Long-Term Efficacy of Fractionated Stereotactic Radiotherapy for Benign Meningiomas

Objective: To assess long-term efficacy of fractionated stereotactic radiotherapy (fSRT) in the treatment of benign intracranial meningiomas.

Patients and Methods: Retrospective study of 222 patients with grade I meningiomas treated with fSRT between 1995 and 2010 in a single institution. Median age was 52 (range, 27–77) years; 170 were women and 52 men. Of these, 145 (65%) tumors involved the skull base. For 103 patients, fSRT was given as primary treatment, and it was used for residual/progressive tumor after previous surgery in 119 patients. Treatment was delivered on a 6-MV linear accelerator to a dose of 50–55 Gy in 30–33 daily fractions. Survival and local progression-free survival (PFS/local control) rates were assessed from the date of fSRT.

Results: At a median follow-up of 43 (range, 3–144) months, the 5- and 10-year local PFS survival rates were 93% and 86%, respectively. Patients with optic nerve and cavernous sinus/parasellar meningiomas had 100% 5- and 10-year local PFS. The 5- and 10-year survival rates were 93% and 84%, respectively.

Better local control was seen in patients treated with primary radiotherapy (5-year PFS was 99% vs 93% after previous surgery; P = 0.04) and in patients with skull base, suprasellar, and optic nerve compared with falx localization (P < 0.0001). No patient developed radiation necrosis or second brain tumor. Two percent of patients developed late events in the form of cerebrovascular accidents.

Conclusion: fSRT achieves excellent tumor control with few complications and should be considered the treatment of choice for patients with benign optic nerve and parasellar meningiomas.