-based practice guidelines on behalf of the International Stereotactic Radiosurgery Society (ISRS). METHODS Articles in English specific to SRS for benign intracranial meningioma, published from January 1964 to April 2018, were systematically reviewed. Three electronic databases, PubMed, EMBASE, and the Cochrane Central Register, were searched. RESULTS Out of the 2844 studies identified, 305 had a full text evaluation and 27 studies met the criteria to be included in this analysis. All but one were retrospective studies. The 10-yr local control (LC) rate ranged from 71% to 100%. The 10-yr progression-free-survival rate ranged from 55% to 97%. The prescription dose ranged typically between 12 and 15 Gy, delivered in a single fraction. Toxicity rate was generally low. CONCLUSION The current literature supporting SRS for benign intracranial meningioma lacks level I and II evidence. However, when summarizing the large number of level III studies, it is clear that SRS can be recommended as an effective evidence-based treatment option (recommendation level II) for grade 1 meningioma.

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