Abstract
Bu çalışmada birimimizde CyberKnife-M6 (CK-M6) cihazı ile stereotaktik radyoterapi (SRT) uygulanan meningiomalı hastaların etkinlik ve dozimetrik açıdan değerlendirilmesi amaçlandı. Ocak 2019-Şubat 2022 arasında 31 lezyon/26 olgu tedavi edildi ve Haziran 2022’de ortanca 12 ay (1-40) izlem ile değerlendirildi. Ortanca yaş 56 (21-84), ortanca KPS 90 (40-100) ve erkek/kadın oranı 9/17 idi. Tanıda 4 olguda multipl, 22 olguda soliter lezyon vardı. En az bir kez cerrahi uygulanan 17 olgunun %65’i grad I, %35’i grad II meningiom tanısı almıştı. Ortanca Ki-67 %2.5 (% 0,8-35) idi. Beş olguda RT öyküsü vardı. Tanıdan SRT’ye kadar geçen süre 28 ay (1-244) idi. SRT öncesi ortanca çap 22 mm (6-50) olup planlama hedef volüm 8,24 cc (0,47- 63,99) idi. Ortanca 25 Gy/5 fraksiyon (13-27 Gy/1-5 fx), ortanca 18 dk (13-25) tedavi süresi ile uygulandı. Hiçbir olguda geç yan etki ve yeni nörolojik defisit gözlenmedi. Ortanca 3 ayda (1-8), parsiyel yanıt %16, stabil yanıt %76 bulundu. Son değerlendirmede %88 olguda lokal kontrol sağlanmıştı. Ortalama ve 2 yıl genel sağkalım (GSK) 38,5 ay ve %96,2 bulundu. Tek değişkenli analizde, GSK açısından KPS ≥ 80 olması (1 yıl %100 vs %80, p=0,04) ve soliter lezyon varlığı (1 yıl %100 vs %66,7, p=0,006) anlamlı bulundu. CK-M6 hasta uyumunu artırmakta, aynı zamanda tedavi süresi ve vücut dozunu azaltarak ikincil kanser riskini azaltmaktadır. Olgularımızda %88 lokal kontrol elde edilmiş olup CK-M6 bazlı SRT etkin, güvenli ve konforlu bulunmuştur.
Ethical Statement
Çalışma yerel etik kurul tarafından onaylandı (10.10.2023, 2023-19/2)
References
- 1. Ostrom QT, Price M, Neff C, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2015-2019. Neuro-Oncology, 2022, 24 (S5): v1-v95.
- 2. Goldbrunner R, Stavrinou P, Jenkinson MD, et al. EANO guideline on the diagnosis and management of meningiomas. Neuro-Oncology, 2021, 23 (11): 1821-1834.
- 3. Fatima N, Meola A, Pollom EL, et al. Stereotactic radiosurgery versus stereotactic radiotherapy in the management of intracranial meningiomas: a systematic review and meta-analysis. Neurosurg Focus, 2019, 46(6): E2.
- 4. Buatti JS, Buatti JM, Yaddanapudi S, et al. Stereotactic radiotherapy of appropriately selected meningiomas and metastatic brain tumor beds with gamma knife icon versus volumetric modulated arc therapy. J Appl Clin Med Phys, 2020, 21 (12): 246-252.
- 5. Alfredo C, Carolin S, Guliz A, et al. Normofractionated stereotactic radiotherapy versus CyberKnife-based hypofractionation in skull base meningioma. A German and Italian pooled cohort analysis. Radiation Oncology, 2019, 14 (1): 201.
- 6. Manabe Y, Murai T, Ogino H, et al. CyberKnife stereotactic radiosurgery and hyporactionated stereotactic radiotherapy as first-line treatments for imaging-diagnosed intracranial meningiomas. Neurol Med Chir (Tokyo), 2017, 57 (12): 627-633
- 7. Schuler E, Lo A, Chuang CF, et al. Clinical impact of the VOLO optimizer on treatment plan quaility and clinical treatment efficacy for CyberKnife. J App Clin Med Phys, 2020, 21 (5): 38-47.
- 8. Shaw E, Scott C, Souhami L, et al. Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys, 2000, 47 (2): 291-8.
- 9. Benedict SH, Yenice KM, Followill D, et al. Report no. 101- Stereotactic body radiation therapy: The report of AAPM Task Group 101, Medical Physics, 2010, 37, 4078-4101.
- 10. Dieterich S, Cavedon C, Chuang CF, et al. Report No. 135 – report of AAPM TG 135: Quality assurance for robotic radiosurgery. Medical Physics, 2011, 38, 2914-2936.
- 11. Wujanto C, Chan TY, Soon YY, Vellayappan B. Should adjuvant radiotherapy be used in atypical meningioma (WHO grade 2) following gross total resection? A systematic review and Meta-analysis. Acta Oncol, 2022, 61 (9): 1075-1083.
- 12. Jenkinson MD, Javadpour M, Haylock BJ, et al. The ROAM/EORTC-1308 trial: radiation versus observation following surgical resection of atypical meningioma: study protocol for a randomised controlled trial. Trials, 2015, 16: 519.
- 13. Rydzewski NR, Lesniak MS, Chandler JP, et al. Gross total resection and adjuvant radiotherapy most signidicant predictors of improved survival in patients with atypical meningioma. Cancer, 2018, 124 (4): 734-42.
- 14. Patibandla MR, Lee CC, Tata A, et al. Stereotactic radiosurgery for WHO grade I posterior fossa meningiomas: long-term outcomes with volumetric evaluation. J Neurosurg, 2018, 129 (5): 1249-1259.
- 15. Wegner RE, Hasan S, Abel S, et al. Linear accelerator-based stereotactic radiotherapy for low-grade meningiomas: improved local control with hypofractionation. J Cent Nerv Syst Dis, 2019, 11: 1179573519843880.
- 16. Milano MT, Sharma M, Soltys SG, et al. Radiation-induced edema after single-fraction or multifraction stereotactic radiosurgery for meningioma: a critical review. Int J radiat Oncol, Biol, Phys, 2018, 101(2): 344-357.
- 17. Hong S, Sato K, Kagawa K, Ichi S. The long-term outcome of CyberKnife-based stereotactic radiotherapy for central skull base meningiomas: a single-center experience. Neurosurg Rev, 2021, 44 (6): 3519-2526.
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- 22. Chang WI, Kim IH, Choi SH, et al. Risk stratification to define the role of radiotherapy for benign and atypical meningioma: A recursive partitioning analysis. Neurosurg, 2022, 90 (5): 619-626.
- 23. Schmutzer M, Skrap B, Thorsteinsdottir J, et al. Meningioma involving the superior sagittal sinus: long-term outcome after robotic radiosurgery in primary and recurrent situation. Front Oncol, 2023, 13: 1206059.
- 24. Asuzu DT, Bunevicius A, Anand RK, et al. Clinical and radiologic outcomes after stereotactic radiosurgery for meningiomas in direct contact with the optic apparatus: an international multicenter study. J Neurosurg, 2021, 136 (4): 1070-1076.
- 25. Han MS, Jang WY, Moon KS, et al. Is fractionated Gamma Knife radiosurgery a safe and effective treatment approach for large-volume (>10 cm3) intracranial meningiomas?. World Neurosurg, 2016, 99: 477-483.
- 26. Choi Y, Lim DH, Yu JI, et al. Prognostic value of Ki-67 labeling index and postoperative radiotherapy in WHO grade II meningioma. Am J Clin Oncol, 2018, 41 (1): 18-23.
- 27. Liu N, Song SY, Jiang JB, et al. The prognostic role of Ki-67/MIB-1 in meningiomas: a systematic review with meta-analysis. Medicine (Baltimore), 2020, 99 (9): e18644.
- 28. Mirian C, Skyrman S, Bartek J, Jr, et al. The Ki-67 proliferation index as a marker of time to recurrence in intracranial meningioma. Neurosurgery, 2020, 87 (6): 1289-1298.
- 29. Fahlström A, Dwivedi S, Drummond K. Multiple meningiomas: epidemiology, management, and outcomes. Neurooncol Adv, 2023, 5 (Suppl 1): i35-i48.
- 30. Huang H, Buhl R, Hugo HH, Mehdorn HM. Clinical and histological features of multiple meningiomas compared with solitary meningiomas. Neurol Res, 2005, 27 (3): 324-32
Abstract
This study aimed to evaluate the effectiveness and dosimetric features of meningioma patients who received stereotactic radiotherapy (SRT) with the CyberKnife-M6 (CK-M6) device in our department. Between January 2019 and February 2022, 31 lesions/26 cases were treated and evaluated in June 2022 with a median follow-up of 12 months (1-40). Median age was 56 (21-84), median KPS was 90 (40-100), and male/female ratio was 9/17. At diagnosis, there were multipl lesions in 4 patients and solitary lesions in 22 patients. Of the 17 patients who underwent surgery at least once, 65% were diagnosed with grade I meningioma and 35% with grade II meningioma. The median Ki-67 was 2.5% (0.8-35 %). There was a history of RT in five cases. The time from diagnosis to SRT was 28 months (1-244). The median lesion size before SRT was 22 mm (6-50) and the planning target volume was 8.24 cc (0.47-63.99). A median of 25 Gy/5 fractions (13-27 Gy/1-5 fx) was administered with a median treatment time of 18 min (13-25). No late side effects and new neurological deficits were observed in any case. At a median of 3 months (1-8), partial response was found to be 16% and stable response was 76%. At the last evaluation, local control was achieved in 88% of the cases. The mean and 2-year overall survival (OS) was 38.5 months and 96.2%. In univariate analysis, KPS ≥ 80 (1 year 100% vs 80%, p=0.04) and the presence of a solitary lesion (1 year 100% vs 66,7%, p =0.006) were found to be significant in terms of OS. CK-M6 increases patient compliance, and also reduces the risk of secondary cancer by reducing treatment duration and body dose. In our cases, 88% local control was achieved and CK-M6 based SRT was found to be effective, safe and comfortable.
References
- 1. Ostrom QT, Price M, Neff C, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2015-2019. Neuro-Oncology, 2022, 24 (S5): v1-v95.
- 2. Goldbrunner R, Stavrinou P, Jenkinson MD, et al. EANO guideline on the diagnosis and management of meningiomas. Neuro-Oncology, 2021, 23 (11): 1821-1834.
- 3. Fatima N, Meola A, Pollom EL, et al. Stereotactic radiosurgery versus stereotactic radiotherapy in the management of intracranial meningiomas: a systematic review and meta-analysis. Neurosurg Focus, 2019, 46(6): E2.
- 4. Buatti JS, Buatti JM, Yaddanapudi S, et al. Stereotactic radiotherapy of appropriately selected meningiomas and metastatic brain tumor beds with gamma knife icon versus volumetric modulated arc therapy. J Appl Clin Med Phys, 2020, 21 (12): 246-252.
- 5. Alfredo C, Carolin S, Guliz A, et al. Normofractionated stereotactic radiotherapy versus CyberKnife-based hypofractionation in skull base meningioma. A German and Italian pooled cohort analysis. Radiation Oncology, 2019, 14 (1): 201.
- 6. Manabe Y, Murai T, Ogino H, et al. CyberKnife stereotactic radiosurgery and hyporactionated stereotactic radiotherapy as first-line treatments for imaging-diagnosed intracranial meningiomas. Neurol Med Chir (Tokyo), 2017, 57 (12): 627-633
- 7. Schuler E, Lo A, Chuang CF, et al. Clinical impact of the VOLO optimizer on treatment plan quaility and clinical treatment efficacy for CyberKnife. J App Clin Med Phys, 2020, 21 (5): 38-47.
- 8. Shaw E, Scott C, Souhami L, et al. Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys, 2000, 47 (2): 291-8.
- 9. Benedict SH, Yenice KM, Followill D, et al. Report no. 101- Stereotactic body radiation therapy: The report of AAPM Task Group 101, Medical Physics, 2010, 37, 4078-4101.
- 10. Dieterich S, Cavedon C, Chuang CF, et al. Report No. 135 – report of AAPM TG 135: Quality assurance for robotic radiosurgery. Medical Physics, 2011, 38, 2914-2936.
- 11. Wujanto C, Chan TY, Soon YY, Vellayappan B. Should adjuvant radiotherapy be used in atypical meningioma (WHO grade 2) following gross total resection? A systematic review and Meta-analysis. Acta Oncol, 2022, 61 (9): 1075-1083.
- 12. Jenkinson MD, Javadpour M, Haylock BJ, et al. The ROAM/EORTC-1308 trial: radiation versus observation following surgical resection of atypical meningioma: study protocol for a randomised controlled trial. Trials, 2015, 16: 519.
- 13. Rydzewski NR, Lesniak MS, Chandler JP, et al. Gross total resection and adjuvant radiotherapy most signidicant predictors of improved survival in patients with atypical meningioma. Cancer, 2018, 124 (4): 734-42.
- 14. Patibandla MR, Lee CC, Tata A, et al. Stereotactic radiosurgery for WHO grade I posterior fossa meningiomas: long-term outcomes with volumetric evaluation. J Neurosurg, 2018, 129 (5): 1249-1259.
- 15. Wegner RE, Hasan S, Abel S, et al. Linear accelerator-based stereotactic radiotherapy for low-grade meningiomas: improved local control with hypofractionation. J Cent Nerv Syst Dis, 2019, 11: 1179573519843880.
- 16. Milano MT, Sharma M, Soltys SG, et al. Radiation-induced edema after single-fraction or multifraction stereotactic radiosurgery for meningioma: a critical review. Int J radiat Oncol, Biol, Phys, 2018, 101(2): 344-357.
- 17. Hong S, Sato K, Kagawa K, Ichi S. The long-term outcome of CyberKnife-based stereotactic radiotherapy for central skull base meningiomas: a single-center experience. Neurosurg Rev, 2021, 44 (6): 3519-2526.
- 18. Lee SH, Sade B. In: Meningiomas, In: Lee J, editor, London, Springer, 2009, p:217-21.
- 19. Sughrue ME, Kane AJ, Shangari G, et al. The relevance of Simpson Grade I and II resection in modern neurosurgical treatment of World Health Organization Grade I meningiomas. J Neurosurg, 2010, 113 (5): 1029-35.
- 20. Sun SQ, Cai CC, Murphy RKJ, et al. Radiation therapy for residual or recurrent atypical meningioma: the effects of modality, timing, and tumo pathology on long-term outcomes. Neurosurgery, 2016, 79 (1): 23-32.
- 21. Tsermoulas G, Turel MK, Wilcox JT, et al. Management of multiple meningiomas, J Neurosurg, 2018, 128 (5): 1403-1409.
- 22. Chang WI, Kim IH, Choi SH, et al. Risk stratification to define the role of radiotherapy for benign and atypical meningioma: A recursive partitioning analysis. Neurosurg, 2022, 90 (5): 619-626.
- 23. Schmutzer M, Skrap B, Thorsteinsdottir J, et al. Meningioma involving the superior sagittal sinus: long-term outcome after robotic radiosurgery in primary and recurrent situation. Front Oncol, 2023, 13: 1206059.
- 24. Asuzu DT, Bunevicius A, Anand RK, et al. Clinical and radiologic outcomes after stereotactic radiosurgery for meningiomas in direct contact with the optic apparatus: an international multicenter study. J Neurosurg, 2021, 136 (4): 1070-1076.
- 25. Han MS, Jang WY, Moon KS, et al. Is fractionated Gamma Knife radiosurgery a safe and effective treatment approach for large-volume (>10 cm3) intracranial meningiomas?. World Neurosurg, 2016, 99: 477-483.
- 26. Choi Y, Lim DH, Yu JI, et al. Prognostic value of Ki-67 labeling index and postoperative radiotherapy in WHO grade II meningioma. Am J Clin Oncol, 2018, 41 (1): 18-23.
- 27. Liu N, Song SY, Jiang JB, et al. The prognostic role of Ki-67/MIB-1 in meningiomas: a systematic review with meta-analysis. Medicine (Baltimore), 2020, 99 (9): e18644.
- 28. Mirian C, Skyrman S, Bartek J, Jr, et al. The Ki-67 proliferation index as a marker of time to recurrence in intracranial meningioma. Neurosurgery, 2020, 87 (6): 1289-1298.
- 29. Fahlström A, Dwivedi S, Drummond K. Multiple meningiomas: epidemiology, management, and outcomes. Neurooncol Adv, 2023, 5 (Suppl 1): i35-i48.
- 30. Huang H, Buhl R, Hugo HH, Mehdorn HM. Clinical and histological features of multiple meningiomas compared with solitary meningiomas. Neurol Res, 2005, 27 (3): 324-32
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences (Other) |
| Journal Section | Research Article |
| Authors | |
| Publication Date | May 17, 2024 |
| Submission Date | November 29, 2023 |
| Acceptance Date | January 26, 2024 |
| Published in Issue | Year 2024 Volume: 50 Issue: 1 |
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