title: Stereotactic radiotherapy of meningiomas: symptomatology, acute and late toxicity.
abstract: OBJECTIVE
  Stereotactic radiosurgery (SRS) is well established in the treatment of skull base meningiomas, but this therapy approach is limited to small tumors only. The fractionated stereotactic radiotherapy (SRT) offers an alternative treatment option. This study aims at local control, symptomatology, and toxicity.
  
  
  METHODS
  Between 1997-2003, 224 patients were treated with SRT (n = 183), hypofractionated SRT (n = 30), and SRS (n = 11). 95/224 were treated with SRT/SRS alone. 129/224 patients underwent previous operations. Freedom from progression and overall survival, toxicity, and symptomatology were evaluated systematically. Additionally, tumor volume (TV) shrinkage was analyzed three-dimensionally within the planning system.
  
  
  RESULTS
  The median follow-up was 36 months (range, 12-100 months). Overall survival and freedom from progression for 5 years were 92.9% and 96.9%. Quantitative TV reduction was 26.2% and 30.3% 12 and 18 months after SRT/SRS (p < 0.0001). 95.9% of the patients improved their symptoms or were stable. Clinically significant acute toxicity (CTC III degrees ) was rarely seen (2.5%). Clinically significant late morbidity (III degrees -IV degrees ) or new cranial nerve palsies did not occur.
  
  
  CONCLUSIONS
  SRT offers an additional treatment option of high efficacy with only few side effects. In the case of large tumor size (> 4 ml) and adjacent critical structures (< 2 mm), SRT is highly recommended.
authors.affiliation: Department of Radiation Oncology, University of Giessen and Marburg, Germany. henzel@med.uni-marburg.de
authors.forename: Martin
authors.initials: M
authors.lastname: Henzel
authors.forename: Markus W
authors.initials: MW
authors.lastname: Gross
authors.forename: Klaus
authors.initials: K
authors.lastname: Hamm
authors.forename: Gunnar
authors.initials: G
authors.lastname: Surber
authors.forename: Gabriele
authors.initials: G
authors.lastname: Kleinert
authors.forename: Thomas
authors.initials: T
authors.lastname: Failing
authors.forename: Gerd
authors.initials: G
authors.lastname: Strassmann
authors.forename: Rita
authors.initials: R
authors.lastname: Engenhart-Cabillic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008579:Meningioma / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D011881:Radiotherapy, Computer-Assisted / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome