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Magnetic resonance images of various types of acoustic neuromas. Homogeneously enhanced tumor with uniform hyperintensity in the T1-weighted magnetic resonance image (a) or uniform isointensity in the T2-weighted magnetic resonance image (d) after contrast injection. b Heterogeneously enhanced tumor with multiple nonenhanced areas inside the tumor. The areas were hyperintense in the T2-weighted image (e). A cystic tumor with a thin, enhanced cystic wall in the tumor’s peripheral area (c). f The cyst content is hypointense in the T2-weighted image. White arrows indicate the location of the acoustic neuroma
Source publication
Background
Initial tumor enlargement (or pseudoprogression) instead of true tumor progression is a common phenomenon in patients with acoustic neuromas who are treated with stereotactic radiosurgery (SRS). This phenomenon can affect clinical decision-making and patient management. This study assessed the correlation between initial tumor enlargemen...
Citations
... However, all these lesions had short follow-up periods within the first year, implying that the observed progression could be a case of pseudoprogression, and volume reduction could still be seen in future radiological assessments. The occurrence of transient enlargement in meningiomas and acoustic neurinomas mainly in the first year after SRS has recently been reported, highlighting the critical interpretation of early progression in benign intracranial diseases (30)(31)(32)(33). Accordingly, transient enlargement of the tumor may be attributed to pseudoprogression in response to SRS and should be initially observed if asymptomatic. ...
Purpose
Stereotactic radiosurgery (SRS) has been increasingly used to treat intracranial pathologies in elderly patients. The treatment efficiency of SRS has been demonstrated in meningiomas, with excellent local control. We aimed to analyze the safety of robotic SRS in elderly patients with meningiomas.
Methods
We searched for patients with suspected WHO °I meningioma ≥ 60 years old, who underwent CyberKnife (CK) SRS from January 2011 to December 2021. Tumor localization was categorized using the “CLASS” algorithmic scale. Tumor response was evaluated using the Response Assessment in Neuro-Oncology (RANO) criteria for meningiomas. Adverse effects were graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 and a cox regression was performed to investigate possible predictors.
Results
We identified 82 patients with 102 CK-treated lesions that matched the criteria for the first SRS. The median age was 70 [IQR 64-75] years, and 24.3% of the patients were aged > 75 years. Multiple lesions (up to six) were treated in 14.1% of the SRS-sessions. A previous surgery was performed in 57.3% of lesions, with a median time interval of 41 [IQR 10 – 58] months between the initial surgical procedure and the SRS treatment. In 47.9% of cases, CLASS 3 meningiomas at high-risk locations were irradiated. Single fraction radiosurgery was applied to 62.5% of the lesions, while in the remaining cases multi-session SRS with three to five fractions was used. During the median follow-up period of 15.9 months, lesion size progression was observed in 3 cases. Karnofsky Performance Status (KPS) declined by ≥ 20 points in four patients. Adverse effects occurred in 13 patients, while only four patients had CTCAE ≥2 toxicities. Hereby only one of these toxicities was persistent. The occurrence of complications was independent of age, planned target volume (PTV), high-risk localization, and surgery before SRS.
Conclusion
The data indicates that SRS is a safe, efficient, and convenient treatment modality for elderly patients with meningioma, even at high-risk locations
