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Article

The Role of Stereotactic Radiosurgery in the Management of Foramen Magnum Meningiomas—A Multicenter Analysis and Review of the Literature

1
Berlin Institute of Health at Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
2
Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, 13353 Berlin, Germany
3
European Radiosurgery Center, 81377 Munich, Germany
4
Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany
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CyberKnife Center Mitteldeutschland, 99089 Erfurt, Germany
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German CyberKnife Center, 59494 Soest, Germany
7
Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité CyberKnife Center, 13353 Berlin, Germany
8
German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
9
Radiochirurgicum, 73035 Göppingen, Germany
10
Department of Neurosurgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
*
Author to whom correspondence should be addressed.
Academic Editor: Shinji Kawabata
Cancers 2022, 14(2), 341; https://doi.org/10.3390/cancers14020341
Received: 22 November 2021 / Revised: 6 January 2022 / Accepted: 7 January 2022 / Published: 11 January 2022
Meningiomas represent the most common central nervous system (CNS) tumor. Despite their often benign nature, a tumor location in direct proximity to vital brain structures may lead to significant morbidity. This is the case for foramen magnum meningiomas (FMMs) as they grow at the skull base, next to the brain stem and foramen magnum. Surgical resection represents the mainstay of FMM treatments. In patients unsuitable for surgery, with tumor recurrences or tumor remnants after surgery, non-invasive treatment modalities may play a crucial role in patient management. Reports and studies on stereotactic radiosurgery (SRS) for the treatment of FMMs are scarce. This multicenter analysis reported the outcome data of 62 patients with FMMs. SRS achieved a high local tumor control and demonstrated a favorable safety profile. These results are in agreement with previous findings. SRS should be considered for selected FMM patients.
Background: Foramen magnum meningiomas (FMMs) represent a considerable neurosurgical challenge given their location and potential morbidity. Stereotactic radiosurgery (SRS) is an established non-invasive treatment modality for various benign and malignant brain tumors. However, reports on single-session or multisession SRS for the management and treatment of FMMs are exceedingly rare. We report the largest FMM SRS series to date and describe our multicenter treatment experience utilizing robotic radiosurgery. Methods: Patients who underwent SRS between 2005 and 2020 as a treatment for a FMM at six different centers were eligible for analysis. Results: Sixty-two patients met the inclusion criteria. The median follow-up was 28.9 months. The median prescription dose and isodose line were 14 Gy and 70%, respectively. Single-session SRS accounted for 81% of treatments. The remaining patients received three to five fractions, with doses ranging from 19.5 to 25 Gy. Ten (16%) patients were treated for a tumor recurrence after surgery, and thirteen (21%) underwent adjuvant treatment. The remaining 39 FMMs (63%) received SRS as their primary treatment. For patients with an upfront surgical resection, histopathological examination revealed 22 World Health Organization grade I tumors and one grade II FMM. The median tumor volume was 2.6 cubic centimeters. No local failures were observed throughout the available follow-up, including patients with a follow-up ≥ five years (16 patients), leading to an overall local control of 100%. Tumor volume significantly decreased after treatment, with a median volume reduction of 21% at the last available follow-up (p < 0.01). The one-, three-, and five-year progression-free survival were 100%, 96.6%, and 93.0%, respectively. Most patients showed stable (47%) or improved (21%) neurological deficits at the last follow-up. No high-grade adverse events were observed. Conclusions: SRS is an effective and safe treatment modality for FMMs. Despite the paucity of available data and previous reports, SRS should be considered for selected patients, especially those with subtotal tumor resections, recurrences, and patients not suitable for surgery. View Full-Text
Keywords: radiosurgery; stereotactic radiosurgery; meningioma; foramen magnum; robotic radiosurgery; CyberKnife; neuro-oncology; literature review; review radiosurgery; stereotactic radiosurgery; meningioma; foramen magnum; robotic radiosurgery; CyberKnife; neuro-oncology; literature review; review
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MDPI and ACS Style

Ehret, F.; Kufeld, M.; Fürweger, C.; Haidenberger, A.; Fichte, S.; Lehrke, R.; Senger, C.; Kaul, D.; Bleif, M.; Becker, G.; Rueß, D.; Ruge, M.; Schichor, C.; Tonn, J.-C.; Muacevic, A. The Role of Stereotactic Radiosurgery in the Management of Foramen Magnum Meningiomas—A Multicenter Analysis and Review of the Literature. Cancers 2022, 14, 341. https://doi.org/10.3390/cancers14020341

AMA Style

Ehret F, Kufeld M, Fürweger C, Haidenberger A, Fichte S, Lehrke R, Senger C, Kaul D, Bleif M, Becker G, Rueß D, Ruge M, Schichor C, Tonn J-C, Muacevic A. The Role of Stereotactic Radiosurgery in the Management of Foramen Magnum Meningiomas—A Multicenter Analysis and Review of the Literature. Cancers. 2022; 14(2):341. https://doi.org/10.3390/cancers14020341

Chicago/Turabian Style

Ehret, Felix, Markus Kufeld, Christoph Fürweger, Alfred Haidenberger, Susanne Fichte, Ralph Lehrke, Carolin Senger, David Kaul, Martin Bleif, Gerd Becker, Daniel Rueß, Maximilian Ruge, Christian Schichor, Jörg-Christian Tonn, and Alexander Muacevic. 2022. "The Role of Stereotactic Radiosurgery in the Management of Foramen Magnum Meningiomas—A Multicenter Analysis and Review of the Literature" Cancers 14, no. 2: 341. https://doi.org/10.3390/cancers14020341

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