Long-Term Outcomes and Complication Prediction after Stereotactic Radiosurgery for Previously Untreated Meningiomas

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Background and Objectives: Stereotactic radiosurgery (SRS) has been utilized as a primary and adjuvant treatment modality for patients with meningiomas. We seek to describe the long-term outcomes for patients who underwent SRS as primary treatment for sporadic intracranial meningiomas while exploring treatment-related outcomes as a function of radiosurgical parameters, including biological effective dose (BED). Methods: A prospectively maintained database was reviewed for all patients with sporadic meningiomas who underwent SRS (Gamma Knife) as primary treatment modality at a single center from April 1997 to February 2022. Clinicodemographic data, tumor measurements, and radiosurgical treatment parameters were abstracted. BED was calculated utilizing published monoexponential fits as a function of treatment time and marginal dose. Primary outcomes included progression-free survival and treatment-related neurological sequalae. Results: A total of 616 patients without prior surgery or radiotherapy underwent single-fraction SRS for treatment of 653 sporadic meningiomas at a single institution over a 25-year period. Median patient age at SRS was 59.1 years with 77.3% females. Median tumor volumes for 456 posterior fossa/skull base and 197 supratentorial lesions were 4.8 and 4.1 cm 3 , respectively. Median isodose line and number of isodose centers were 50% and 9, respectively. Median marginal and biological effective doses were 15.2 and 86.0 gray, respectively. With median and mean radiographic follow-up time of 6.50 and 7.43 years, median progression-free survival (PFS) estimates at 5, 10, and 15 years were 99.8, 98.9, and 92.9%, respectively. A total of 310 patients (50.2%) had lesions that decreased in size while 295 patients (48.0%) had lesions that remained stable. Local progression was noted in 7 patients (1.0%), marginal progression in 2 patients (0.4%, 1 patient with multiple lesions), and distant progression was observed in 2 patients (0.3%). Treatment-associated neurological sequalae were noted in 56 patients (9.1%), of which 6 (1.0%) were permanent and/or required intervention. Cranial neuropathies and/or neuralgias accounted for 46.4% of all sequalae. Perilesional cerebral edema post-SRS was noted in 75 patients (12.2%), among which 24 (3.9%) required steroid therapy and 2 (0.3%) underwent surgical intervention. Univariable logistic regression and receiver operating characteristics revealed marginal superiority of BED (AUC: 0.61) compared to marginal dose (AUC: 0.54) in predicting treatment-related sequalae. Multiple random forest classification models also confirmed relative importance of BED over marginal dose in predicting treatment-related neurological sequalae. Conclusion: SRS is highly efficacious and safe as primary treatment modality for sporadic intracranial meningiomas. Minimization of treatment-related sequalae remains an important incremental milestone to further enhance patient outcomes and may be achieved by refinement of treatment planning paradigms utilizing BED. Publication History Article published online: 07 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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