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by: Dr. Gil Lederman096
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Gil Lederman: Patients with Meningiomas


Meningiomas are very frequently benign tumors but can undergo malignant transformation. The usual treatment in the past has been surgery. Many meningiomas are located in delicate
areas around the brain which are difficult – if not impossible – to fully resect, while leaving the patient intact. Fractionated stereotactic radiosurgery in our hands has been used with a high degree of success.

For patients diagnosed radiographically, our success rate (meaning control of the tumor, shrinkage or disappearance) is approximately 98%. For patients who had recurrent tumors after
surgery, the success rate is high – but not as high as in non-surgical cases. The beauty of our program is that fractionated radiosurgery is non-invasive and well-tolerated. Radiation is given in
a series of treatments to help avoid toxicity to healthy surrounding brain.

Patients with meningiomas come for fractionated radiosurgery especially when located around crucial blood vessels and nerves. Tumors are frequently incompletely-resected or regrow after surgical resection. Others simply do not want surgery and its associated hospitalization and convalescence. Fractionated radiosurgery can be used primarily in place of surgery or when surgery has failed. Thanks to fractionated radiosurgery, we can treat tumors about critical structures such as the carotid artery, optic nerve, optic chiasm and brain stem. We frequently treat meningiomas in the most difficult areas of the brain – in place of surgery or standard radiation. Each circumstance is unique – that is why we review the materials, films and patient first.


Results of newly diagnosed meningiomas show the vast majority – over 95% - are successfully treated and need no further treatment. Even those patients who have had prior surgery can be treated with most likely a successful outcome. Success or control of tumors means cessation of growth, shrinkage or disappearance of the abnormality on imaging. Many people come to us with tumors that were thought impossible to treat otherwise – which for us are done on a routine basis. Some ask whether there is an issue of claustrophobia undergoing treatment. Our answer is simple – No.

Arteriovenous malformations - entangled blood vessels within the brain that are prone to bleed causing stroke or even death - remain an important indication for radiosurgery. Patients are treated with especially close neuroradiologic and neurosurgical collaboration. Treatment of AVM’s requires angiography at the time of treatment to best define the shape, contour and size of these potentially fatal weakened blood vessels - that are prone to bleed. Success - meaning obliteration of arteriovenous malformations - is high using radiosurgery - a time-proven technique.
Of course, many other tumors - perhaps too numerous to mention in this short brochure - are treated by the experts at RSNY. Our group has experience with many more unusual tumors such as craniopharyngiomas, chordomas, hemangioblastomas, oligodendrogliomas, ependymomas, glomus tumors, medulloblastomas and many others. Since each person is unique, we encourage your questions and interaction.

A recent paper in the International Journal of Radiation, Oncology, Biology and Physics evaluated twenty-eight patients treated for primary or recurrent meningiomas in the cavernous sinus. Since
meningiomas are responsible for about one-sixth of all brain tumors they are a prominent source of diagnosis, treatment and, unfortunately, morbidity and sometimes mortality. While many meningiomas are slow growing and can be resected, others are more difficult to attack surgically and likely to leave the patient significantly altered in function post-operatively. Furthermore many of these difficult-to-extricate meningiomas are incompletely removed and eventually will grow back. The time of regrowth depends on the growth rate. Some meningiomas
indeed become aggressive or even malignant and can act like cancerous tumors.


Our center often sees recurrent meningiomas, that is tumors that have been previously treated. A significant share of those are indeed aggressive or malignant and are much more difficult to
manage. Yet radiation has been shown to be of benefit. A significant site of meningiomas is the cavernous sinus. Our center dwells on fractionated radiosurgeries using conventional doses; there is longer follow up with standard techniques. It is important to know the outcome since the effect on the tumor cells should be similar; a potential benefit of radiosurgery is relative protection of the healthy normal tissue.


Twenty-eight patients with cavernous sinus meningiomas were reported by McGuire et al in the International Journal of Radiation, Oncology, Biology and Physics. Patients ranged in age from
seventeen to seventy-six years with a median of forty-three years. There were twenty-one women and seven men. Not all patients underwent biopsy although in seven patients tumor was found to be invading adjacent bone or having excessive mitoses that is cell divisions suggestive of unusual or aggressive meningiomas. Radiation was given out with a median dose of 5310 cGy with a range
of 3060 to 6000 cGy.


There were twenty-seven patients alive at reporting and twenty-two were imaged by CT or MRI within two years of the medical analysis. Follow up ranged 3 to 145 months with a median of 41 months. The authors defined late toxicity "as the onset or worsening of neurological symptoms beyond three months after the completion of radiotherapy not attributable to disease progression by radiographic or clinical criteria." One of the twenty-eight patients died thus the eight year actuarial survival was 96%. However two other patients were alive with progressive disease producing an eight year progression free survival rate of 81%. One patient that died had a surgical resection yet the tumor recurred. The patient passed away eight months following radiation. Side effects included short-term memory loss in one patient treated with standard techniques in 1985. Another patient developed fibrosis in the orbit 35 years after having radiation for an eye
tumor.

We have a special program for head and neck cancers – many we see come to us after prior surgery, chemo or radiation have not produced the desired results. Our panel of experts may help. This article discusses the benefits in brief.

About the Author

Please visit our before and after visual Body Radiosurgery gallery. For more information about non-invasive cancer treatment , please visit http://www.rsny.org/ or email Dr. Gil Lederman at Gil.Lederman@RSNY.ORG  

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