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Purpose.-To date, no correlation has been found between clinical and radiological efficacy after irradiation of skull base meningiomas. However, the evaluation of the radiological response was most often made by questionable methods that may have underestimated the radiological effectiveness of radiotherapy. The objective of this work is to verify this hypothesis by quantitative volumetric analysis. Material and methods.-Data from 35 patients treated with either helical tomotherapy (45.7%) or fractionated stereotactic radiotherapy (54.3%) were retrospectively analysed. These were mainly women (94%) aged 59 (43-81) with lesions mainly of the cavernous sinus (60%). There was a median of 2 (1-4) symptoms and the main symptoms were visual impairment (39%), cranial nerve deficits (23.4%) and headaches (17.2%). Results.-Median tumour volume decreased significantly (P<0.05) from 9.6 mL (0.3-36.6) to 6.8 mL (0.1-26.5) after median follow-up of 44 months (24-77). Sixty-three percent of patients had an improvement of at least one symptom. In univariate analysis, clinical efficacy (P<0.05), radiotherapy technique (P<0.05), tumor topography (P<0.05) and initial tumor volume (P<0.05) were predictive factors for radiological response. In multivariate analysis, only the inverse correlation between radiological response and initial tumor volume remained significant (rho: -0.47 95% CI -3.2 to 5.7; P<0.05). Conclusion.-The quantitative volumetric monitoring demonstrates a major radiological efficiency of radiotherapy. However, no clear correlation between clinical and radiological efficacy was found. (C) 2019 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

Skull base meningioma leads to functional disturbances, which can significantly alter the quality of life. The optimal management of these lesions, whose goals are neurological preservation and tumour local control, is not yet clearly established. It is widely recognized that the goal of a radical excision should be abandoned despite the advances in the field of microsurgery of skull base lesions. Although less morbid, partial tumour excision would be associated with increased risk of local tumour recurrence. Although discussed both exclusive and adjuvant have proven to be highly successful in terms of clinical improvement and local control. Various radiation techniques have demonstrated their efficacy in the management of this pathology. However, high rates of clinical improvement are in contrast with low rates of radiological improvement. The notion of clinical and radiological dissociation appeared. However, in most of these studies, the analysis of the radiological response could be subject of legitimate criticism. This work proposes to review the local control, the efficacy and the clinical tolerance and the radiological response of the various radiation techniques for the meningioma of the base of the skull and to demonstrate the interest of quantitative volumetric analyses in the follow-up of meningioma after radiotherapy. (C) 2018 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

Les méningiomes de la base du crâne entraînent des troubles fonctionnels qui peuvent significativement altérer la qualité de vie. La prise en charge optimale de ces lésions dont l’objectif est une préservation neurologique et le contrôle tumoral local n’est actuellement pas encore clairement établie. Il est largement reconnu aujourd’hui que l’objectif d’une exérèse tumorale radicale doit être abandonné et ce malgré les avancées dans le domaine de la microchirurgie des lésions de la base du crâne. Bien que moins morbide, l’exérèse tumorale partielle serait associée à un risque majoré de récidive tumorale locale. Bien que toujours discutée, la radiothérapie, aussi bien en traitement adjuvant qu’exclusif a largement fait les preuves d’excellents résultats en termes d’amélioration clinique et de contrôle local. Cependant, les taux d’amélioration clinique retrouvés contrastent avec de faibles taux d’amélioration radiologique. La notion d’une dissociation clinique et radiologique de l’irradiation des méningiomes de la base du crâne est apparue. Toutefois, dans la majorité de ces études, l’analyse de la réponse radiologique pouvait faire l’objet de critiques légitimes. Ce travail avait pour objectif de passer en revue le contrôle local, l’efficacité et la tolérance clinique et la réponse radiologique des différentes alternatives radiothérapeutiques des méningiomes de la base du crâne et de démontrer l’intérêt des analyses volumétriques quantitatives dans le suivi des méningiomes après radiothérapie.

Purpose. - Bevacizumab and stereotactic treatment are efficient combined or alone in relapse glioma. However, patterns of relapse after this kind of salvage treatment have never been studied. The purpose of this unicentric retrospective analysis was to assess and understand the patterns of relapse of high grade glioma treated with stereotactic radiation, with or without bevacizumab.Patients and methods. - Twenty patients with high grade glioma relapse received a stereotactic radiation; among them two patients received temozolomide and eight patients received bevacizumab; among the latter, four received also irinotecan. We matched the stereotactic radiation treatment planning scan with the images of the first treatment and of the second relapse in order to determine the patterns of failure and associate dosimetric profile.Results. - For the total population, median follow-up from the first diagnosis and relapse were 46.1 and 17.6 months, respectively. Among the 13 patients who relapsed, ten did not receive chemotherapy and three received it (P < 0.05), two received temozolomide and one bevacizumab. Patients who received bevacizumab had no "out-of-field" recurrences. Among the 32 irradiated relapses, 15 were "in-field" recurrences; among them two were treated with bevacizumab and 13 were not (P < 0.05). For the 32 lesions, a favourable prognostic factor of control was the association of a high-dose of irradiation and the use of bevacizumab.Conclusion. - For patients with relapsed high grade glioma, local control was higher with combined bevacizumab and high-dose stereotactic radiation. (C) 2016 Published by Elsevier Masson SAS on behalf of Societe francaise de radiotherapie oncologique (SFRO).