title: High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results.
abstract: OBJECTIVE
  Large skull-base meningiomas are difficult to treat due to their proximity or adherence to critical structures. We analyzed the long-term results of patients with skull-base meningiomas treated by a new approach with high-precision fractionated stereotactic radiotherapy.
  
  
  METHODS
  One hundred eighty-nine patients with benign meningiomas were treated with conformal fractionated stereotactic radiotherapy between 1985 and 1998. Patients were undergoing a course of radiotherapy either as primary treatment, following subtotal resection, or for recurrent disease. The median target volume was 52.5 mL (range, 5.2 to 370 mL). The mean radiation dose was 56.8 Gy (+/- 4.4 Gy). Follow-up examinations, including magnetic resonance imaging, were performed at 6-month intervals thereafter.
  
  
  RESULTS
  The median follow-up period was 35 months (range, 3 months to 12 years). Overall actuarial survival for patients with World Health Organization (WHO) grade I meningiomas was 97% after 5 years and 96% after 10 years. Local tumor failure was observed in three of 180 patients with WHO grade I tumors and was significantly higher in two of nine patients with WHO grade II tumors. A volume reduction of more than 50% was observed in 26 patients (14%). Preexisting cranial nerve symptoms resolved completely in 28% of the patients. Clinically significant treatment-induced toxicity was seen in 1.6% of the patients. No treatment-related deaths occurred.
  
  
  CONCLUSIONS
  The results of this study demonstrate that fractionated stereotactic radiotherapy is safe and effective in the therapy of subtotally resected or unresectable meningiomas. The overall morbidity and incidence subacute and late side effects of this conformal radiotherapy approach were low.
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, and Research Program, Radiological Diagnostics and Therapy, German Cancer Research Center, Heidelberg, Germany. j.debus@dkfz.de
authors.forename: J
authors.initials: J
authors.lastname: Debus
authors.forename: M
authors.initials: M
authors.lastname: Wuendrich
authors.forename: A
authors.initials: A
authors.lastname: Pirzkall
authors.forename: A
authors.initials: A
authors.lastname: Hoess
authors.forename: W
authors.initials: W
authors.lastname: Schlegel
authors.forename: I
authors.initials: I
authors.lastname: Zuna
authors.forename: R
authors.initials: R
authors.lastname: Engenhart-Cabillic
authors.forename: M
authors.initials: M
authors.lastname: Wannenmacher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000532:radiotherapy*; D008579:Meningioma / Q000532:radiotherapy*; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D019292:Skull Base Neoplasms / Q000532:radiotherapy*