XRT-04. THE ROLE OF STEREOTACTIC RADIOSURGERY FOR MENINGIOMAS IN PEDIATRIC PATIENTS

Despite the generally benign and slow-growing nature, meningiomas in pediatric populations often exhibit more aggressive behavior. Stereotactic radiosurgery (SRS) is a non-invasive modality that is widely used as an upfront or adjuvant treatment for patients with meningiomas. Due to the rarity of meningiomas in pediatric patients, the outcomes of SRS for childhood meningiomas have never been described. From 1987 to 2022, a total of 2,030 patients with meningiomas underwent SRS at the University of Pittsburgh Medical Center. Nine patients (2 female; incidence rate = 0.44%) with a median age of 14.5 years (range, 9—17 years) at SRS were identified. Three patients (33.3%) had a history of total body irradiation. Seven patients (77.8%) were asymptomatic at the time of SRS presentation. Seven patients (77.8%) had a pre-SRS craniotomy; two patients (22.2%) had pre-SRS fractionated radiotherapy. The median cumulative tumor volume was 3.65 cc (range, 0.01—11.84 cc). The median margin dose prescribed was 14 Gy (range, 11—25 Gy). The median follow-up time was 107 months (range, 24—194 months). Five patients (55.6%) experienced tumor progression at a median of 25 months (range, 13—161 months). Local tumor control at 1-, 5-, and 10 years was 100%, 55.56%, and 55.56%, respectively. After local tumor progression, 2 patients received repeat SRS, 2 patients had surgical resection and 1 was placed on hydroxyurea for an unresectable tumor. At the date of the last clinical follow-up, 5 patients (55.6%) were still alive while 4 patients (44.4%) expired due to the progression of intracranial disease. 1-, 5-, and 10-year survival was 100%, 88.89%, and 64.81%, respectively. Childhood meningioma is a rare tumor that exhibits aggressive behaviors. SRS should be considered as an upfront or adjuvant treatment option in the multi-modal management of childhood meningiomas for optimal tumor control and maximal quality of life preservation.