title: Stereotactic radiation therapy for benign meningioma: long-term outcome in 318 patients.
abstract: OBJECTIVE
  To investigate the long-term outcome of stereotactic-based radiation therapy in a large cohort of patients with benign intracranial meningiomas.
  
  
  METHODS
  Between 1997 and 2010, 318 patients with histologically confirmed (44.7%; previous surgery) or imaging-defined (55.3%) benign meningiomas were treated with either fractionated stereotactic radiation therapy (79.6%), hypofractionated stereotactic radiation therapy (15.4%), or stereotactic radiosurgery (5.0%), depending on tumor size and location. Local control (LC), overall survival (OS), cause-specific survival (CSS), prognostic factors, and toxicity were analyzed.
  
  
  RESULTS
  The median follow-up was 50 months (range, 12-167 months). Local control, OS, and CSS at 5 years were 92.9%, 88.7%, and 97.2%, and at 10 years they were 87.5%, 74.1%, and 97.2%, respectively. In the multivariate analysis, tumor location (P=.029) and age >66 years (P=.031) were predictors of LC and OS, respectively. Worsening of pre-existing neurologic symptoms immediately after radiation therapy occurred in up to 2%. Clinically significant acute toxicity (grade 3°) occurred in 3%. Only grade 1-2 late toxicity was observed in 12%, whereas no new neurologic deficits or treatment-related mortality were encountered.
  
  
  CONCLUSIONS
  Patients with benign meningiomas predominantly treated with standard fractionated stereotactic radiation therapy with narrow margins enjoy excellent LC and CSS, with minimal long-term morbidity.
authors.affiliation: Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, Marburg, Germany; Department of Radiation Therapy and Oncology, Johann Wolfgang Goethe University, Frankfurt, Germany. Electronic address: emmanouil.fokas@kgu.de.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Fokas
authors.affiliation: Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, Marburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Henzel
authors.affiliation: Department for Stereotactic Neurosurgery and Radiosurgery, HELIOS Klinikum Erfurt, Erfurt, Germany.
authors.forename: Gunar
authors.initials: G
authors.lastname: Surber
authors.affiliation: Department for Stereotactic Neurosurgery and Radiosurgery, HELIOS Klinikum Erfurt, Erfurt, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Hamm
authors.affiliation: Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, Marburg, Germany.
authors.forename: Rita
authors.initials: R
authors.lastname: Engenhart-Cabillic
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003071:Cognition / Q000528:radiation effects; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D015996:Survival Rate; D047368:Tumor Burden; D055815:Young Adult