Efficacy and safety of stereotactic radiosurgery for large meningiomas: A comprehensive systematic review and meta-analysis.

BACKGROUND

Managing large intracranial meningiomas (LIMs) is challenging. Because of the significant morbidity associated with resection, stereotactic radiosurgery (SRS) has increasingly been employed for LIMs. This systematic review and meta-analysis assessed the role of SRS in LIMs.

METHODS

On March 21, 2025, we performed a literature search. Studies evaluating outcomes after upfront or adjuvant SRS in patients with LIMs, with volumes larger than 8 cm3 or a maximum diameter exceeding 2.5 cm, were included.

RESULTS

Eleven studies involving 793 patients were included. The mean tumor volume ranged from 14.1 to 37.3 cm3. The meta-analysis revealed a pooled local control (LC) rate of 91 % (95 % CI: 86 %-94 %). Additionally, the analysis demonstrated a pooled 5-year progression-free survival (PFS) rate of 92 % (95 % CI: 86 %-96 %) and a 10-year PFS rate of 81 % (95 % CI: 76 %-84 %). It exhibited a pooled overall survival (OS) rate of 88 % (95 % CI: 77 %-96 %), a 5-year OS rate of 94 % (95 % CI: 89 %-97 %), and a 10-year OS rate of 88 % (95 % CI: 58 %-100 %). Moreover, the meta-analysis revealed a pooled adverse radiation effect (ARE) and post-SRS resection rates of 19 % (95 % CI: 7 %-36 %) and 3 % (95 % CI: 0 %-8%), respectively. Hypofractionated SRS (99 % [95 % CI: 91 %-100 %]) was associated with a significantly higher pooled OS rate than volume-staged SRS (82 % [95 % CI: 69 %-92 %]) and single session SRS (85 % [95 % CI: 48 %-100 %]) (P = 0.01).

CONCLUSION

Upfront or adjuvant SRS is linked to promising radiological and clinical outcomes with manageable radiation-related complications. Further research is needed to compare upfront versus adjuvant SRS and evaluate the relative efficacy and safety of single-session, hypofractionated, and volume-staged SRS in individuals with LIMs.