Predictors of response to Gamma Knife radiosurgery for intracranial meningiomas

Seyed Alireza Mansouri, Soroush Larjani, George Klironomos, Normand Laperriere, Michael Cusimano, Fred Gentili, Michael Schwartz, Gelareh Zadeh

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

OBJECT: In this paper, the authors' aim was to determine short-term volumetric and diametric tumor growth and identify clinical, radiological, and dosimetric predictors of adverse radiation events (AREs) following stereotactic radiosurgery (SRS) for intracranial WHO Grade I meningiomas. METHODS: This is a retrospective review of all WHO Grade I meningiomas that were treated with SRS (primary or adjuvant) between December 2005 and June 2012 at the University Health Network. Seventy-five patients had at least 24 months of both clinical and radiological follow-up and were, therefore, included in this study. Tumor growth was defined as any volumetric or diametric change greater than 10% per year. Any variation less than +10% was considered growth stability. Volumetric measurements were made using T1-weighted gadolinium-enhanced 3-T MRI scans and ITK-SNAP software. Tumor growth rates were calculated using the specific growth rate (SGR). Univariate statistics were used to identify predictors of post-SRS AREs. All statistical analyses were performed using IBM SPSS. RESULTS: Women accounted for 69.3% of patients, and the mean treatment age was 58.6 years. Median follow-up was 36.2 months. Twenty-one (28%) patients had undergone prior resection. Two (3%) patients required salvage surgical intervention following SRS. The majority of the lesions (56%) were skull base tumors. Median tumor volume and diameter were 5.2 cm3 and 27.5 mm, respectively. The absence of tumor growth was observed in 39 cases (52%) based on the volumetric measurements, while the absence of tumor growth was observed in 69 cases (92%) based on the diametric measurements. Twenty-six patients (34.6%) experienced new-onset AREs, including headache (17.3%), cranial neuropathy (10.6%), speech impairment (2.7%), tremors (2.7%), and ataxia (1.3%). Fourteen patients (18.7%) experienced new-onset edema, and 4 of these patients were symptomatic. A lower conformity index (1.24 vs 1.4) was significantly associated with the development of edema (p < 0.001 power > 0.8). Patients with meningiomas that had growth rates of more than 10% per year were more likely to experience long-term headaches after SRS (p = 0.022). CONCLUSIONS: Volume-based reporting of SRS outcomes for meningiomas may be a more accurate method given the complex morphology of some lesions. The conformity index was identified as a predictor of edema following radiosurgery.

Original languageEnglish (US)
Pages (from-to)1294-1300
Number of pages7
JournalJournal of neurosurgery
Volume123
Issue number5
DOIs
StatePublished - Nov 1 2015

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Radiosurgery
Meningioma
Growth
Edema
Neoplasms
Radiation
Headache
Cranial Nerve Diseases
Skull Base
Gadolinium
Tremor
Ataxia
Tumor Burden
Software
Magnetic Resonance Imaging
Health

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Mansouri, S. A., Larjani, S., Klironomos, G., Laperriere, N., Cusimano, M., Gentili, F., ... Zadeh, G. (2015). Predictors of response to Gamma Knife radiosurgery for intracranial meningiomas. Journal of neurosurgery, 123(5), 1294-1300. https://doi.org/10.3171/2014.12.JNS141687
Mansouri, Seyed Alireza ; Larjani, Soroush ; Klironomos, George ; Laperriere, Normand ; Cusimano, Michael ; Gentili, Fred ; Schwartz, Michael ; Zadeh, Gelareh. / Predictors of response to Gamma Knife radiosurgery for intracranial meningiomas. In: Journal of neurosurgery. 2015 ; Vol. 123, No. 5. pp. 1294-1300.
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abstract = "OBJECT: In this paper, the authors' aim was to determine short-term volumetric and diametric tumor growth and identify clinical, radiological, and dosimetric predictors of adverse radiation events (AREs) following stereotactic radiosurgery (SRS) for intracranial WHO Grade I meningiomas. METHODS: This is a retrospective review of all WHO Grade I meningiomas that were treated with SRS (primary or adjuvant) between December 2005 and June 2012 at the University Health Network. Seventy-five patients had at least 24 months of both clinical and radiological follow-up and were, therefore, included in this study. Tumor growth was defined as any volumetric or diametric change greater than 10{\%} per year. Any variation less than +10{\%} was considered growth stability. Volumetric measurements were made using T1-weighted gadolinium-enhanced 3-T MRI scans and ITK-SNAP software. Tumor growth rates were calculated using the specific growth rate (SGR). Univariate statistics were used to identify predictors of post-SRS AREs. All statistical analyses were performed using IBM SPSS. RESULTS: Women accounted for 69.3{\%} of patients, and the mean treatment age was 58.6 years. Median follow-up was 36.2 months. Twenty-one (28{\%}) patients had undergone prior resection. Two (3{\%}) patients required salvage surgical intervention following SRS. The majority of the lesions (56{\%}) were skull base tumors. Median tumor volume and diameter were 5.2 cm3 and 27.5 mm, respectively. The absence of tumor growth was observed in 39 cases (52{\%}) based on the volumetric measurements, while the absence of tumor growth was observed in 69 cases (92{\%}) based on the diametric measurements. Twenty-six patients (34.6{\%}) experienced new-onset AREs, including headache (17.3{\%}), cranial neuropathy (10.6{\%}), speech impairment (2.7{\%}), tremors (2.7{\%}), and ataxia (1.3{\%}). Fourteen patients (18.7{\%}) experienced new-onset edema, and 4 of these patients were symptomatic. A lower conformity index (1.24 vs 1.4) was significantly associated with the development of edema (p < 0.001 power > 0.8). Patients with meningiomas that had growth rates of more than 10{\%} per year were more likely to experience long-term headaches after SRS (p = 0.022). CONCLUSIONS: Volume-based reporting of SRS outcomes for meningiomas may be a more accurate method given the complex morphology of some lesions. The conformity index was identified as a predictor of edema following radiosurgery.",
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Mansouri, SA, Larjani, S, Klironomos, G, Laperriere, N, Cusimano, M, Gentili, F, Schwartz, M & Zadeh, G 2015, 'Predictors of response to Gamma Knife radiosurgery for intracranial meningiomas', Journal of neurosurgery, vol. 123, no. 5, pp. 1294-1300. https://doi.org/10.3171/2014.12.JNS141687

Predictors of response to Gamma Knife radiosurgery for intracranial meningiomas. / Mansouri, Seyed Alireza; Larjani, Soroush; Klironomos, George; Laperriere, Normand; Cusimano, Michael; Gentili, Fred; Schwartz, Michael; Zadeh, Gelareh.

In: Journal of neurosurgery, Vol. 123, No. 5, 01.11.2015, p. 1294-1300.

Research output: Contribution to journalArticle

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AU - Gentili, Fred

AU - Schwartz, Michael

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N2 - OBJECT: In this paper, the authors' aim was to determine short-term volumetric and diametric tumor growth and identify clinical, radiological, and dosimetric predictors of adverse radiation events (AREs) following stereotactic radiosurgery (SRS) for intracranial WHO Grade I meningiomas. METHODS: This is a retrospective review of all WHO Grade I meningiomas that were treated with SRS (primary or adjuvant) between December 2005 and June 2012 at the University Health Network. Seventy-five patients had at least 24 months of both clinical and radiological follow-up and were, therefore, included in this study. Tumor growth was defined as any volumetric or diametric change greater than 10% per year. Any variation less than +10% was considered growth stability. Volumetric measurements were made using T1-weighted gadolinium-enhanced 3-T MRI scans and ITK-SNAP software. Tumor growth rates were calculated using the specific growth rate (SGR). Univariate statistics were used to identify predictors of post-SRS AREs. All statistical analyses were performed using IBM SPSS. RESULTS: Women accounted for 69.3% of patients, and the mean treatment age was 58.6 years. Median follow-up was 36.2 months. Twenty-one (28%) patients had undergone prior resection. Two (3%) patients required salvage surgical intervention following SRS. The majority of the lesions (56%) were skull base tumors. Median tumor volume and diameter were 5.2 cm3 and 27.5 mm, respectively. The absence of tumor growth was observed in 39 cases (52%) based on the volumetric measurements, while the absence of tumor growth was observed in 69 cases (92%) based on the diametric measurements. Twenty-six patients (34.6%) experienced new-onset AREs, including headache (17.3%), cranial neuropathy (10.6%), speech impairment (2.7%), tremors (2.7%), and ataxia (1.3%). Fourteen patients (18.7%) experienced new-onset edema, and 4 of these patients were symptomatic. A lower conformity index (1.24 vs 1.4) was significantly associated with the development of edema (p < 0.001 power > 0.8). Patients with meningiomas that had growth rates of more than 10% per year were more likely to experience long-term headaches after SRS (p = 0.022). CONCLUSIONS: Volume-based reporting of SRS outcomes for meningiomas may be a more accurate method given the complex morphology of some lesions. The conformity index was identified as a predictor of edema following radiosurgery.

AB - OBJECT: In this paper, the authors' aim was to determine short-term volumetric and diametric tumor growth and identify clinical, radiological, and dosimetric predictors of adverse radiation events (AREs) following stereotactic radiosurgery (SRS) for intracranial WHO Grade I meningiomas. METHODS: This is a retrospective review of all WHO Grade I meningiomas that were treated with SRS (primary or adjuvant) between December 2005 and June 2012 at the University Health Network. Seventy-five patients had at least 24 months of both clinical and radiological follow-up and were, therefore, included in this study. Tumor growth was defined as any volumetric or diametric change greater than 10% per year. Any variation less than +10% was considered growth stability. Volumetric measurements were made using T1-weighted gadolinium-enhanced 3-T MRI scans and ITK-SNAP software. Tumor growth rates were calculated using the specific growth rate (SGR). Univariate statistics were used to identify predictors of post-SRS AREs. All statistical analyses were performed using IBM SPSS. RESULTS: Women accounted for 69.3% of patients, and the mean treatment age was 58.6 years. Median follow-up was 36.2 months. Twenty-one (28%) patients had undergone prior resection. Two (3%) patients required salvage surgical intervention following SRS. The majority of the lesions (56%) were skull base tumors. Median tumor volume and diameter were 5.2 cm3 and 27.5 mm, respectively. The absence of tumor growth was observed in 39 cases (52%) based on the volumetric measurements, while the absence of tumor growth was observed in 69 cases (92%) based on the diametric measurements. Twenty-six patients (34.6%) experienced new-onset AREs, including headache (17.3%), cranial neuropathy (10.6%), speech impairment (2.7%), tremors (2.7%), and ataxia (1.3%). Fourteen patients (18.7%) experienced new-onset edema, and 4 of these patients were symptomatic. A lower conformity index (1.24 vs 1.4) was significantly associated with the development of edema (p < 0.001 power > 0.8). Patients with meningiomas that had growth rates of more than 10% per year were more likely to experience long-term headaches after SRS (p = 0.022). CONCLUSIONS: Volume-based reporting of SRS outcomes for meningiomas may be a more accurate method given the complex morphology of some lesions. The conformity index was identified as a predictor of edema following radiosurgery.

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Mansouri SA, Larjani S, Klironomos G, Laperriere N, Cusimano M, Gentili F et al. Predictors of response to Gamma Knife radiosurgery for intracranial meningiomas. Journal of neurosurgery. 2015 Nov 1;123(5):1294-1300. https://doi.org/10.3171/2014.12.JNS141687