title: Quantitative tumor volumetric responses after Gamma Knife radiosurgery for meningiomas.
abstract: OBJECT The reported tumor control rates for meningiomas after stereotactic radiosurgery (SRS) are high; however, early imaging assessment of tumor volumes may not accurately predict the eventual tumor response. The objective in this study was to quantitatively evaluate the volumetric responses of meningiomas after SRS and to determine whether early volume responses are predictive of longer-term tumor control. METHODS The authors performed a retrospective review of 252 patients (median age 56 years, range 14-87 years) who underwent Gamma Knife radiosurgery between 2002 and 2010. All patients had evaluable pre- and postoperative T1-weighted contrast-enhanced MRIs. The median baseline tumor volume was 3.5 cm(3) (range 0.2-33.8 cm(3)) and the median follow-up was 19.5 months (range 0.1-104.6 months). Follow-up tumor volumes were compared with baseline volumes. Tumor volume percent change and the tumor volume rate of change were compared at 3-month intervals. Eventual tumor responses were classified as progressed for > 15% volume change, regressed for ≤ 15% change, and stable for ± 15% of baseline volume at time of last follow-up. Volumetric data were compared with the final tumor status by using univariable and multivariable logistic regression. RESULTS Tumor volume regression (median decrease of -40.2%) was demonstrated in 168 (67%) patients, tumor stabilization (median change of -2.7%) in 67 (26%) patients, and delayed tumor progression (median increase of 104%) in 17 (7%) patients (p < 0.001). Tumors that eventually regressed had an average volume reduction of -18.2% at 3 months. Tumors that eventually progressed all demonstrated volume increase by 6 months. Transient progression was observed in 15 tumors before eventual decrease, and transient regression was noted in 6 tumors before eventual volume increase. CONCLUSIONS The volume response of meningiomas after SRS is dynamic, and early imaging estimations of the tumor volume may not correlate with the final tumor response. However, tumors that ultimately regressed tended to respond in the first 3 months, whereas tumors that ultimately progressed showed progression within 6 months.
authors.affiliation: Department of Neurosurgery, New York University Langone Medical Center, New York, New York; and 
authors.forename: Gillian
authors.initials: G
authors.lastname: Harrison
authors.affiliation: Departments of 2 Neurological Surgery and.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kano
authors.affiliation: Departments of 2 Neurological Surgery and.
authors.forename: L Dade
authors.initials: LD
authors.lastname: Lunsford
authors.affiliation: Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: John C
authors.initials: JC
authors.lastname: Flickinger
authors.affiliation: Department of Neurosurgery, New York University Langone Medical Center, New York, New York; and 
authors.forename: Douglas
authors.initials: D
authors.lastname: Kondziolka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011237:Predictive Value of Tests; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
keywords: ARC = absolute rate of change; GKRS = Gamma Knife radiosurgery; Gamma Knife; PRC = percent rate of change; SRS = stereotactic radiosurgery; brain tumor; imaging; meningioma; oncology; response; stereotactic radiosurgery