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Original article
peer-reviewed

Post-Treatment Edema after Meningioma Radiosurgery is a Predictable Complication



Abstract

Symptomatic post-treatment edema (PTE) causing seizures, focal deficits, and intracranial hypertension is a rather common complication of meningioma radiosurgery. Factors associated to the occurrence of PTE still needs to be clarified. We retrospectively analyzed our patients’ data to identify factors associated with the development of symptomatic PTE. Supposed risk factors were systematically analyzed.

Between July 2007 and March 2014, 245 meningiomas in 229 patients were treated by a single fraction or multisession radiosurgery (2-5 fractions) or hypofractionated stereotactic radiotherapy (6-15 fractions) using the CyberKnife system (Accuray Inc., Sunnyvale, CA) at the University Hospital of Messina, Italy.

Local tumor control was achieved in 200 of 212 patients with World Health Organization (WHO) Grade I meningiomas (94%) at a mean follow-up of 62 months. Symptomatic PTE on MRI was diagnosed in 19 patients (8.3%) causing seizure (n=17, 89%), aggravating headache (n=12, 63%), or focal deficits (n=13, 68%). Four variables were found to be associated with the likelihood of edema development, including tumor volume > 4.5 mL, non-basal tumor location, tight brain/tumor interface, and atypical histology. Nonetheless, when multivariate logistic regression analysis was performed, only tumor volume and brain-tumor interface turned out to be independent predictors of PTE development.

Our results suggest that the factor associated with the risk of developing PTE is associated to characteristics of meningioma rather than to the treatment modality used. Accordingly, an appropriate patient selection is the way to achieve safe treatment and long-term disease control.



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Original article
peer-reviewed

Post-Treatment Edema after Meningioma Radiosurgery is a Predictable Complication


Author Information

Alfredo Conti Corresponding Author

Department of Neurological Surgery, University of Messina

Antonio Pontoriero

Radiation Oncology, University of Messina

Francesca Siddi

Department of Neurological Surgery, University of Messina

Giuseppe Iatì

Radiation Oncology, University of Messina

Salvatore Cardali

Department of Neurological Surgery, University of Messina

Filippo F. Angileri

Department of Neurological Surgery, University of Messina

Francesca Granata

Neuroradiology, University of Messina

Stefano Pergolizzi

Radiation Oncology, University of Messina

Antonino Germanò

Department of Neurological Surgery, University of Messina

Francesco Tomasello

Department of Neurological Surgery, University of Messina


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Original article
peer-reviewed

Post-Treatment Edema after Meningioma Radiosurgery is a Predictable Complication


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Original article
peer-reviewed

Post-Treatment Edema after Meningioma Radiosurgery is a Predictable Complication

  • Author Information
    Alfredo Conti Corresponding Author

    Department of Neurological Surgery, University of Messina

    Antonio Pontoriero

    Radiation Oncology, University of Messina

    Francesca Siddi

    Department of Neurological Surgery, University of Messina

    Giuseppe Iatì

    Radiation Oncology, University of Messina

    Salvatore Cardali

    Department of Neurological Surgery, University of Messina

    Filippo F. Angileri

    Department of Neurological Surgery, University of Messina

    Francesca Granata

    Neuroradiology, University of Messina

    Stefano Pergolizzi

    Radiation Oncology, University of Messina

    Antonino Germanò

    Department of Neurological Surgery, University of Messina

    Francesco Tomasello

    Department of Neurological Surgery, University of Messina


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: May 09, 2016

    DOI

    10.7759/cureus.605

    Cite this article as:

    Conti A, Pontoriero A, Siddi F, et al. (May 09, 2016) Post-Treatment Edema after Meningioma Radiosurgery is a Predictable Complication. Cureus 8(5): e605. doi:10.7759/cureus.605

    Publication history

    Received by Cureus: April 05, 2016
    Peer review began: April 06, 2016
    Peer review concluded: April 23, 2016
    Published: May 09, 2016

    Copyright

    © Copyright 2016
    Conti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Symptomatic post-treatment edema (PTE) causing seizures, focal deficits, and intracranial hypertension is a rather common complication of meningioma radiosurgery. Factors associated to the occurrence of PTE still needs to be clarified. We retrospectively analyzed our patients’ data to identify factors associated with the development of symptomatic PTE. Supposed risk factors were systematically analyzed.

Between July 2007 and March 2014, 245 meningiomas in 229 patients were treated by a single fraction or multisession radiosurgery (2-5 fractions) or hypofractionated stereotactic radiotherapy (6-15 fractions) using the CyberKnife system (Accuray Inc., Sunnyvale, CA) at the University Hospital of Messina, Italy.

Local tumor control was achieved in 200 of 212 patients with World Health Organization (WHO) Grade I meningiomas (94%) at a mean follow-up of 62 months. Symptomatic PTE on MRI was diagnosed in 19 patients (8.3%) causing seizure (n=17, 89%), aggravating headache (n=12, 63%), or focal deficits (n=13, 68%). Four variables were found to be associated with the likelihood of edema development, including tumor volume > 4.5 mL, non-basal tumor location, tight brain/tumor interface, and atypical histology. Nonetheless, when multivariate logistic regression analysis was performed, only tumor volume and brain-tumor interface turned out to be independent predictors of PTE development.

Our results suggest that the factor associated with the risk of developing PTE is associated to characteristics of meningioma rather than to the treatment modality used. Accordingly, an appropriate patient selection is the way to achieve safe treatment and long-term disease control.



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Alfredo Conti, Associate Professor, M.D., Ph.D.

Department of Neurological Surgery, University of Messina

For correspondence:
alfredo.conti@unime.it

Antonio Pontoriero

Radiation Oncology, University of Messina

Francesca Siddi

Department of Neurological Surgery, University of Messina

Giuseppe Iatì

Radiation Oncology, University of Messina

Salvatore Cardali

Department of Neurological Surgery, University of Messina

Filippo F. Angileri

Department of Neurological Surgery, University of Messina

Francesca Granata

Neuroradiology, University of Messina

Stefano Pergolizzi

Radiation Oncology, University of Messina

Antonino Germanò

Department of Neurological Surgery, University of Messina

Francesco Tomasello

Department of Neurological Surgery, University of Messina

Alfredo Conti, Associate Professor, M.D., Ph.D.

Department of Neurological Surgery, University of Messina

For correspondence:
alfredo.conti@unime.it

Antonio Pontoriero

Radiation Oncology, University of Messina

Francesca Siddi

Department of Neurological Surgery, University of Messina

Giuseppe Iatì

Radiation Oncology, University of Messina

Salvatore Cardali

Department of Neurological Surgery, University of Messina

Filippo F. Angileri

Department of Neurological Surgery, University of Messina

Francesca Granata

Neuroradiology, University of Messina

Stefano Pergolizzi

Radiation Oncology, University of Messina

Antonino Germanò

Department of Neurological Surgery, University of Messina

Francesco Tomasello

Department of Neurological Surgery, University of Messina