Gamma Knife Strahlentherapie bei malignen Meningeomen

[Ulrich]

J Neurosurg. 2000 Dec;93 Suppl 3:62-7

Radiosurgery for malignant meningioma: results in 22 patients.

Ojemann SG, Sneed PK, Larson DA, Gutin PH, Berger MS, Verhey L, Smith V V, Petti P, Wara W, Park E, McDermott MW.
Department of Neurological Surgery, University of California, San Francisco 94143, USA.

OBJECT: The initial treatment of malignant meningiomas in the past has included surgical removal followed by fractionated external-beam radiotherapy. Radiosurgery has been added to the options for treatment of primary or recurrent tumors over the last 10 years. The authors report their results of using gamma knife radiosurgery (GKS) to treat 22 patients over an 8-year period.

METHODS: Twenty-two patients who underwent GKS for malignant meningioma between December 1991 and May 1999 were evaluated. Three patients were treated with GKS as a boost to radiotherapy and 19 for recurrence following radiotherapy. Outcome factors including patient survival, freedom from progression, and complications were analyzed. In addition, in the recurrent group, variables such as patient age, sex, tumor location, target volume, margin dose, and maximum dose were also analyzed. Univariate and multivariate analyses were performed. Overall 5-year survival and progression-free survival estimates were 40% and 26%, respectively. Age (p < or = 0.003) and tumor volume (p < or = 0.05) were significant predictors of time to progression and survival in both univariate and multivariate analyses. Five patients (23%) developed radiation necrosis. Significant relationships between complications and treatment variables or patient characteristics could not be established.

CONCLUSIONS: Tumor control following GKS is greater in patients with smaller-sized tumors (< 8 cm3) and in younger patients. Gamma knife radiosurgery can be performed to treat malignant meningioma with acceptable toxicity. The efficacy of GKS relative to other therapies for recurrent malignant meningioma as well as the value of GKS as a boost to radiotherapy will require further evaluation.

[Ulrich]

J Neurosurg. 2000 Dec;93 Suppl 3:57-61.

Early complications following gamma knife radiosurgery for intracranial meningiomas.
Singh VP, Kansai S, Vaishya S, Julka PK, Mehta VS.
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi. vpsingh@medinst.ernet.in

OBJECT: The purpose of this paper was to assess the early complications, defined as occurring within 1 year, following gamma knife radiosurgery (GKS) for the treatment of intracranial meningiomas.

METHODS: Seventy-seven of 306 patients undergoing GKS in the last 2.5 years harbored meningiomas. There were 35 men and 42 women with a mean age of 32.4 years (range 10-80 years). Tumor volume ranged from 0.35 to 28.6 cm3 (mean 7.9 cm3). Gamma knife radiosurgery was the primary therapy in 28 patients and followed surgery in 49 patients. There were 50 basal and 27 nonbasal meningiomas. The most common sites were parasagittal (23 patients) and cerebellopontine angle (14 patients). Ten to 15 Gy was administered to the tumor margins. Clinical and radiological follow up with a mean duration of 122 months was available in 40 patients. Seizures and increased headache were found in five and four patients, respectively. A temporary worsening of hemiparesis was seen in two patients (both with parasagittal tumors). One patient with a cavernous sinus meningioma developed a herpes labialis eruption. Perilesional edema was demonstrated in nine patients and was symptomatic in six. Six (22%) of the 27 patients with nonbasal tumors had edema (all parasagittal) and four patients were symptomatic. Only three (6%) of the 50 basal meningiomas had edema, and only one patient was symptomatic. The occurence of edema did not correlate with tumor volume, margin or maximum dose, or with radiation received by adjacent brain. A reduction in tumor size was seen in seven patients. In one patient a new recurrent lesion developed adjacent to the previously treated tumor.

CONCLUSIONS: Although GKS provides good results for selected patients with meningiomas, caution is required in treating patients with parasagittal tumors as the incidence of perilesional edema is considerable.

[Ulrich]

Acta Neurol Scand. 1997 Nov;96(5):297-304.

Role of radiosurgery in the management of cavernous sinus meningiomas.
Kurita H, Sasaki T, Kawamoto S, Taniguchi M, Terahara A, Tago M, Kirino T.
Department of Neurosurgery, Faculty of Medicine, University of Tokyo, Japan.

OBJECTIVE: To provide our early experience and philosophy in the utility of radiosurgery in the management of cavernous sinus meningiomas.

METHODS: Twenty-five consecutive cases with cavernous sinus meningiomas treated between 1990 and 1995 were reviewed. Three cases were treated with gamma-knife radiosurgery, 15 with preceding surgery and gamma knife, 7 with surgery. Mean follow-up following radiosurgery and surgery were 34.8 and 25.4 months, respectively.

RESULTS: The 5-year actuarial tumor control rate following radiosurgery was 85.7% and tumor remission rate was 61.4%. Permanent neurological deterioration after radiosurgery was seen in 1 case (5.9%), whereas newly developed or worsened neurological deficits permanently persisted in 59.1% of patients after surgery. There was a clear correlation between surgical radicality and postoperative morbidity rate.

CONCLUSIONS: Gamma-knife radiosurgery is a valuable addition to surgical removal in the treatment of cavernous sinus meningiomas. Combination of non-radical resection and subsequent radiosurgery is recommended to improve treatment-associated morbidity.

[Ulrich]

Hier wird von schweren Komplikationen berichtet. Ödembildung, Notoperation wegen steigendem Hirndruck!

http://www.brainlife.org/treatment/radiosurgery/olds_2003.htm


39th ASCO Annual Meeting o Chicago, IL o May 31-June 3, 2003 (Abstract No. 484)

Gamma-knife radiosurgery for meningiomas: Predisposing factors for cerebral edema

T. D. Olds, C. T. Chung, S. S. Hahn, C. Hodge, R. Schelper

SUNY Upstate Univ, Syracuse, NY; SUNY Upstate Medical University, Syracuse, NY

Purpose: Identify causative or contributory factors for the development of cerebral edema following Gamma Knife Radiosurgery (GKS) for meningiomas.

Materials and Methods: We evaluated 80 patients with meningiomas treated with Gamma-Knife radiosurgery at the Central New York Gamma Knife Center between August, 1998 and September, 2001.
Median age was 65 years (range 29-92).
Fifty-three were female and 27 male.
Twenty-seven had prior surgical resection (8 gross total and 19 subtotal) and 9 prior radiotherapy.
Three patients developed steroid-refractory edema after GKS eventually necessitating surgery.
Clinical findings, treatment course, imaging alterations, and pathologic findings of these three patients were reviewed and compared to the remaining 77 cases.
Particular attention was given to location, size, rapidity of symptom onset, histopathologic analysis, and underlying disease conditions.
Median follow-up was 11 months (range 1-33).

Results: Forty-six (58%) of the patients had meningiomas that were non-skull based.
The median treatment volume was 5.1 cc (range 0.4-3.8).
The median maximum dose was 30 Gy.
Three patients developed steroid-refractory edema within 2 months following GKS and eventually were treated with surgical resection for symptom relief.
None of these patients had prior resection, external-beam radiation therapy or GKS.
The volumes treated were 5.9, 18.4, and 22 cc treated with 17, 13, and 11 Gy (x2), respectively.
Two of the patients developed symptoms within 4 weeks of completing GKS, the other within 8 weeks.
All were postmenopausal females and hypertensive.
Two had a history of diabetes (medicated) and one was diagnosed with hyperglycemia following long-term steroid use.
Only one patient exhibited focal Ki-67 positivity.

Conclusion: Severe cerebral edema necessitating surgical intervention is a potential complication of GKS.
We cannot confirm that skull-based location, association with venous sinuses, prior surgery or radiotherapy contributes to the development of cerebral edema.
Predisposing factors such as hypertension and hyperglycemia were identified as possible contributors and should be further evaluated.

© Copyright 2003 American Society of Clinical Oncology All rights reserved worldwide
Source: http://www.asco.org/ac/1,1003,_12-002489-00_18-002003-00_19-00103971-00_29-00A,00.asp?cat=CNS+Tumors&parent=
Central+Nervous+System+Tumors&returnpid=2325&SubCat_ID=4  
 

[PetraElisabeth]

J Neurosurg. 2000 Dec;93 Suppl 3:62-7

Radiosurgery for malignant meningioma: results in 22 patients.

Ojemann SG, Sneed PK, Larson DA, Gutin PH, Berger MS, Verhey L, Smith V V, Petti P, Wara W, Park E, McDermott MW.
Department of Neurological Surgery, University of California, San Francisco 94143, USA.

OBJECT: The initial treatment of malignant meningiomas in the past has included surgical removal followed by fractionated external-beam radiotherapy. Radiosurgery has been added to the options for treatment of primary or recurrent tumors over the last 10 years. The authors report their results of using gamma knife radiosurgery (GKS) to treat 22 patients over an 8-year period.

METHODS: Twenty-two patients who underwent GKS for malignant meningioma between December 1991 and May 1999 were evaluated. Three patients were treated with GKS as a boost to radiotherapy and 19 for recurrence following radiotherapy. Outcome factors including patient survival, freedom from progression, and complications were analyzed. In addition, in the recurrent group, variables such as patient age, sex, tumor location, target volume, margin dose, and maximum dose were also analyzed. Univariate and multivariate analyses were performed. Overall 5-year survival and progression-free survival estimates were 40% and 26%, respectively. Age (p < or = 0.003) and tumor volume (p < or = 0.05) were significant predictors of time to progression and survival in both univariate and multivariate analyses. Five patients (23%) developed radiation necrosis. Significant relationships between complications and treatment variables or patient characteristics could not be established.

CONCLUSIONS: Tumor control following GKS is greater in patients with smaller-sized tumors (< 8 cm3) and in younger patients. Gamma knife radiosurgery can be performed to treat malignant meningioma with acceptable toxicity. The efficacy of GKS relative to other therapies for recurrent malignant meningioma as well as the value of GKS as a boost to radiotherapy will require further evaluation.

Hallo Ulrich

Wäre es möglich den Text auch in Deutsch hier lesen zu können?

Gruß Petra

[Mike]

Achtung: Text wurde maschinell übersetzt.

J Neurosurg. 2000 Dez; 93 Suppl 3:62-7

Radiosurgery für bösartiges meningioma: Ergebnisse in 22 Patienten.

Ojemann SG, Sneed PK, Larson DA, Gutin PH-Wert, Berger MS, Verhey L, Smith V V, Petti P, Wara W, Park E, McDermott MW.
Abteilung einer neurologischen Operation, Universität von Kalifornien, San Francisco 94143, USA.

Objekt: Die Anfangsbehandlung von bösartigem meningiomas in der Vergangenheit hat chirurgisches Entfernen eingeschlossen, dem von fraktionierter externem Strahlenstrahlentherapie gefolgt wird. Radiosurgery ist den Optionen für Behandlung von Haupt- oder wiederkehrenden Tumoren über die letzten 10 Jahre hinzugefügt worden. Die Autoren berichten von ihren Ergebnissen, Gammamesser radiosurgery (GKS) zu benutzen, um in einer 8-jährigen Periode 22 Patienten zu behandeln.

Methoden: Zweiundzwanzig Patienten, die GKS für bösartiges meningioma zwischen dem Dezember 1991 und dem Mai 1999 erlebten, wurden beurteilt. Drei Patienten wurden mit GKS als Auftrieb zu Strahlentherapie und 19 dafür behandelt, dass erneutes Auftreten Strahlentherapie folgte. Ergebnisfaktoren, die geduldiges Überleben, Freiheit von Fortentwicklung und Komplikationen enthielten, wurden analysiert. Außerdem wurden Variable wie geduldige Alter, Geschlecht, Tumorstandort, Zielvolumen, Randdosis und Maximaldosis in der wiederkehrenden Gruppe auch analysiert. Univariate und multivariate Analysen wurden ausgeführt. Allgemeines 5-jähriges Überleben und fortentwicklungsfreie Überlebensschätzungen waren 40%ig und 26%ig beziehungsweise. Alter (P < oder = 0,003) und Tumorvolumen (P < oder = 0,05) waren signifikante Propheten von Zeit zu Fortentwicklung und Überleben in sowohl univariate als auch multivariaten Analysen. Fünf Patienten (23%) entwickelten Strahlungsnekrose. Signifikante Beziehungen zwischen Komplikationen und Behandlungsvariablen oder geduldigen Merkmalen konnten nicht eingeführt werden.

Schlüsse: Tumorkontrolle, die GKS folgt, ist in Patienten großartiger mit kleiner dimensionierte Tumoren (< 8 cm3) und in jüngeren Patienten. Gammamesser radiosurgery kann ausgeführt werden, um bösartiges meningioma mit akzeptabler Toxizität zu behandeln. Sowohl die Wirksamkeit von GKS verglichen mit anderen Therapien für wiederkehrendes bösartiges meningioma als auch der Wert von GKS als Auftrieb zu Strahlentherapie erfordern weitere Auswertung.

[PetraElisabeth]

Danke Mike,
jetzt weiß ich immer noch nicht ob mir eine GammaKnife Behandlung besser kommen würde als eine Op. Die Ärzte meinen durch eine Op am Stammhirn könnte es sein das ich bis zu 77% Schwerbehindert werden kann. Beim GammaKnife sagen sie bis zu 3% das irgendwelche körperliche Leiden bleiben , wo kann ich mir Rat holen ? Denke jeder Arzt für sich entscheidet immer was er gerade machen kann oder?
Gruß Petra

[Ciconia]

Klar, ein Neurochirurg sagt operieren und ein Strahlentherapeut will natürlich bestrahlen.
Kannst du dir nicht nochmal eine möglichst neutrale Meinung einholen? Ich war z.B. bei einem Neurologen, der selbst nicht in einer Klinik eingebunden ist.
Alles Gute
ciconia