Radiosurgery is ionizing radiation treatment. Concentration of a large amount of radiation in an area of the brain results in ablation of the lesion. The technique was designed and perfected by Dr. Lars Lexell, Swedish neurosurgeon, in 1951.
Meningiomas are usually benign and slow-growing tumors, derived from the leptomeninges. First line treatment for meningiomas is surgery. They occasionally are difficult to treat surgically because of their location, the associated vascular and nerve structures and patient comorbidities. Stereotactic Radiosurgery (SRS) is an option to manage these cases.
Objective: This studi is retrospective, from Novembner 2013 to January 2018 (4 years), SRS for meningioma in X-Knife Unit, Neurosurgery Service prof. Kurti UC, Mother Theresa,, Tirana. During this period we evaluated the long term effect of SRS on tumor control.
Material and Methods: We analyzed data from 17 Meningiomas in 14 patinets (4 meningiomatosis) to these variables: age, presenting symptoms, intracranial location of meningiomas, surgery prior to SRS, extension of tumor resection, the radiation dose, tumor volume coverage, pre-SRS tumor volume, tumor volume on latest follow up MR biopsy results, Assessment of tumor control was based on VOLUMETRIC criteria and RECIST criteria.
Results: 14 patients in a total (17 meningiomas, 4 of them was meningiomatosis), (Male 4 (23%), Female 13 (77%), Age 45-75 years (average 59.5 Median 62.0). Follow up from (23 months), (Range 59.9-99 99.5), intracranial localization of meningiomas: Medial sphenoid crystal – 8, Convection – 7, Falx/Parasagittal – 2. Residual 4 - (24%), Recurence 5 - (29%), New 8 – (47%), WHO I – 8 (47%), WHO II – 4 (23%), WHO III – 1 (7%). With out biopsy – 4. Prescripted dose – 14-16 Gy, tumor coverage – 59 – 100%, (91.70), median 95.40, tumor volume – 0.27 – 10.36 cc (3.84), 1-isocenter – 9 cases, 2-isocenter – 8 cases. Number for arcs for isocenter – 1-5. Tumor volume, controlled - 12 (70%), reduced – 22 (48%) – 5 (PR), unchanged – 7 (SD), adult (WHO 2 and 3) – 5 (PD), side effects - 0. Follow up from 2-51 months (23 months) Mean tumor volume on follow up MRI was 0.31 cm3 and maximum Diameter over 4.83 cm. According to Volumetric criteria and RECIST criteria (adapted version), remained stable disease and excellent control - 70% total, 100% grade 1 WHO).
Conclusions: SRS is one of the safest and most effective strategies to keep meningiomas under control and management in different patients, both those with primary tumors and those with relapses or those left over from previous interventions. Doing the comparative analysis shows an improved analysis and long-term effects with SRS. The criteria used during the evaluation and standardization of these criteria make possible the effect on the duration of treatment of meningiomas with SRS.