title: Linac-based stereotactic radiotherapy and radiosurgery in patients with meningioma.
abstract: BACKGROUND
  It was our purpose to analyze long-term clinical outcome and to identify prognostic factors after Linac-based fractionated stereotactic radiotherapy (Linac-based FSRT) and stereotactic radiosurgery (SRS) in patients with intracranial meningiomas.
  
  
  METHODS
  Between 10/1995 and 03/2009, 297 patients with a median age of 59 years were treated with FSRT for intracranial meningioma. 50 patients had a Grade I meningioma, 20 patients had a Grade II meningioma, 12 patients suffered from a Grade III tumor, and in 215 cases no histology was obtained (Grade 0). Of the 297 patients, 144 underwent FSRT as their primary treatment and 158 underwent postoperative FSRT. 179 patients received normofractionated radiotherapy (nFSRT), 92 patients received hypofractionated FSRT (hFSRT) and 26 patients underwent SRS. Patients with nFSRT received a mean total dose of 57.31 ± 5.82 Gy, patients with hFSRT received a mean total dose of 37.6 ± 4.4 Gy and patients who underwent SRS received a mean total dose of 17.31 ± 2.58 Gy.
  
  
  RESULTS
  Median follow-up was 35 months. Overall progression free survival (PFS) was 92.3% at 3 years, 87% at 5 years and 84.1% at 10 years. Patients with adjuvant radiotherapy showed significantly better PFS-rates than patients who had been treated with primary radiotherapy. There was no significant difference between PFS-rates of nFSRT, hFSRT and SRS patients. PFS-rates were independent of tumor size. Patients who had received nFSRT showed less acute toxicity than those who had received hFSRT. In the Grade 0/I group the rate of radiologic focal reactions was significantly lower than in the atypical/malignant histology group.
  
  
  CONCLUSIONS
  This large study showed that FSRT is an effective and safe treatment modality with high PFS-rates for intracranial meningioma. We identified "pathological grading" and and "prior surgery" as significant prognostic factors.
authors.affiliation: Department of Radiation Oncology, Charité School of Medicine and University Hospital, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. David.Kaul@charite.de.
authors.forename: David
authors.initials: D
authors.lastname: Kaul
authors.forename: Volker
authors.initials: V
authors.lastname: Budach
authors.forename: Reinhard
authors.initials: R
authors.lastname: Wurm
authors.forename: Arne
authors.initials: A
authors.lastname: Gruen
authors.forename: Lukas
authors.initials: L
authors.lastname: Graaf
authors.forename: Piet
authors.initials: P
authors.lastname: Habbel
authors.forename: Harun
authors.initials: H
authors.lastname: Badakhshi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D016634:Radiosurgery; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D055815:Young Adult