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Pseudoprogression and peritumoral edema due to intratumoral necrosis after Gamma knife radiosurgery for meningioma

 In-Ho Jung  ;  Kyung Won Chang  ;  So Hee Park  ;  Hyun Ho Jung  ;  Jong Hee Chang  ;  Jin Woo Chang  ;  Won Seok Chang 
 SCIENTIFIC REPORTS, Vol.12(1) : 13663, 2022-08 
Journal Title
Issue Date
Edema / etiology ; Follow-Up Studies ; Humans ; Meningeal Neoplasms* / etiology ; Meningeal Neoplasms* / radiotherapy ; Meningeal Neoplasms* / surgery ; Meningioma* / etiology ; Meningioma* / radiotherapy ; Meningioma* / surgery ; Necrosis / etiology ; Necrosis / surgery ; Radiosurgery* / adverse effects ; Retrospective Studies ; Treatment Outcome
Peritumoral cerebral edema is reported to be a side effect that can occur after stereotactic radiosurgery. We aimed to determine whether intratumoral necrosis (ITN) is a risk factor for peritumoral edema (PTE) when gamma knife radiosurgery (GKRS) is performed in patients with meningioma. In addition, we propose the concept of pseudoprogression: a temporary volume expansion that can occur after GKRS in the natural course of meningioma with ITN. This retrospective study included 127 patients who underwent GKRS for convexity meningioma between January 2019 and December 2020. Risk factors for PTE and ITN were investigated using logistic regression analysis. Analysis of variance was used to determine whether changes in tumor volume were statistically significant. After GKRS, ITN was observed in 34 (26.8%) patients, and PTE was observed in 10 (7.9%) patients. When postoperative ITN occurred after GKRS, the incidence of postoperative PTE was 18.970-fold (p = 0.009) greater. When a 70% dose volume ≥ 1 cc was used, the possibility of ITN was 5.892-fold (p < 0.001) higher. On average, meningiomas with ITN increased in volume by 128.5% at 6 months after GKRS and then decreased to 94.6% at 12 months. When performing GKRS in meningioma, a 70% dose volume ≥ 1 cc is a risk factor for ITN. At 6 months after GKRS, meningiomas with ITN may experience a transient volume expansion and PTE, which are characteristics of pseudoprogression. These characteristics typically improve at 12 months following GKRS.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Park, So Hee(박소희)
Chang, Kyung Won(장경원)
Chang, Won Seok(장원석) ORCID logo https://orcid.org/0000-0003-3145-4016
Chang, Jong Hee(장종희) ORCID logo https://orcid.org/0000-0003-1509-9800
Chang, Jin Woo(장진우) ORCID logo https://orcid.org/0000-0002-2717-0101
Jung, In-Ho(정인호)
Jung, Hyun Ho(정현호)
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