title: Adjuvant Stereotactic Radiosurgery Reduces Need for Retreatments in Patients with Meningioma Residuals.
abstract: BACKGROUND
  Radical surgical resection of cerebral meningiomas involving the dura mater of venous sinuses is challenging, and tumor residuals are frequently left after surgery. This study sought to evaluate the effect of adjuvant stereotactic radiosurgery (aSRS) on the time to significant growth of meningioma residuals requiring retreatment.
  
  
  METHODS
  A total of 119 consecutive patients (2004-2013) receiving primary surgical treatment for a meningioma in proximity to a venous structure were included. The patients were assessed retrospectively, with a focus on retreatments and mortality. Radicality of initial tumor surgery was scored using postoperative magnetic resonance imaging. Three subgroups were identified: 1) radical total resection (RTR); 2) near-total resection (NTR), followed by aSRS (NTR + aSRS); and 3) NTR but no aSRS (NTR - aSRS). In the NTR - aSRS group, intervention was initiated after radiologic (magnetic resonance imaging) findings verified growth of residual tumor, in contrast to the NTR + aSRS group, which received aSRS before regrowth. Time to first retreatment, progression-free survival (PFS), and overall survival were analyzed with the log-rank test and multiple-events Cox regression.
  
  
  RESULTS
  RTR was associated with the best prognosis. The patients in the NTR + aSRS group had significantly longer time to first retreatment compared with NTR - aSRS patients (P < 0.001). There was also a significant difference in mortality (P < 0.05) and a tendency to prolonged PFS (P = 0.07) in the NTR + aSRS group. The Cox regressions confirmed the positive effects of NTR + aSRS on time to retreatment (hazard ratio, 7.3; P < 0.01) and PFS (hazard ratio, 3.69; P = 0.055).
  
  
  CONCLUSIONS
  aSRS of meningioma residuals had a positive effect on tumor control and should be considered in patients with meningioma residuals.
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Arvid
authors.initials: A
authors.lastname: Frostell
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ramil
authors.initials: R
authors.lastname: Hakim
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Ernest
authors.initials: E
authors.lastname: Dodoo
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Georges
authors.initials: G
authors.lastname: Sinclair
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Marcus
authors.initials: M
authors.lastname: Ohlsson
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Petter
authors.initials: P
authors.lastname: Förander
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Biljana
authors.initials: B
authors.lastname: Milovac
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Lou
authors.initials: L
authors.lastname: Brundin
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden. Electronic address: mikael.svensson@ki.se.
authors.forename: Mikael
authors.initials: M
authors.lastname: Svensson
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D020380:Needs Assessment; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control; D018365:Neoplasm, Residual; D019635:Neurosurgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data; D015995:Prevalence; D016634:Radiosurgery / Q000401:mortality* / Q000706:statistics & numerical data; D018714:Radiotherapy, Adjuvant / Q000401:mortality / Q000706:statistics & numerical data; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adjuvant stereotactic radiosurgery; Meningioma in proximity to a venous structure; Tumor residual