Regression Of All Untreated Lesions In Multifocal Low-grade Meningioma Following Fractionated Stereotactic Radiotherapy—abscopal Effect Or Spontaneous Regression?
Pinkawa, M., Boström, J., Temming, S., Schäfer, A., Kovács, A., & Boström, A. (2025). Regression of all untreated lesions in multifocal low-grade meningioma following fractionated stereotactic radiotherapy-abscopal effect or spontaneous regression? : Case report and review of the literature. Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al], 201(2), 191–196. https://doi.org/10.1007/s00066-024-02248-0
View Original Source →Case Details
Disease Location
Brain
Personal Characteristics
66-year-old woman, diagnosed with meningiomatosis 1 year earlier, she suffered from multiple allergies (pollinosis). She was under treatment with amitriptyline, pantoprazole, candesartan, ursodeoxycholic acid, thyroxine and metamizole.
Clinical Characteristics
Progressive occipital lesion at the cerebral falx with infiltration of the superior sagittal sinus. Cerebral MRI demonstrated multiple meningiomas (meningiomatosis), including the supratentorial convexity of both hemispheres, the sphenoid bone on both sides with infiltration of the cavernous sinus, the middle cranial fossa and the pterygopalatine fossa on the right side. It was treated stereotactically using multiple arcs with 6mev photon energy. Daily single fractions of 1.8 gy up to a total dose of 50.4 gy, prescribed to the minimum planning target dose
Remission Characteristics
After 12 months, slightly decreasing tumour volumes were also visible at distant meningioma lesions that had not been included within the radiotherapy treatment volume. 7.5 years after stereotactic radiotherapy. MRI demonstrated an almost complete response of all initial lesions
Treatment & Mechanisms
Proposed Remission Mechanisms
Radiation-induced cell death leads to antigen release from tumor cells, activating antigen-presenting cells and t-lymphocytes and inducing cytokines that further augment the immunological effect. (abscopal effect) (the blood-brain barrier is likely to have been destroyed due to the infiltrating tumour, even in a low-grade tumour, but possibly also due to focal irradiation. This infiltration and overcoming the blood–brain barrier is likely to be a prerequisite for the immune response)
Clinical Treatment
Stereotactic radiotherapy for comorbidities: amitriptyline, pantoprazole, candesartan, ursodeoxycholic acid, thyroxine and metamizole.
Non-Clinical Treatment
None reported