Plenary Oral Presentations - Macquarie University Hospital

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16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaBE-298Radiosurgery for Pineal Tumours: Lessonsfrom a Single Unit’s Experience1Jeremy Rowe, 1 John Yianni, 2 Nader Khandanpour, 1 Gabor Nagy,2Nigel Hoggard, 1 Matthias Radatz, 1 Andras Kemeny1National Centre for Stereotactic Radiosurgery, Sheffield, UK.2Dept Radiology, Royal Hallamshire <strong>Hospital</strong>, Sheffield, UK.Objective: Pineal tumours present management dilemmas. This reflects their varied histology, andthe hazards of surgical approaches. These issues prompted a systematic review of our radiosurgicalexperience to rationalize future therapeutic choices.Methods: From 1987-2009, 44 patients (66% male) underwent 50 Gamma Knife radiosurgicaltreatments. Mean(±SD) age at first radiosurgery was 34±16 years. Twenty-four patients had definitivehistology (11 pineal parenchymal tumours(PPT), including 2 pineoblastomas, 6 pineocytomas and 3 ofintermediate differentiation; 6 astrocytomas, 3 ependymomas, 2 papillary epithelial tumours, 2 germ celltumours(GCT)). Eleven patients had undergone surgery without a definitive tissue diagnosis: nine hadnot undergone surgery. Ten patients had received radiotherapy (5 PPT, 3 astrocytomas, 2 without tissuediagnosis).At treatment, mean tumour volume was 3.7±3.5cm3. Mean marginal dose was 18±4Gy.Mean follow-up was 62±53months (range 6-240). Radiological features were assessed blindly by tworadiologists.Results: Of 44 patients, five died 36±37 months after radiosurgery. Five further individuals showedradiological disease progression. Seven of these 10 patients had received radiosurgery as salvagetherapy. Malignant tumour histology (p=0.04), previous radiotherapy (p=0.002) and radiologicalevidence of necrosis (p=0.03) were associated with poor outcomes. Patients with none of thesefeatures had a 5 year progression free survival of 91% (80% at 10 years). If any of these featureswere present, the 5 year progression free survival fell to 48%. No complications were identifieddue to radiosurgery.Conclusions: Patients referred for radiosurgery are clearly super-selected. GCTs are under-representedin this series reflecting their established and effective treatment paradigms, and clearly they need to beidentified with blood/CSF markers and biopsy as appropriate. The finding that a quarter of this seriesdid not have a tissue diagnosis despite undergoing surgery, raises the question of how far it is mandatoryto pursue tissue diagnoses. The high control rate if no worrying features are present, combined with thelack of complications, suggests that primary radiosurgery without a tissue diagnosis is justifiable. Oncethere are concerns of malignancy, necrosis or failed radiotherapy, we suspect that a tissue diagnosis isessential, as these patients are often young and their response to radiosurgery less certain.16
16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaBE-304Risk factors for recurrences after Gamma Knife radiosurgeryof intracranial meningiomas3Vincent Bulthuis, 1,2 Patrick Hanssens, 1,2 Suan Te Lie, 4 Fons Kessels, 1,3 Koo van Overbeeke1Gamma Knife Center, St Elisabeth Ziekenhuis, Tilburg, The Netherlands2Department of Neurosurgery, St Elisabeth Ziekenhuis, Tilburg, The Netherlands3Department of Neurosurgery, Maastricht Universitair Medisch Centrum, Maastricht,4Department of Clinical Epidemiology and MTA, Maastricht Universitair Medisch CenObjective: Gamma Knife radiosurgery (GKRS) is a well established treatment for intracranial meningiomas.Regrowth of treated tumors occurs in about 10% of the patients. Apart from histopathologyas a known risk factor for regrowth, the importance of other patient, tumor or treatment planningrelated factors, like involving the dural tail in the plan, are not clearly defined. We reviewed the resultsof our center to access the risk factors for regrowth of mengiomas after GKRS.Methods: Between June 2002 and April 2008, 246 patients with 297 meningiomas were treated in ourcenter. The median tumor volume was 4,5cc. Median follow up period was 61 monthsThe dural tail was not included in the treatment plan.Based on the diagnosis of a meningioma, 2 groups were distinguished:Group A: There were 115 patients with 118 meningiomas without previous treatment. The diagnosiswas based upon defined MRI-characteristics.Group B: 131 patients with 179 meningiomas had surgery prior to the first GKRS. 125 (69.8%)tumors were classified as WHO I, 49 (27.4%) as WHO II and 5 (2, 8%) as WHO III.Results: Group A: Progression of 7 of 118 meningiomas resulted in a overall local control rate of93,9%.No significant risk factors for progression were indentified.Group B: In 26 of 179 meningiomas progression was documented. For WHO grade I meningiomasthe overall local control rate was 90,1%.In WHO grade II and III meningiomas, the overall recurrence rate was 46, 7%.Risk factors indentified in this group were: (1) WHO II/III histology, (2) prior surgery with additionaltreatment, (3) >1 meningioma treated in one session.No tumor recurrences were seen at the dural tail.Conclusions: No histological verification is needed to treat benign meningiomas with GKRS whenMRI criteria are respected. Tumor histology is a known risk factor for regrowth which is confirmedin this study. In our study, the dural tail was not involved in the treatment plan. No recurrences wereseen at the dural tail. In our opinion it is not necessary to involve the dural tail in the treatment plan.17
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Author IndexAAhluwalia Manmeet 49,
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RRadatz Matthias 12, 16Radatz Matth
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