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  • The Geriatric Scoring System (GSS) for Risk Stratification in Meningioma Patients as a Predictor of Outcome in Patients Treated With Radiosurgery

    Final Number:

    Or Cohen-Inbar MD PhD; Zhiyuan Xu MD; David Schlesinger; Jason P. Sheehan MD, PhD, FACS

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Meningiomas are the most common primary benign brain tumor. Radiosurgery (primary or adjuvant to partial resection) allows for excellent local control. The Geriatric scoring system (GSS) for pre-operative risk stratification and outcome prediction of patients with meningiomas has been previously reported. The GSS incorporates eight tumor and patient parameters on admission. A GSS score higher than 16 was found to be associated with a more favorable outcome. We assessed the validity of the GSS score and its influence on outcome in patients treated with gamma-knife radiosurgery (GKRS).

    Methods: Patients treated with single session GKRS for WHO-1 meningioma during 1989-2013 at the University of Virginia were reviewed.

    Results: A cohort of 323 patients, 50.2% (n=162) males. Median age 56 (29-84), median follow-up 53.6 (6-235) months. Median tumor volume 4.5 cm3 (0.2-23). Median margin and maximal doses 15 Gy (8-36) and 32.25 Gy (20-65) respectively. Tumor volume control was achieved in 87% (n=281), post-GKRS clinical improvement reported in 66.3% (n=214). Median change in KPS per-patient of +10 (-30 to +40) reported. The most common complication was headache (34.1%, n=110), followed by cranial nerve deficits (14.2%, n=46). The GSS (calculated and grouped as GSS>16 and GSS<=16) was found to significantly correlate with different outcome parameters (p=0.003 and p<0.0001 respectively).

    Conclusions: The GSS scale, used for risk stratification and outcome prediction in patients with meningiomas seems valid for patients undergoing single session radiosurgery too. A GSS score greater than 16 is associated with a better long-term functional status, and tumor control.

    Patient Care: Better outcome prediction can better assist in proper patient selection for benefit / risk ratio improvement.

    Learning Objectives: The prognostic importance of the previously published GSS score in meningioma patients treated with stereotactic radiosurgery.

    References: 1. Cahill KS, Claus EB. Treatment and survival of patients with nonmalignant intracranial meningioma: Results from the Surveillance, Epidemiology, and End Results Program of the National Cancer. J Neurosurg. 2011 Aug;115(2):259-67. 2. Mathiesen T, Gerlich A, Kihlstrom L, et al. Effects of using combined transpetrosal surgical approaches to treat petroclival meningiomas. Neurosurgery 2007;60:982-991. discussion 991-992. 3. Mathiesen T, Lindquist C, Kihlstrom L, et al. Recurrence of cranial base meningiomas. Neurosurgery 1996;39:2-7. discussion 8-9. 4. Bambakidis NC, Kakarla UK, Kim LJ, Nakaji P, Porter RW, Daspit CP, et al: Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery 61 (5 Suppl 2):202–211, 2007 5. Cohen-Inbar O, Soustiel JF, Zaaroor M (2010) Meningiomas in the elderly, the surgical benefit and a new scoring system. Acta Neurochir (Wien) 87:87 – 97 6. Cohen-Inbar O, Sviri GE, Soustiel JF et al. The Geriatric Scoring System (GSS) in meningioma patients--validation. Acta Neurochir (Wien). 2011 Jul;153(7):1501-8; discussion 1508. 7. Clancey JK (1995) Karnofsky performance scale. J Neurosci Nurs 27:220 8. Flannery TJ, Kano H, Lunsford LD, et al. Long-term control of petroclival meningiomas through radiosurgery. J Neurosurg 2010;112: 957-964. 9. Combs SE, Adeberg S, Dittmar JO, et al. Skull base meningiomas: Long-term results and patient self-reported outcome in 507 patients 10. Fokas E, Henzel M, Surber G et al. Stereotactic Radiation Therapy for Benign Meningioma: Long-Term Outcome in 318 Patients. Int J Radiat Oncol Biol Phys. 2014 Jul 1;89(3):569-75. 11. DiBiase SJ, Kwok Y, Yovino S, Arena C, Naqvi S, Temple R, et al: Factors predicting local tumor control after .gamma knife stereotactic radiosurgery for benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 60:1515-1519, 2004 12. Iwai Y, Yamanaka K, Ikeda H: Gamma Knife radiosurgery for skull base meningioma: long-term results of low-dose treatment. J Neurosurg 109:804–810, 2008 13. Lee JY, Niranjan A, McInerney J, Kondziolka D, Flickinger JC, Lunsford LD: Stereotactic radiosurgery providing longterm tumor control of cavernous sinus meningiomas. J Neurosurg 97:65–72, 2002 14. Starke RM, Przybylowski CJ, Sugoto M et al. Gamma Knife radiosurgery of large skull base meningiomas. J Neurosurg. 2014 Dec 5:1-10. 15. Starke RM, Williams BJ, Hiles C, Nguyen JH, Elsharkawy MY, Sheehan JP: Gamma knife surgery for skull base meningiomas. J Neurosurg 116:588–597, 2012 16. Snell JW1, Sheehan J, Stroila M, Steiner L: Assessment of imaging studies used with radiosurgery: a volumetric algorithm and an estimation of its error. Technical note. J Neurosurg. Jan; 104(1):157-62, 2006. 17. Cushing H Eisenhardt H (1938) Meningiomas: their classification, regional behavior, life history and surgical end results. Charles C. Thomas, Springfield 18. Sutherland GR, Florell R, Louw D, Choi NW, Sima AA (1987) Epidemiology of primary intracranial neoplasms in Manitoba, Canada. Can J Neurol Sci 14:586 – 592 19. Rubin G, Herscovici Z, Laviv Y, Jackson S, Rappaport ZH. Outcome of untreated meningiomas. Isr Med Assoc J. 2011 Mar;13(3):157-60. 20. Rogers L1, Barani I, Chamberlain M, Kaley TJ, McDermott M, Raizer J, Schiff D, Weber DC, Wen PY, Vogelbaum MA. Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review. J Neurosurg. 2015 Jan;122(1):4-23. 21. Arnautovic KI, Al-Mefty O, Husain M. Ventral foramen magnum meningiomas. J Neurosurg 2000 92:71–80. 22. Bricolo AP, Turazzi S, Talacchi A, Cristofori L. Microsurgical removal of petroclival meningiomas: A report of 33 patients. Neurosurgery 1992 31:813–828. 23. De Jesús O, Sekhar LN, Parikh HK, Wright DC, Wagner DP. Long-term follow-up of patients with meningiomas involving the cavernous sinus: Recurrence, progression, and quality of life. Neurosurgery 1996 39:915–920. 24. Couldwell WT, Fukushima T, Giannotta SL, Weiss MH. Petroclival meningiomas: Surgical experience in 109 cases. J Neurosurg 1996 84:20–28. 25. DeMonte F, Smith HK, Al-Mefty O. Outcome of aggressive removal of cavernous sinus meningiomas. J Neurosurg 1994 81:245–251. 26. George B, Lot G, Boissonnet H. Meningioma of the foramen magnum: A series of 40 cases. Surg Neurol 1997 47:371–379. 27. Natarajan SK, Sekhar LN, Schessel D, Morita A. Petroclival meningiomas: Multimodality treatment and outcomes at long-term follow-up. Neurosurgery 2007 60:965–981. 28. Samii M, Carvalho GA, Tatagiba M, Matthies C. Surgical management of meningiomas originating in Meckel’s cave. Neurosurgery 1997 41:767–775. 29. Samii M, Klekamp J, Carvalho G. Surgical results for meningiomas of the craniocervical junction. Neurosurgery 1996 39:1086–1095. 30. Condra KS, Buatti JM, Mendenhall WM, Friedman WA, Marcus RB Jr, Rhoton AL. Benign meningiomas: Primary treatment selection affects survival. Int J Radiat Oncol Biol Phys 1997 39:427–436. 31. Kondziolka D, Patel A, Kano H et al. Long-term Outcomes After Gamma Knife Radiosurgery for Meningiomas. Am J Clin Oncol. 2014 Apr 21. 32. Lee JH, Sade B (2009) The novel “ CLASS ” algorithmic scale for patient selection in meningioma surgery. In: Lee JH (ed) Meningiomas: diagnosis, treatment, and outcome. Springer, London, pp 217 – 223 33. Sacko O, Sesay M, Roux FE, Riem T, Grenier B, Liguoro D, Loiseau H (2007) Intracranial meningioma surgery in the ninth decade of life. Neurosurgery 61:950

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