Strahlentherapie bei Meningeomen

[Ulrich]

Der Artikel stammt von einer Forschergruppe am Krebsforschungsinstitut in Heidelberg. Man kann sich mit den Autoren also auch auf deutsch unterhalten.
----
Quelle: Journal of Clinical Oncology, Vol 19, Issue 15 (August), 2001: 3547-3553

Zitat: >High Efficacy of Fractionated Stereotactic Radiotherapy of Large Base-of-Skull Meningiomas: Long-Term Results

By Juergen Debus, Martina Wuendrich, Andrea Pirzkall, Angelika Hoess, Wolfgang Schlegel, Ivan Zuna, Rita Engenhart-Cabillic, Michael Wannenmacher

From the Department of Radiation Oncology, University of Heidelberg, and Research Program, Radiological Diagnostics and Therapy, German Cancer Research Center, Heidelberg, Germany.

Address reprint requests to Jürgen Debus, MD, PhD, Department of Radiation Oncology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany; email: j.debus@dkfz.de.

PURPOSE: Large skull-base meningiomas are difficult to treat due to their proximity or adherence to critical structures. We analyzed the long-term results of patients with skull-base meningiomas treated by a new approach with high-precision fractionated stereotactic radiotherapy.

PATIENTS AND METHODS: One hundred eighty-nine patients with benign meningiomas were treated with conformal fractionated stereotactic radiotherapy between 1985 and 1998. Patients were undergoing a course of radiotherapy either as primary treatment, following subtotal resection, or for recurrent disease. The median target volume was 52.5 mL (range, 5.2 to 370 mL). The mean radiation dose was 56.8 Gy (± 4.4 Gy). Follow-up examinations, including magnetic resonance imaging, were performed at 6-month intervals thereafter.

RESULTS: The median follow-up period was 35 months (range, 3 months to 12 years). Overall actuarial survival for patients with World Health Organization (WHO) grade I meningiomas was 97% after 5 years and 96% after 10 years. Local tumor failure was observed in three of 180 patients with WHO grade I tumors and was significantly higher in two of nine patients with WHO grade II tumors. A volume reduction of more than 50% was observed in 26 patients (14%). Preexisting cranial nerve symptoms resolved completely in 28% of the patients. Clinically significant treatment-induced toxicity was seen in 1.6% of the patients. No treatment-related deaths occurred.

CONCLUSION: The results of this study demonstrate that fractionated stereotactic radiotherapy is safe and effective in the therapy of subtotally resected or unresectable meningiomas. The overall morbidity and incidence subacute and late side effects of this conformal radiotherapy approach were low. <

[Ulrich]

Quelle

Zitat:
RADIOSURGERY AS DEFINITIVE MANAGEMENT OF INTRACRANIAL MENINGIOMAS.
CLINICAL STUDIES

Neurosurgery. 62(1):53-60, January 2008.
Kondziolka, Douglas M.D., M.Sc.; Mathieu, David M.D.; Lunsford, L. Dade M.D.; Martin, Juan J. M.D.; Madhok, Ricky M.D.; Niranjan, Ajay M.Ch.; Flickinger, John C. M.D.
Abstract:
OBJECTIVE: Stereotactic radiosurgery has become an important primary or adjuvant minimally invasive management strategy for patients with intracranial meningiomas with the goals of long-term tumor growth prevention and maintenance of patient neurological function. We evaluated clinical and imaging outcomes of meningiomas stratified by histological tumor grade.

METHODS: The patient cohort consisted of 972 patients with 1045 intracranial meningiomas managed during an 18-year period. The series included 70% women, 49% of whom had undergone a previous resection and 5% of whom had received previous fractionated radiation therapy. Tumor locations included middle fossa (n = 351), posterior fossa (n = 307), convexity (n = 126), anterior fossa (n = 88), parasagittal region (n = 113), or other (n = 115).

RESULTS: The overall control rate for patients with benign meningiomas (World Health Organization Grade I) was 93%. In those without previous histological confirmation (n = 482), tumor control was 97%. However, for patients with World Health Organization Grade II and III tumors, tumor control was 50 and 17%, respectively. Delayed resection after radiosurgery was necessary in 51 patients (5%) at a mean of 35 months. After 10 years, Grade 1 tumors were controlled in 91% (n = 53); in those without histology, 95% (n = 22) were controlled. None of the patients developed a radiation-induced tumor. The overall morbidity rate was 7.7%. Symptomatic peritumoral imaging changes developed in 4% of the patients at a mean of 8 months.

CONCLUSION: Stereotactic radiosurgery provided high rates of tumor growth control or regression in patients with benign meningiomas with low risk. This study confirms the role of radiosurgery as an effective management choice for patients with small to medium-sized symptomatic, newly diagnosed or recurrent meningiomas of the brain.

Copyright (C) by the Congress of Neurological Surgeons

Stereotaktische Bestrahlung bewirkt eine hochgradige Kontrolle (sinngemäß = Limitierung) des Tumorwachstums oder ein Kleinerwerden (Regression) bei Patienten mit gutartigen Meningeomen bei gleichzeitig geringem Risiko. Die Studie bestätigt die Bedeutung der Strahlentherapie als wirksames Mittel (oder wirksame Wahl) für Patienten mit geringer bis mittleren Symptomatik, bei neu diagnostizierten Meningeomen oder Meningeomrezidiven (im Kopf).

[Jo]

Hallo,

http://www.ncbi.nlm.nih.gov/pubmed/18812954?ordinalpos=9&itool=EntrezSyste
m2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

(bei parasagittalen Meningeomen gibts bei der Bestrahlung öfters Probleme mit einem Ödem, deshalb ist hinterher eine engmaschige Kontrolle wichtig)

Gruß, Jo

[Ulrich]

Die Ödemproblematik schwingt immer mit bei der Bestrahlung von Hirntumoren. Deshalb auch das schon oft diskutierte "Limit" von 2-3 cm Durchmesser.

Als ich den Artikel las, fand ich einen anderen, der eine gute Übersicht über die Bestrahlung von Meningeomen bietet. Etwa 1000 Fälle wurden untersucht:

Quelle: Neurosurgery. 2008 Jan;62(1):53-8; discussion 58-60.
Titel: Radiosurgery as definitive management of intracranial meningiomas.

Autoren: Kondziolka D, Mathieu D, Lunsford LD, Martin JJ, Madhok R, Niranjan A, Flickinger JC.
Department of Neurological Surgery, The Center for Image-guided Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. kondziolkads@upmc.edu

Zitat: OBJECTIVE: Stereotactic radiosurgery has become an important primary or adjuvant minimally invasive management strategy for patients with intracranial meningiomas with the goals of long-term tumor growth prevention and maintenance of patient neurological function. We evaluated clinical and imaging outcomes of meningiomas stratified by histological tumor grade.
METHODS: The patient cohort consisted of 972 patients with 1045 intracranial meningiomas managed during an 18-year period. The series included 70% women, 49% of whom had undergone a previous resection and 5% of whom had received previous fractionated radiation therapy. Tumor locations included middle fossa (n = 351), posterior fossa (n = 307), convexity (n = 126), anterior fossa (n = 88), parasagittal region (n = 113), or other (n = 115).
RESULTS: The overall control rate for patients with benign meningiomas (World Health Organization Grade I) was 93%. In those without previous histological confirmation (n = 482), tumor control was 97%. However, for patients with World Health Organization Grade II and III tumors, tumor control was 50 and 17%, respectively. Delayed resection after radiosurgery was necessary in 51 patients (5%) at a mean of 35 months. After 10 years, Grade 1 tumors were controlled in 91% (n = 53); in those without histology, 95% (n = 22) were controlled. None of the patients developed a radiation-induced tumor. The overall morbidity rate was 7.7%. Symptomatic peritumoral imaging changes developed in 4% of the patients at a mean of 8 months.
CONCLUSION: Stereotactic radiosurgery provided high rates of tumor growth control or regression in patients with benign meningiomas with low risk. This study confirms the role of radiosurgery as an effective management choice for patients with small to medium-sized symptomatic, newly diagnosed or recurrent meningiomas of the brain.

[Jo]

Hallo,
das Interessante an diesem Artikel ist , dass Patienten mit einem Meningeom im Bereich des Sinus saggitalis, die ja oft auf Bestrahlung zurückgreifen müssen, weil eine vollständige Tumorentfernung nicht möglich oder zu gefährlich ist, mehr mit Problemen durch ein Ödem rechnen müssen, als Patienten mit einer anderen Tumorlokalisation.
Der behandelnde Arzt sollte möglicherweise schon vor Beginn der Bestrahlung, Maßnahmen einleiten und ständig überprüfen. (Cortison, Weihrauch)

Eine wichtige Info für eine spezielle Gruppe hier, mit Meningeomen am Sinus saggitalis, die sich für eine Bestrahlung entscheiden müssen.
Gruß Jo


edit: Nix für ungut: Tippfehler geändert. Mir ist besonders wichtig, daß in unserem Forum medizinische Begriffe absolut korrekt wiedergegeben werden. Die Suchmaschinen sind ja so blöd. Die bestehen darauf, den exakten Begriff zu suchen und zu finden. Ulrich

[Ulrich]

http://www.irsa.org/meningioma.html