Early outcomes of Gamma Knife stereotactic radiosurgery for symptomatic intracranial meningiomas in octogenarians: technique analysis and rationale

Abstract

Background and objectives: Resection of symptomatic intracranial meningiomas in octogenarians poses significant risks related to the patients' advanced age and associated comorbidities. Stereotactic radiosurgery (SRS) offers a minimally invasive management alternative, but its efficacy and safety in this age group warrant further evaluation. This study aims to evaluate the outcomes of SRS in octogenarian patients with intracranial meningiomas.

Methods: We conducted a retrospective analysis of 74 patients aged ≥ 80 years, all of whom underwent outpatient SRS at the [Blinded for Review] during the past 37 years. Primary outcomes were tumor response, neurological function, and adverse radiation effects (ARE). The median age was 82 years (IQR, 81-84); 64% were female. At presentation, primary symptoms included gait instability (39%), headaches (38%), and visual symptoms (35%). The median tumor volume was 7.7 cm³ (IQR, 4.2-14.4), and the median prescription margin dose was 12 Gy (IQR, 11-13).

Results: Patients were followed for at least 6 months with a median follow up of 19 months (range, 6-173). The Kaplan Meier tumor control rates were 91% and 80% at the 2- and 4-year time points, respectively. During the observation interval, 46 (62%) died; no deaths were related to tumor progression or SRS complications. Symptom improvement or stability was observed in 87% of patients at their last follow-up. Transient adverse radiation effects including peritumoral edema were observed in 4%; 2 patients were treated with steroids only and 1 patient was treated with steroids, pentoxifylline, vitamin E, and levetiracetam as the patient had associated seizures.

Conclusions: In our experience, SRS in octogenarian patients with symptomatic intracranial meningiomas provided early tumor control and was associated with a low risk of transient radiosurgical morbidity.

Keywords: Adverse radiation effects; Intracranial meningiomas; Octogenarians; Overall survival; Stereotactic radiosurgery; Tumor control.