Transient Enlargement in Meningiomas Treated with Stereotactic Radiotherapy
To investigate the occurrence of pseudoprogression/transient enlargement in meningiomas after stereotactic radiotherapy (RT) and to evaluate recently proposed volumetric RANO meningioma criteria for response assessment in the context of RT. Sixty-nine meningiomas (benign: 90%, atypical: 10%) receive...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-03-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/6/1547 |
| _version_ | 1797446911316197376 |
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| author | Ziad Maksoud Manuel Alexander Schmidt Yixing Huang Sandra Rutzner Sina Mansoorian Thomas Weissmann Christoph Bert Luitpold Distel Sabine Semrau Sebastian Lettmaier Ilker Eyüpoglu Rainer Fietkau Florian Putz |
| author_facet | Ziad Maksoud Manuel Alexander Schmidt Yixing Huang Sandra Rutzner Sina Mansoorian Thomas Weissmann Christoph Bert Luitpold Distel Sabine Semrau Sebastian Lettmaier Ilker Eyüpoglu Rainer Fietkau Florian Putz |
| author_sort | Ziad Maksoud |
| collection | DOAJ |
| description | To investigate the occurrence of pseudoprogression/transient enlargement in meningiomas after stereotactic radiotherapy (RT) and to evaluate recently proposed volumetric RANO meningioma criteria for response assessment in the context of RT. Sixty-nine meningiomas (benign: 90%, atypical: 10%) received stereotactic RT from January 2005–May 2018. A total of 468 MRI studies were segmented longitudinally during a median follow-up of 42.3 months. Best response and local control were evaluated according to recently proposed volumetric RANO criteria. Transient enlargement was defined as volumetric increase ≥20% followed by a subsequent regression ≥20%. The mean best volumetric response was −23% change from baseline (range, −86% to +19%). According to RANO, the best volumetric response was SD in 81% (56/69), MR in 13% (9/69) and PR in 6% (4/69). Transient enlargement occurred in only 6% (4/69) post RT but would have represented 60% (3/5) of cases with progressive disease if not accounted for. Transient enlargement was characterized by a mean maximum volumetric increase of +181% (range, +24% to +389 %) with all cases occurring in the first year post-RT (range, 4.1–10.3 months). Transient enlargement was significantly more frequent with SRS or hypofractionation than with conventional fractionation (25% vs. 2%, <i>p</i> = 0.015). Five-year volumetric control was 97.8% if transient enlargement was recognized but 92.9% if not accounted for. Transient enlargement/pseudoprogression in the first year following SRS and hypofractionated RT represents an important differential diagnosis, especially because of the high volumetric control achieved with stereotactic RT. Meningioma enlargement during subsequent post-RT follow-up and after conventional fractionation should raise suspicion for tumor progression. |
| first_indexed | 2024-03-09T13:47:24Z |
| format | Article |
| id | doaj.art-a408053c7b154f4bbec99a4b8d87df21 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T13:47:24Z |
| publishDate | 2022-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-a408053c7b154f4bbec99a4b8d87df212023-11-30T20:56:57ZengMDPI AGCancers2072-66942022-03-01146154710.3390/cancers14061547Transient Enlargement in Meningiomas Treated with Stereotactic RadiotherapyZiad Maksoud0Manuel Alexander Schmidt1Yixing Huang2Sandra Rutzner3Sina Mansoorian4Thomas Weissmann5Christoph Bert6Luitpold Distel7Sabine Semrau8Sebastian Lettmaier9Ilker Eyüpoglu10Rainer Fietkau11Florian Putz12Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, GermanyComprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, GermanyDepartment of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, GermanyDepartment of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, GermanyDepartment of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, GermanyDepartment of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, GermanyDepartment of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, GermanyDepartment of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, GermanyDepartment of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, GermanyDepartment of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, GermanyComprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, GermanyDepartment of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, GermanyDepartment of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054 Erlangen, GermanyTo investigate the occurrence of pseudoprogression/transient enlargement in meningiomas after stereotactic radiotherapy (RT) and to evaluate recently proposed volumetric RANO meningioma criteria for response assessment in the context of RT. Sixty-nine meningiomas (benign: 90%, atypical: 10%) received stereotactic RT from January 2005–May 2018. A total of 468 MRI studies were segmented longitudinally during a median follow-up of 42.3 months. Best response and local control were evaluated according to recently proposed volumetric RANO criteria. Transient enlargement was defined as volumetric increase ≥20% followed by a subsequent regression ≥20%. The mean best volumetric response was −23% change from baseline (range, −86% to +19%). According to RANO, the best volumetric response was SD in 81% (56/69), MR in 13% (9/69) and PR in 6% (4/69). Transient enlargement occurred in only 6% (4/69) post RT but would have represented 60% (3/5) of cases with progressive disease if not accounted for. Transient enlargement was characterized by a mean maximum volumetric increase of +181% (range, +24% to +389 %) with all cases occurring in the first year post-RT (range, 4.1–10.3 months). Transient enlargement was significantly more frequent with SRS or hypofractionation than with conventional fractionation (25% vs. 2%, <i>p</i> = 0.015). Five-year volumetric control was 97.8% if transient enlargement was recognized but 92.9% if not accounted for. Transient enlargement/pseudoprogression in the first year following SRS and hypofractionated RT represents an important differential diagnosis, especially because of the high volumetric control achieved with stereotactic RT. Meningioma enlargement during subsequent post-RT follow-up and after conventional fractionation should raise suspicion for tumor progression.https://www.mdpi.com/2072-6694/14/6/1547meningiomavolumetric analysissegmentationtransient enlargementpseudoprogressionstereotactic radiotherapy |
| spellingShingle | Ziad Maksoud Manuel Alexander Schmidt Yixing Huang Sandra Rutzner Sina Mansoorian Thomas Weissmann Christoph Bert Luitpold Distel Sabine Semrau Sebastian Lettmaier Ilker Eyüpoglu Rainer Fietkau Florian Putz Transient Enlargement in Meningiomas Treated with Stereotactic Radiotherapy Cancers meningioma volumetric analysis segmentation transient enlargement pseudoprogression stereotactic radiotherapy |
| title | Transient Enlargement in Meningiomas Treated with Stereotactic Radiotherapy |
| title_full | Transient Enlargement in Meningiomas Treated with Stereotactic Radiotherapy |
| title_fullStr | Transient Enlargement in Meningiomas Treated with Stereotactic Radiotherapy |
| title_full_unstemmed | Transient Enlargement in Meningiomas Treated with Stereotactic Radiotherapy |
| title_short | Transient Enlargement in Meningiomas Treated with Stereotactic Radiotherapy |
| title_sort | transient enlargement in meningiomas treated with stereotactic radiotherapy |
| topic | meningioma volumetric analysis segmentation transient enlargement pseudoprogression stereotactic radiotherapy |
| url | https://www.mdpi.com/2072-6694/14/6/1547 |
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