Featured Case Studies 2004, Volume 1, Number 3

Meningioma: a Case for Radiosurgery In a Medically Compromised Patient

by > John Breneman, MD and Ron Warnick, MD

Clinical problem

This is an 83-year-old woman with an incidental finding of a right posterior frontal convexity meningioma several years ago. Initially, observation was recommended, however serial follow-up scans showed progressive growth of the lesion. Having a past medical history of pulmonary fibrosis, the patient was felt to be a poor operative candidate. Stereotactic radiosurgery was recommended for control of her asymptomatic, though progressive tumor.


Treatment options

The patient underwent single-dose radiosurgery treatment. The BrainLab stereotactic headring was used for localization of the lesion and immobilization during treatment. The Novalis treatment unit was configured for Dynamic Conformal Arc therapy with the shape of the radiation beam profile continuously modified as it moved over the surface of the patient’s head. A single dose of 1600 cGy was delivered. The entire procedure lasted approximately 3 hours and the patient was discharged home. The patient experienced no adverse effects from treatment. Follow-up MR done 6 months after treatment showed a significant decrease in the lesion size.



Figure1. [top] Dynamic Conformal Arc therapy delivers highly conformal radiation to the target, minimizing side effects of treatment.

 

Comments

Though surgical resection is the treatment of choice for operable meningiomas, stereotactic radiosurgery and radiotherapy are excellent alternatives for those unable to undergo surgery. Local control after treatment exceeds 90% at 10 years, and objective radiographic response and/or symptomatic relief are seen in almost 50% of patients. Using highly conformal techniques such as Dynamic Conformal Arc therapy, risks and side effect of treatment are minimal. Most patients are able to continue normal work and activities in the peri-treatment period. Even minor effects such as hair loss are uncommon.


References
  • Long-term results after radiosurgery for benign intracranial tumors. Neurosurgery 53(4):815-21, 2003
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