title: The Geriatric Scoring System (GSS) for Risk Stratification in Meningioma Patients as a Predictor of Outcome in Patients Treated with Radiosurgery.
abstract: BACKGROUND
  Meningiomas are the most common primary benign brain tumor. Radiosurgery (primary or adjuvant) allows excellent local control. The Geriatric Scoring System (GSS) for preoperative risk stratification and outcome prediction of patients with meningiomas has been reported previously. The GSS incorporates 8 tumor and patient parameters on admission. A GSS score greater than 16 was reported previously to be associated with a more favorable outcome. We assessed the validity of the GSS score and its influence on outcome in patients treated with Gamma-Knife radiosurgery (GKRS).
  
  
  METHODS
  Patients treated with single-session GKRS for World Health Organization grade I meningioma during 1989-2013 at the University of Virginia were reviewed. The cohort comprised 323 patients, 50.2% (n = 162) male. Median age was 56 years (29-84 years), and median follow-up was 53.6 months (6-235 months). Median tumor volume was 4.5 cm(3) (0.2-23). Median margin and maximal doses were 15 Gy (8-36) and 32.3 Gy (20-65), respectively.
  
  
  RESULTS
  Tumor volume control was achieved in 87% (n = 281), and post-GKRS clinical neurologic improvement was reported in 66.3% (n = 214). The median change in KPS was +10 (range -30 to +40). The most common complication was intermittent headaches (34.1%, n = 110) and cranial nerve deficits (14.2%, n = 46). The GSS (calculated and grouped as GSS > 16 and GSS ≤ 16) was found to correlate with different post-GKRS functional status (P < 0.0001) and tumor control (P = 0.028).
  
  
  CONCLUSIONS
  The GSS, used for risk stratification and outcome prediction in patients with meningiomas, seems valid for patients undergoing single-session GRKS. A GSS score greater than 16 is associated with a better long-term functional status and tumor control.
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA. Electronic address: oc2f@virginia.edu.
authors.forename: Or
authors.initials: O
authors.lastname: Cohen-Inbar
authors.affiliation: Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan; National Yang-Ming University, Taipei, Taiwan.
authors.forename: Cheng-chia
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: David
authors.initials: D
authors.lastname: Schlesinger
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sheehan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003389:Cranial Nerve Diseases / Q000453:epidemiology / Q000209:etiology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D005853:Geriatrics / Q000379:methods / Q000592:standards; D006261:Headache / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011237:Predictive Value of Tests; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: GSS score; Gamma knife; Meningioma; Outcome prediction