title: Hypofractionated stereotactic radiation therapy in skull base meningiomas.
abstract: To investigate the role of hypo-fractionated stereotactic radiation treatment (HSRT) in the management of skull base meningioma. Twenty-six patients were included in the study and treated with a dose of 30 Gy in 5 fractions with volumetric modulated arc therapy (RapidArc). Eighteen patients were symptomatic before treatment. Endpoints were local toxicity and relief from symptoms. Tumors were located in anterior skull base in 4/27 cases, in middle skull base in 12/27 and in posterior skull base in 11/27. HSRT was performed as first treatment in 17 (65 %) patients, in 9 (35 %) patients it followed a previous partial resection. Median follow up was 24.5 months (range 5-57 months). clinical remission of symptoms, complete or partial, was obtained in the vast majority of patients after treatment. Out of the 18 symptomatic patients, partial remission occurred in 9 (50 %) patients and complete remission in 9 (50 %). All asymptomatic patients retained their status after treatment. No severe neurologic toxicity grade III-IV was recorded. No increase of meningioma in the same site of treatment occurred; 16 (62 %) patients had stable disease and 9 (38 %) patients had tumor reduction. The mean tumor volume after treatment was 10.8 ± 17.8 cm(3) compared with 13.0 ± 19.1 cm(3) before treatment (p = 0.02). The mean actuarial OS was 54.4 ± 2.8 months. The 1- and 2-years OS was 92.9 ± 0.7 %. HSRT proved to be feasible for these patients not eligible to full surgery or to ablative radiation therapy. Local control and durability of results suggest for a routine application of this approach in properly selected cases.
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center Rozzano Milano, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
authors.forename: Pierina
authors.initials: P
authors.lastname: Navarria
authors.affiliation: Neurosurgery Department, Humanitas Research Hospital, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Pessina
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center Rozzano Milano, Via Manzoni 56, 20089, Rozzano, Milano, Italy. luca.cozzi@humanitas.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center Rozzano Milano, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Clerici
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center Rozzano Milano, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Villa
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center Rozzano Milano, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ascolese
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center Rozzano Milano, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
authors.forename: Fiorenza
authors.initials: F
authors.lastname: De Rose
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center Rozzano Milano, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Comito
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center Rozzano Milano, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Franzese
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center Rozzano Milano, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Agostino
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center Rozzano Milano, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Lobefalo
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center Rozzano Milano, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Fogliata
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center Rozzano Milano, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Reggiori
authors.affiliation: Neurosurgery Department, Humanitas Research Hospital, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fornari
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center Rozzano Milano, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tomatis
authors.affiliation: Neurosurgery Department, Humanitas Research Hospital, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bello
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center Rozzano Milano, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology / Q000528:radiation effects / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008579:Meningioma / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy* / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D000069473:Radiation Dose Hypofractionation; D016634:Radiosurgery / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D019292:Skull Base Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Hypofractionation; Meningioma; RapidArc; Stereotactic radiation therapy