Stereotactic Radiosurgery for Intracranial Meningiomas: Current Concepts and Future Perspectives

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Abstract

Meningiomas are among the most common adult brain tumors. Although the optimal management of meningiomas would provide complete elimination of the lesion, this cannot always be accomplished safely through resection. Therefore, other therapeutic modalities, such as stereotactic radiosurgery (as primary or adjunctive therapy), have emerged. In the current review, we have provided an overview of the historical outcomes of various radiosurgical modalities applied in the management of meningiomas. Furthermore, we provide a discussion on key factors (eg World Health Organization grade, lesion size, and lesion location) that affect tumor control and adverse event rates. We discuss recent changes in our understanding of meningiomas, based on molecular and genetic markers, and how these will change our perspective on the management of meningiomas. We conclude by outlining the areas in which knowledge gaps persist and provide suggestions as to how these can be addressed.

ABBREVIATIONS:

ARE, adverse radiation event

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CI, conformity index

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FSRT, fractionated radiotherapy

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GK, Gamma Knife

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GTR, gross total resection

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HGM, high-grade meningioma

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LINAC, linear accelerator

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NF2, neurofibromatosis type 2

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OA, optic apparatus

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OS, overall survival

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PFS, progression-free survival

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SRS, stereotactic radiosurgery

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STR, subtotal resection

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TC, tumor control

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VS, vestibular schwannoma

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WHO, World Health Organization

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