Volumetric follow-up of meningiomas: A quantitative method to evaluate treatment outcome of gamma knife radiosurgery

OBJECTIVE: The most important treatment options for meningiomas are microsurgery, radiotherapy, and gamma knife radiosurgery (GKRS). The efficacy of GKRS in terms of local tumor control and tumor volume (TV) reduction can best be determined by accurate analysis of changes in tumor size in pre- and post-GKRS images. In this prospective study, we set the focus on evaluating TV changes and treatment outcome of meningiomas using a quantitative volumetric follow-up protocol after GKRS. METHODS: Consecutive patients with World Health Organization Grade I and II meningiomas were included in this study. Most patients underwent a microsurgical TV reduction before being treated with GKRS. Follow-up examinations were performed according to a standardized protocol and included magnetic resonance imaging and quantitative volumetric tumor analyses as well as thorough neurological examinations. RESULTS: Complete follow-up data was available for 211 patients (243 tumors) with a mean age of 57.9 years. TVs ranging from 0.1 to 48.3 cm(3) were treated with GKRS using prescription doses ranging from 10 to 22 Gy. The achieved overall tumor control rate determined with quantitative TV analyses after GKRS was 93.4%; a mean TV reduction of 42.1% was achieved in 74.5% of all treated patients. CONCLUSION: Results of this study show that a quantitative volumetric follow-up study of meningiomas is a useful method to demonstrate the efficacy of GKRS for meningiomas. Statistically significant TV reductions with a low rate of side effects can be achieved with GKRS.