title: Long-term tumor control of benign intracranial meningiomas after radiosurgery in a series of 4565 patients.
abstract: BACKGROUND
  Radiosurgery is the main alternative to microsurgical resection for benign meningiomas.
  
  
  OBJECTIVE
  To assess the long-term efficacy and safety of radiosurgery for meningiomas with respect to tumor growth and prevention of associated neurological deterioration. Medium- to long-term outcomes have been widely reported, but no large multicenter series with long-term follow-up have been published.
  
  
  METHODS
  From 15 participating centers, we performed a retrospective observational analysis of 4565 consecutive patients harboring 5300 benign meningiomas. All were treated with Gamma Knife radiosurgery at least 5 years before assessment for this study. Clinical and imaging data were retrieved from each center and uniformly entered into a database by 1 author (A.S.).
  
  
  RESULTS
  Median tumor volume was 4.8 cm³, and median dose to tumor margin was 14 Gy. All tumors with imaging follow-up < 24 months were excluded. Detailed results from 3768 meningiomas (71%) were analyzed. Median imaging follow-up was 63 months. The volume of treated tumors decreased in 2187 lesions (58%), remained unchanged in 1300 lesions (34.5%), and increased in 281 lesions (7.5%), giving a control rate of 92.5%. Only 84 (2.2%) enlarging tumors required further treatment. Five- and 10-year progression-free survival rates were 95.2% and 88.6%, respectively. Tumor control was higher for imaging defined tumors vs grade I meningiomas (P < .001), for female vs male patients (P < .001), for sporadic vs multiple meningiomas (P < .001), and for skull base vs convexity tumors (P < .001). Permanent morbidity rate was 6.6% at the last follow-up.
  
  
  CONCLUSIONS
  Radiosurgery is a safe and effective method for treating benign meningiomas even in the medium to long term.
authors.affiliation: Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany. antoniosantacroce@msn.com
authors.forename: Antonio
authors.initials: A
authors.lastname: Santacroce
authors.forename: Maja
authors.initials: M
authors.lastname: Walier
authors.forename: Jean
authors.initials: J
authors.lastname: Régis
authors.forename: Roman
authors.initials: R
authors.lastname: Liščák
authors.forename: Enrico
authors.initials: E
authors.lastname: Motti
authors.forename: Christer
authors.initials: C
authors.lastname: Lindquist
authors.forename: Andras
authors.initials: A
authors.lastname: Kemeny
authors.forename: Klaus
authors.initials: K
authors.lastname: Kitz
authors.forename: Bodo
authors.initials: B
authors.lastname: Lippitz
authors.forename: Roberto
authors.initials: R
authors.lastname: Martínez Álvarez
authors.forename: Paal-Henning
authors.initials: PH
authors.lastname: Pedersen
authors.forename: Shoji
authors.initials: S
authors.lastname: Yomo
authors.forename: Francesco
authors.initials: F
authors.lastname: Lupidi
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Dominikus
authors.forename: Philip
authors.initials: P
authors.lastname: Blackburn
authors.forename: Thomas
authors.initials: T
authors.lastname: Mindermann
authors.forename: Otto
authors.initials: O
authors.lastname: Bundschuh
authors.forename: A T C J
authors.initials: AT
authors.lastname: van Eck
authors.forename: Rolf
authors.initials: R
authors.lastname: Fimmers
authors.forename: Gerhard A
authors.initials: GA
authors.lastname: Horstmann
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden