Hypofractionated Stereotactic Radiotherapy for Intracranial Meningiomas: Preliminary Results of a Feasible Trial

Aim: Fractionated stereotactic radiotherapy is an alternative to radiosurgery or conformal radiotherapy when meningiomas are surgically inaccessible, incompletely removed, or recurrent. The authors report preliminary results of a feasible trial on hypofractionated stereotactic radiotherapy (hFSRT) in patients (pts) with intracranial meningiomas.

Methods: From August 2003 to May 2007, 35 consecutive pts with a median age of 59 years (range, 23-86) underwent hFSRT for intracranial meningiomas. Male/female ratio was 9/26, median Karnofsky performance status was 90 (range, 60-100). In 14 lesions (40%) diagnosis was based upon clinical and radiological data. After surgery or biopsy, 19 pts had histologically proven World Health Organization grade I and 2 pts grade II meningiomas. The median treatment volume was 23 cc (range, 4-58 cc). Before hFSRT, 26 (74%) pts had neurologic symptoms. Nineteen (54%) pts received 42 Gy and 16 (46%) 45 Gy of total dose, 3 Gy/fraction, 5 fractions/week.

Results: The median follow-up was 29 months (range, 10-51) and 22 (63%) pts had a follow-up 24 months. Treatment was well tolerated and we did not observe clinically significant acute and late toxicity. At instrumental control, 32 (91%) lesions remained stable, 2 (6%) decreased and 1 (3%) progressed in size. Median duration of local control was 24 months (range, 4-47), and median progression free survival 23 months (range, 4-47). Clinical improvement of pre-existing neurological symptoms was observed in 84% of cases.

Conclusions: These preliminary data suggest that hFSRT is a safe and effective treatment modality for intracranial meningiomas.