title: Meningioma of the skull base: long-term outcome after image-guided stereotactic radiotherapy.
abstract: OBJECTIVE
  The purpose of this study was to analyse the feasibility, safety, and long-term efficacy of linear accelerator-based fractionated stereotactic radiotherapy for meningiomas of the skull base. We evaluated the long-term clinical outcome of patients and identified prognostic factors after fractionated stereotactic radiotherapy.
  
  
  METHODS
  Between 10/1995 and 03/2009, 136 patients with a median age of 57 years with skull base meningioma received fractionated stereotactic radiotherapy. A total of 34 patients had a grade I meningioma, in 102 cases no histology was obtained (grade 0). Fractionated stereotactic radiotherapy was delivered as primary treatment for 57 patients and postoperatively for 79. The patients received a mean total dose of 56.95 (min/max 32.4/63)Gy.
  
  
  RESULTS
  Median follow-up was 44.9 months. Overall progression-free survival was 96.9% after 3 years, 93.8% after 5 years, and 91.5% after 10 years. Patients with unknown histology showed progression-free survival rates of 100%, 98.7%, and 93.5% at 3, 5, and 10 years and patients with biopsy-proven grade I meningioma showed rates of 100% after 3 years, 91.7% after 5 years and 85.9% after 10 years. Patients with adjuvant radiotherapy showed significantly worse progression-free survival rates than patients who had been treated with primary radiotherapy (P=0.043), progression-free survival rates were independent of tumour size. The most common acute grade I symptoms were headache, fatigue, and local alopecia. The most common chronic grade I symptoms were fatigue and headache.
  
  
  CONCLUSIONS
  This large study showed that fractionated stereotactic radiotherapy is an effective and safe treatment modality with high progression-free survival rates for intracranial meningioma. We identified "prior surgery" as significant poor prognostic factor.
authors.affiliation: Department of Radiation Oncology, Charité School of Medicine and University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Kaul
authors.affiliation: Department of Radiation Oncology, Charité School of Medicine and University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Budach
authors.affiliation: Department of Neurosurgery, Charité School of Medicine and University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Misch
authors.affiliation: Department of Neuroradiology, Charité School of Medicine and University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Wiener
authors.affiliation: Department of Radiation Oncology, Charité School of Medicine and University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Exner
authors.affiliation: Department of Radiation Oncology, Charité School of Medicine and University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: Harun.Badakhshi@charite.de.
authors.forename: H
authors.initials: H
authors.lastname: Badakhshi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008579:Meningioma / Q000532:radiotherapy*; D008875:Middle Aged; D011379:Prognosis; D016634:Radiosurgery; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000532:radiotherapy*; D025321:Surgery, Computer-Assisted; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Base du crâne; Contrôle local; Image-guided intervention; Local control; Meningioma; Méningiome; Radiothérapie guidée par l’image; Radiothérapie stéréotaxique; Skull base; Stereotactic radiotherapy