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. 2025 Jul 4:54:101010.
doi: 10.1016/j.ctro.2025.101010. eCollection 2025 Sep.

Symptomatic posttreatment edema after stereotactic radiotherapy (SRS/FSRS) for intracranial meningiomas: patterns and predictive factors

Dorra Aissaoui  1   2 , Naoual Oulmoudne  1 , Houda Bahig  1   2 , Giuseppina Laura Masucci  1   2 , Robert Moumdjian  2   3 , David Roberge  1   2 , Cynthia Menard  1   2 , Laurent Létourneau-Guillon  2   4 , Carole Lambert  1   2 , Jean-Paul Bahary  1   2
Affiliations

Symptomatic posttreatment edema after stereotactic radiotherapy (SRS/FSRS) for intracranial meningiomas: patterns and predictive factors

Dorra Aissaoui et al. Clin Transl Radiat Oncol. .

Abstract

Background: Symptomatic posttreatment edema (SPTE) is a complication that may develop after radiotherapy for intracranial meningiomas. Our study aims at reviewing rates of SPTE in a large cohort of a single institution and identifying possible predictive factors.

Methods: We retrospectively analyzed data of 293 patients with 304 intracranial meningiomas irradiated at our institution between 2005 and 2018. We evaluated rates of SPTE and investigated numerous factors by univariate and multivariate analysis. Kaplan Meier analysis was used for estimation of actuarial local control and overall survival.

Results: Median age was 60 years. Meningiomas were treated with fractionated stereotactic radiation therapy (70 %), single fraction stereotactic radiosurgery (24 %) or fractionated stereotactic radiosurgery (6 %). Median imaging follow-up was 60 months, actuarial 10 year local control rate for patients with grade 1 meningiomas who received radiotherapy as definitive treatment was 99 %. Local control at 5 years was 94 % for grade 1 meningioma, 57 % and 53 % for grade 2 and 3 respectively. Sixteen patients (5.5 %) developed SPTE, median time to onset was 3 months (range 1-26 months). the higher rates of SPTE observed were in midline (13 %) and convexity (9 %), compared to skull base tumors (2 %). On univariate analysis, age > 60 years (p > 0.03), pretreatment peritumoral edema (p = 0.014), medline location (p = 0.018), tumor size > 30 mm (p = 0.015) and grade 2 histology (p = 0.03) were predictive of SPTE. On multivariate analysis, only tumor location and size remained statistically significant.

Conclusions: Based on our results, patients at high risk of SPTE can be identified based on patient and tumor characteristics. The best treatment technique in high risk patients is yet to be defined.

Keywords: Intracranial meningioma; Radiosurgery; Stereotactic radiation therapy; Symptomatic posttreatment edema.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Houda Bahig and David Roberge received research grant from Varian Medical Systems, and speakers Honoraria from Siemens Healthineers/Varian Medical Systems, unrelated to the current work. David Roberge also reports honoraria and research funding from Accuray, BrianLab and Elekta unrelated to the current work. Carole Lambert reports honoraria in relation to a lecture for Abbvie and advisory role for Ferring and Sanofi unrelated to the current work. Giuseppina Laura Masucci also reports Astrazeneca honoraria et cerapedics honoraria unrelated to the current work. Cynthia Ménard reported research fundings from Promaxo, Lantheus, Varian, and Tersera unrelated to the current work. No other disclosures are declared.

Figures

Fig. 1
Fig. 1
A: Axial T1-weighted MRI of a right convexity meningioma. B: Axial T1-weighted MRI showing de-novo edema 6 months after single fraction radiosurgery (15 Gy to the 81 % isodose line). C: Axial T2 FLAIR-weighted MRI showing extensive edema. The 83 years old patient was successfully managed with corticosteroids.
Fig. 2
Fig. 2
A: Axial T2 FLAIR-weighted MRI of a left parafalcine occipital meningioma with peri-tumoral edema in a 75 years old patient. B: Axial T2 FLAIR-weighted MRI showing edema progression 2 months after fractionated stereotactic radiotherapy (54 Gy in 30 fractions), patient had to undergo salvage surgery, pathology showed a WHO grade 1 meningioma.
See this image and copyright information in PMC

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