Radiotherapy for Meningioma Treatment in Germany

Meningioma is usually a benign brain tumor. It can be treated with the help of surgery or radiotherapy. Meningioma is usually removed surgically. If the neoplasm is benign, and the doctor is able to perform total resection of the tumor, then other treatments are not required. In some patients, the disease needs to be additionally treated with radiotherapy in order to avoid a recurrence.

Radiation therapy after surgery

Radiation therapy is most often used as an addition to the surgery. It stops the growth of the tumor and reduces its size. In addition, radiation therapy reduces the risk of continued meningioma growth and neoplasm recurrence. It is necessary in the following cases:

• Inability to perform the radical surgery for tumor removal – if the doctor did not remove and coagulate the matrix (part of the dura mater from which the meningioma grows)
• Intermediate or malignant meningiomas (occur rarely)

The irradiation is carried out after healing of the soft tissues of the operating wound. That is why the course of radiotherapy usually stars no earlier than 4 weeks after the tumor has been removed surgically.

Radiation therapy as an alternative to surgery

Meningiomas are tumors with distinct boundaries that do not invade surrounding healthy tissues. As a rule, they are sensitive to radiotherapy. Therefore, radiation is sometimes used as an alternative to surgery.

Radiosurgical techniques are used for destruction of tumors during 1 session. They are indicated in the following cases:

• Location of the tumor is inconvenient for surgical removal
• Tumor has small size and / or do not cause severe symptoms
• There are contraindications for the operation
• The patient refuses surgery

What is radiosurgery?

Radiosurgery is a type of radiotherapy, which is performed in one session. It is very precise and powerful, so it allows the doctor to destroy tumors, reduce their size, or at least stop their growth.

The following devices are most often used for radiosurgery:

• «Gamma Knife» (Electa, Sweden)
• «CyberKnife» (Accuray, USA)
• «Novalis» (BrainLab, Germany)
• «Trilogy» (Varian Medical System, USA)

For the first time, radiosurgical treatment was carried out by the Swedish neurosurgeon Lars Leksell. It was used for destruction of foci of pathological activity in the brain, but not in patients with tumors. After the widespread implementation of CT and MRI in the clinical practice, the era of the use of radiosurgery in neuro-oncology began. The technique is most often used for the treatment of metastatic, hard-to-reach or multiple neoplasms. The first GammaKnife system was used in Sweden in 1968. It contained 179 sources of radiation. Only 20 years later mass production was launched, and similar devices appeared in many countries of the world.

GammaKnife requires the use of stereotaxic frame. It is fixed to the patient's skull with screws under the local anesthesia. The stereotaxic frame allows for the precise direction of the radiation beams. Radiation therapy is performed using radioactive substances as the sources of radiation.

The first linear accelerators appeared as early as 1994. By the beginning of the twenty-first century, they became the basis of radiotherapy for malignant tumors. Linear accelerators do not use radioactive substances.

The next generation of linear accelerators is the CyberKnife Robotic Radiosurgery System. It was developed in the USA under the direction of J. Adler, a student of Lars Leksell. The CyberKnife system combines all the technological advances in robotics, computer navigation and radiotherapy. It allows the doctors to irradiate meningioma without using the stereotactic frame which makes the procedure more comfortable for the patient.

How is radiotherapy carried out?

German hospitals use both Gamma Knife and linear accelerators for destruction of brain tumors, including the CyberKnife system.

The treatment with the Gamma Knife requires fixation of the stereotaxic frame. Most systems contain about 200 radiation sources. They have a built-in automatic positioning system. The new Gamma Knife devices have only 30 radiation sources, but they can move, directing beams into the meningioma site from an infinite number of angles. The function of selective opening and closing of the collimator holes allows the doctors to irradiate even tumors of complex configuration quickly and automatically.

Radiation therapy with Gamma Knife involves 4 stages:

1. Placement of the frame
2. Localization of the target
3. Treatment planning
4. Irradiation itself

The location of meningioma is determined by CT scan or MRI.

Many hospitals in Germany use linear accelerators for radiotherapy, including the CyberKnife systems. The patient does not need to be prepared for the procedure or fixed. The imaging system works in real time. CyberKnife detects the slightest changes in body position and redirects the beams in a given direction.

Advantages and disadvantages of radiosurgery

The advantages of radiotherapy as compared to meningioma surgery are as follows:

• Bloodless, non-invasive treatment method
• Absence of pain syndrome
• Minimal risk of complications development
• No need for long hospital stay and postoperative recovery
• No need to shave off the hair on the head
• No scars
• Opportunity to undergo treatment without leaving the everyday life, without a break in work

However, such treatment also has certain disadvantages. Despite the name of the treatment method, radiosurgery does not physically remove the tumor. After the therapy completion, meningioma regresses gradually over time. As a rule, it only decreases in size, and does not disappear completely. This happens only in a few months after irradiation. Sometimes meningioma does not regress at all, but only stops growing.

In general, radiotherapy is less effective than the conventional surgery. As a radical treatment method, it is not suitable for patients with aggressive, rapidly growing tumors, with severe neurological symptoms, progressive cerebral edema and liquor hypertension. In contrast to radiotherapy, the surgical intervention eliminates the tumor immediately, so it leads to rapid regression of symptoms in the early postoperative period.

Side effects and complications

Although radiotherapy is safer than surgery, it can sometimes lead to complications and often causes side effects. Their likelihood depends on the number of factors, such as:

• Size of the tumor and, accordingly, the volume of the irradiation area
• Equipment (some methods of radiotherapy are more precise and safer)
• Number of fractions (irradiation in 1 session is more convenient, but more often leads to complications, therefore, it is used only for the treatment of small meningiomas)

During the period of receiving radiation sessions, a person may experience nausea, headache and weakness. Several months after, such complications as decreased cognitive functions, mental disorders, cerebral radiation necrosis, neurological symptoms, occur in a small percentage of patients. Follow-up examinations need to be carried out in order to detect and treat the complications timely.

Proton therapy

Some German hospitals use proton therapy, the most accurate and safest treatment for meningioma treatment. The main fields of application are:

• Tumors of ​​the skull base, cavernous sinus or optic chiasm
• Meningiomas in children

Proton therapy has no efficacy advantages in the treatment of meningioma as compared to the conventional photon irradiation. Its main advantage is safety. Proton therapy can irradiate tumors of any location without damaging the adjacent cranial nerves. It is 5 times less likely to cause secondary brain tumors as compared to intensity-modulated radiotherapy. Side effects and complications are also less common after proton therapy.

There is no doubt that proton irradiation is better than photon irradiation, but due to high price, the method has not become widespread yet. Another disadvantage is insufficient availability of proton therapy. It is available only in a small number of specialized hospitals. Therefore, the patients sometimes have to wait a long time for their turn to undergo treatment.

Why is it better to undergo treatment in German hospitals?

Many patients from countries with low levels of medicine prefer to undergo treatment of meningioma in Germany. You can use Booking Health service to reduce treatment costs and choose the best hospital.

In German hospitals, you can really count on the best results. Here are some reasons why it is better to go to Germany for a treatment:

• High-precision diagnosis – allows the doctor to determine if you need radiotherapy and which radiation regimen is more suitable for achieving the best results and not damaging important anatomical structures
• State-of-the-art equipment – new radiosurgical systems and linear accelerators are used in Germany for irradiation of meningioma with minimal risk of side effects and complications
• Availability of innovative radiotherapy methods – CyberKnife systems are used in Germany, as well as proton therapy, which is the safest option for irradiation of brain tumors

In German hospitals, prices for medical services may be higher than in your native country, but the ratio of the cost of treatment to its quality is one of the best in the world.

Treatment in Germany with Booking Health

You can find the information about German hospitals, doctors and prices on the Booking Health website. You can compare the cost of treatment in different hospitals and book a medical program at the best price. Booking Health will arrange medical treatment abroad for you. We provide the following services and benefits:

• Selection of the hospital which specializes in the treatment of meningioma and uses the latest types of radiation therapy
• Direct communication with the attending physician
• Reduced waiting period for a treatment and appointment on the convenient date
• Reduced cost of treatment abroad; costs are reduced due to the absence of additional coefficients for foreign patients
• Relevant information about your expenses, the cost of treatment, funds remaining in your account
• Elaboration of the treatment program for meningioma in Germany without repeating previously performed diagnostic tests
• Communication with the hospital upon the medical program completion
• Buying and forwarding medicines
• Organization of additional diagnosis making procedures or treatment in Germany

The specialists of Booking Health provide high-quality service for you in order to be treated well. We will book a hotel and airline tickets for you, organize a transfer from the airport to the hospital and back.