A Pathophysiological Approach to Reduce Peritumoral Edema with Gamma Knife Radiosurgery for Large Incidental Meningiomas
Background: Peritumoral edema may be a prohibitive side effect in treating large incidental meningiomas with stereotactic radiosurgery. An approach that limits peritumoral edema and achieves tumor control with SRS would be an attractive management option for large incidental meningiomas. Methods: Th...
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MDPI AG
2022-10-01
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| Series: | Life |
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| Online Access: | https://www.mdpi.com/2075-1729/12/11/1683 |
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| author | Cheng-Siu Chang Cheng-Wei Huang Hsi-Hsien Chou Hsien-Tang Tu Ming-Tsung Lee Chuan-Fu Huang |
| author_facet | Cheng-Siu Chang Cheng-Wei Huang Hsi-Hsien Chou Hsien-Tang Tu Ming-Tsung Lee Chuan-Fu Huang |
| author_sort | Cheng-Siu Chang |
| collection | DOAJ |
| description | Background: Peritumoral edema may be a prohibitive side effect in treating large incidental meningiomas with stereotactic radiosurgery. An approach that limits peritumoral edema and achieves tumor control with SRS would be an attractive management option for large incidental meningiomas. Methods: This is a retrospective cohort study of patients with large incidental meningiomas (≥2 mL in volume and/or 2 cm in diameter) treated with gamma knife radiosurgery (GKRS) between 2000 and 2019 in Taiwan and followed up for 5 years. The outcomes of a pathophysiological approach targeting the dural feeding artery site with a higher marginal dose (18–20 Gy) to enhance vascular damage and the parenchymal margin of the tumor with a lower dose (9–11 Gy) to reduce parenchymal damage were compared with those of a conventional approach targeting the tumor center with a higher dose and tumor margin with a lower dose (12–14 Gy). Results: A total of 53 incidental meningiomas were identified, of which 23 (43.4%) were treated with a pathophysiological approach (4 cases underwent a two-stage approach) and 30 (56.7%) were treated with a conventional approach. During a median follow-up of 3.5 (range 1–5) years, tumor control was achieved in 19 (100%) incidental meningiomas that underwent a single-stage pathophysiological approach compared with 29 (96.7%) incidental meningiomas that underwent a conventional approach (log-rank test: <i>p</i> = 0.426). Peritumoral edema developed in zero (0%) incidental meningiomas that underwent a single stage pathophysiological approach compared to seven (23.3%) incidental meningiomas that underwent a conventional approach (log-rank test: <i>p</i> = 0.023). Conclusions: Treatment of large incidental meningiomas with a pathophysiological approach with GKRS achieves similar rates of tumor control and reduces the risk of peritumoral edema. GKRS with a pathophysiological approach may be a reasonable management strategy for large incidental meningiomas. |
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| language | English |
| last_indexed | 2024-03-09T18:56:06Z |
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| spelling | doaj.art-c1147c6cc12941c6beb64b576437d7982023-11-24T05:29:14ZengMDPI AGLife2075-17292022-10-011211168310.3390/life12111683A Pathophysiological Approach to Reduce Peritumoral Edema with Gamma Knife Radiosurgery for Large Incidental MeningiomasCheng-Siu Chang0Cheng-Wei Huang1Hsi-Hsien Chou2Hsien-Tang Tu3Ming-Tsung Lee4Chuan-Fu Huang5Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung 402, TaiwanDepartment of Hospital Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA 90027, USASchool of Medicine, Chung-Shan Medical University, Taichung 402, TaiwanGamma Knife Center, Chang Bing Show Chwan Memorial Hospital, Changhua 505, TaiwanNational Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin 632, TaiwanGamma Knife Center, Chang Bing Show Chwan Memorial Hospital, Changhua 505, TaiwanBackground: Peritumoral edema may be a prohibitive side effect in treating large incidental meningiomas with stereotactic radiosurgery. An approach that limits peritumoral edema and achieves tumor control with SRS would be an attractive management option for large incidental meningiomas. Methods: This is a retrospective cohort study of patients with large incidental meningiomas (≥2 mL in volume and/or 2 cm in diameter) treated with gamma knife radiosurgery (GKRS) between 2000 and 2019 in Taiwan and followed up for 5 years. The outcomes of a pathophysiological approach targeting the dural feeding artery site with a higher marginal dose (18–20 Gy) to enhance vascular damage and the parenchymal margin of the tumor with a lower dose (9–11 Gy) to reduce parenchymal damage were compared with those of a conventional approach targeting the tumor center with a higher dose and tumor margin with a lower dose (12–14 Gy). Results: A total of 53 incidental meningiomas were identified, of which 23 (43.4%) were treated with a pathophysiological approach (4 cases underwent a two-stage approach) and 30 (56.7%) were treated with a conventional approach. During a median follow-up of 3.5 (range 1–5) years, tumor control was achieved in 19 (100%) incidental meningiomas that underwent a single-stage pathophysiological approach compared with 29 (96.7%) incidental meningiomas that underwent a conventional approach (log-rank test: <i>p</i> = 0.426). Peritumoral edema developed in zero (0%) incidental meningiomas that underwent a single stage pathophysiological approach compared to seven (23.3%) incidental meningiomas that underwent a conventional approach (log-rank test: <i>p</i> = 0.023). Conclusions: Treatment of large incidental meningiomas with a pathophysiological approach with GKRS achieves similar rates of tumor control and reduces the risk of peritumoral edema. GKRS with a pathophysiological approach may be a reasonable management strategy for large incidental meningiomas.https://www.mdpi.com/2075-1729/12/11/1683peritumoral edemagamma kniferadiosurgerystereotactic radiosurgeryincidental meningiomameningioma |
| spellingShingle | Cheng-Siu Chang Cheng-Wei Huang Hsi-Hsien Chou Hsien-Tang Tu Ming-Tsung Lee Chuan-Fu Huang A Pathophysiological Approach to Reduce Peritumoral Edema with Gamma Knife Radiosurgery for Large Incidental Meningiomas Life peritumoral edema gamma knife radiosurgery stereotactic radiosurgery incidental meningioma meningioma |
| title | A Pathophysiological Approach to Reduce Peritumoral Edema with Gamma Knife Radiosurgery for Large Incidental Meningiomas |
| title_full | A Pathophysiological Approach to Reduce Peritumoral Edema with Gamma Knife Radiosurgery for Large Incidental Meningiomas |
| title_fullStr | A Pathophysiological Approach to Reduce Peritumoral Edema with Gamma Knife Radiosurgery for Large Incidental Meningiomas |
| title_full_unstemmed | A Pathophysiological Approach to Reduce Peritumoral Edema with Gamma Knife Radiosurgery for Large Incidental Meningiomas |
| title_short | A Pathophysiological Approach to Reduce Peritumoral Edema with Gamma Knife Radiosurgery for Large Incidental Meningiomas |
| title_sort | pathophysiological approach to reduce peritumoral edema with gamma knife radiosurgery for large incidental meningiomas |
| topic | peritumoral edema gamma knife radiosurgery stereotactic radiosurgery incidental meningioma meningioma |
| url | https://www.mdpi.com/2075-1729/12/11/1683 |
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