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      Robotic stereotactic radiosurgery for intracranial meningiomas in elderly patients: assessment of treatment efficacy and safety

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          Abstract

          Purpose

          Stereotactic radiosurgery (SRS) has been increasingly used to treat intracranial pathologies in elderly patients. The treatment efficiency of SRS has been demonstrated in meningiomas, with excellent local control. We aimed to analyze the safety of robotic SRS in elderly patients with meningiomas.

          Methods

          We searched for patients with suspected WHO °I meningioma ≥ 60 years old, who underwent CyberKnife (CK) SRS from January 2011 to December 2021. Tumor localization was categorized using the “CLASS” algorithmic scale. Tumor response was evaluated using the Response Assessment in Neuro-Oncology (RANO) criteria for meningiomas. Adverse effects were graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 and a cox regression was performed to investigate possible predictors.

          Results

          We identified 82 patients with 102 CK-treated lesions that matched the criteria for the first SRS. The median age was 70 [IQR 64-75] years, and 24.3% of the patients were aged > 75 years. Multiple lesions (up to six) were treated in 14.1% of the SRS-sessions. A previous surgery was performed in 57.3% of lesions, with a median time interval of 41 [IQR 10 – 58] months between the initial surgical procedure and the SRS treatment. In 47.9% of cases, CLASS 3 meningiomas at high-risk locations were irradiated. Single fraction radiosurgery was applied to 62.5% of the lesions, while in the remaining cases multi-session SRS with three to five fractions was used. During the median follow-up period of 15.9 months, lesion size progression was observed in 3 cases. Karnofsky Performance Status (KPS) declined by ≥ 20 points in four patients. Adverse effects occurred in 13 patients, while only four patients had CTCAE ≥2 toxicities. Hereby only one of these toxicities was persistent. The occurrence of complications was independent of age, planned target volume (PTV), high-risk localization, and surgery before SRS.

          Conclusion

          The data indicates that SRS is a safe, efficient, and convenient treatment modality for elderly patients with meningioma, even at high-risk locations

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          Most cited references37

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          Stereotactic body radiation therapy: the report of AAPM Task Group 101.

          Stanley H. Benedict, Kamil M Yenice, David Followill … (2010)
          Task Group 101 of the AAPM has prepared this report for medical physicists, clinicians, and therapists in order to outline the best practice guidelines for the external-beam radiation therapy technique referred to as stereotactic body radiation therapy (SBRT). The task group report includes a review of the literature to identify reported clinical findings and expected outcomes for this treatment modality. Information is provided for establishing a SBRT program, including protocols, equipment, resources, and QA procedures. Additionally, suggestions for developing consistent documentation for prescribing, reporting, and recording SBRT treatment delivery is provided.
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            CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2009-2013.

            Quinn Ostrom, Haley Gittleman, Jordan Xu … (2016)
            Article 0 comments Cited 228 times – based on 0 reviews     Review now
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              An overview of meningiomas

              Robin A Buerki, Craig M. Horbinski, Timothy Kruser … (2018)
              Meningiomas are the most common primary intracranial tumor. Important advances are occurring in meningioma research. These are expected to accelerate, potentially leading to impactful changes on the management of meningiomas in the near and medium term. This review will cover the histo- and molecular pathology of meningiomas, including recent 2016 updates to the WHO classification of CNS tumors. We will discuss clinical and radiographic presentation and therapeutic management. Surgery and radiotherapy, the two longstanding primary therapeutic modalities, will be discussed at length. In addition, data from prior and ongoing investigations of other treatment modalities, including systemic and targeted therapies, will be covered. This review will quickly update the reader on the contemporary management and future directions in meningiomas.
              Article 0 comments Cited 149 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Anton Früh: URI : https://loop.frontiersin.org/people/1404579Role: Role: Role: Role: Role: Role: Role: Role:
                Bohdan Bodnar: URI : https://loop.frontiersin.org/people/2099889Role: Role: Role: Role:
                Marcel Nachbar: URI : https://loop.frontiersin.org/people/1531013Role: Role:
                Julia Gradhand: Role: Role:
                Goda Kalinauskaite: Role: Role:
                Kerstin Rubarth: Role: Role: Role: Role:
                Peter Truckenmueller: Role: Role:
                David Kaul: URI : https://loop.frontiersin.org/people/1493551Role: Role: Role: Role: Role:
                Daniel Zips: Role: Role: Role: Role:
                Peter Vajkoczy: URI : https://loop.frontiersin.org/people/764245Role: Role: Role: Role: Role: Role:
                Carolin Senger: URI : https://loop.frontiersin.org/people/806092Role: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role:
                Güliz Acker: URI : https://loop.frontiersin.org/people/734412Role: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role:
                Journal
                Journal ID (nlm-ta): Front Oncol
                Journal ID (iso-abbrev): Front Oncol
                Journal ID (publisher-id): Front. Oncol.
                Title: Frontiers in Oncology
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2234-943X
                Publication date (Electronic): 29 January 2024
                Publication date Collection: 2024
                Volume: 14
                Electronic Location Identifier: 1329696
                Affiliations
                [1] 1 Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin, Germany
                [2] 2 Berlin Institute of Health Charité Junior Digital Clinician Scientist Program, Berlin Institute of Health Biomedical Innovation Academy , Berlin, Germany
                [3] 3 Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin, Germany
                [4] 4 Insitute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin, Germany
                [5] 5 Insitute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin, Germany
                [6] 6 Berlin Institute of Health at Charité – Universitätsmedizin Berlin , Berlin, Germany
                Author notes

                Edited by: Shinji Kawabata, Osaka Medical and Pharmaceutical University, Japan

                Reviewed by: Delia Cannizzaro, Humanitas Research Hospital, Italy

                Steven D. Chang, Stanford University, United States

                Johannes Kerschbaumer, Innsbruck Medical University, Austria

                *Correspondence: Güliz Acker, gueliz.acker@ 123456charite.de

                †These authors have contributed equally to this work and share last authorship

                Article
                DOI: 10.3389/fonc.2024.1329696
                PMC ID: 10860398
                PubMed ID: 38347835
                SO-VID: be8c49f5-13e1-4251-9539-4a7cfa2d752f
                Copyright © Copyright © 2024 Früh, Bodnar, Nachbar, Gradhand, Kalinauskaite, Rubarth, Truckenmueller, Kaul, Zips, Vajkoczy, Senger and Acker
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 29 October 2023
                Date accepted : 08 January 2024
                Page count
                Figures: 4, Tables: 4, Equations: 0, References: 37, Pages: 9, Words: 4757
                Funding
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article. AF is funded by the Junior Digital Scientist Program of the Berlin Institute of Health (BIH). GA was funded by the Clinician Scientist Program of the BIH until June 2023.
                Categories
                Subject: Oncology
                Subject: Original Research
                Custom metadata
                section-in-acceptance Neuro-Oncology and Neurosurgical Oncology

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: meningioma,elderly patients,cyberknife,stereotactic radiosurgery,brain tumor
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: meningioma, elderly patients, cyberknife, stereotactic radiosurgery, brain tumor

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