Grade 2 meningioma and radiosurgery.
OBJECTIVE
World Health Organization Grade 2 meningiomas are aggressive tumors associated with a high recurrence rate leading to repeated surgical procedures, which can seriously worsen a patient's neurological status. Although radiosurgery is an increasingly popular technique, its role in the management of Grade 2 meningiomas has yet to be defined. In this study the authors aimed to evaluate radiosurgery in achieving control of proven tumor progression occurring after resection of Grade 2 meningioma.


METHODS
This retrospective study included consecutive patients who, between 2000 and 2012, had undergone radiosurgery for radiologically proven progression of a previously surgically treated Grade 2 meningioma.


RESULTS
Twenty-seven patients were eligible for analysis. There were 9 men and 18 women with a mean age of 59 years. The mean radiation dose was 15.2 Gy (range 12-21 Gy), and the mean target volume was 5.4 cm(3) (range 0.194-14.2 cm(3)). Thirty-four radiosurgical procedures were performed in the 27 patients. The mean progression-free survival after radiosurgery was 32.4 months among those with progression in a target irradiated volume and 26.4 months among those with progression in any intracranial meninges. With a mean follow-up of 56.4 months (range 12-108 months), the 12-, 24-, and 36-month actuarial local control rates for all patients were 75%, 52%, and 40%, respectively, and the regional control rates were 75%, 48%, and 33%. A single case of transient hemiparesis completely resolved without sequelae.


CONCLUSIONS
Radiosurgery appears to be a safe and effective treatment for the local control of delayed progression after resection of a Grade 2 meningioma. Higher radiation doses similar to those applied for malignant tumors should be recommended when possible.
Departments of 1 Neurosurgery.
Rabih
R
Aboukais
Fahed
F
Zairi
Jean-Paul
JP
Lejeune
Emile
E
Le Rhun
Maximilien
M
Vermandel
Serge
S
Blond
Patrick
P
Devos
Nicolas
N
Reyns
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery; D012189:Retrospective Studies; D055815:Young Adult
Grade 2 meningioma; oncology; radiosurgery; radiotherapy; stereotactic radiosurgery; tumor progression