Radiotherapy alone or after subtotal resection for benign skull base meningiomas

BACKGROUND: The objective of the current study was to analyze the long-term local control and complications in a series of patients who were treated with radiotherapy for benign skull base meningiomas. METHODS: Between January 1984 and July 2001, 101 patients were treated with radiotherapy alone (n = 66) or after undergoing subtotal resection (n = 35). Sixty-one patients had previously untreated tumors, and 40 patients had tumors that were recurrent after prior surgery. Patients had follow-up from 0.6 years to 19 years (median, 5.1 years). The follow-up of living patients ranged from 1.3 years to 19 years (median, 5.4 years). RESULTS: The long-term local control rates were 95% at 5 years, 92% at 10 years, and 92% at 15 years. Multivariate analysis of local control revealed that none of the parameters evaluated significantly influenced this endpoint. The cause-specific survival rates were 97% at 5 years, 92% at 10 years, and 92% at 15 years; and the absolute survival rates were 86% at 5 years, 71% at 10 years, and 62% at 15 years. Multivariate analysis of cause-specific survival revealed that only gender significantly influenced this endpoint (P = 0.0185). Severe complications were observed in eight patients, and three patients experienced complications that were fatal. CONCLUSIONS: The probability of long-term progression-free survival after radiotherapy exceeded 90% and was comparable to the results of complete resection and radiosurgery. Subtotal resection was useful for decompressing the tumor if improvement in neurologic function was anticipated after surgery. Extensive subtotal resection may result in permanent neurologic deficits and did not improve long-term local control.