Combined proton and photon conformal radiotherapy for intracranial atypical and malignant meningioma.

PURPOSE To evaluate retrospectively the efficacy of conformal fractionated radiotherapy combining proton and photon beams after primary surgery for treatment of atypical and malignant meningiomas. PATIENTS AND METHODS Between September 1999 and October 2006, 24 patients (12 male, 12 female) with histopathologically proven meningioma (atypical 19, malignant 5) received postoperative combined radiotherapy with a 201-MeV proton beam at the Centre Protontherapie d'Orsay and a high-energy photon beam. Six patients underwent gross total resection and 18 a subtotal resection. Median gross tumor volume and clinical target volume were 44.7 cm(3) and 153.3 cm(3), respectively. Mean total irradiation dose was 65.01 CGE (cobalt gray equivalent), with a mean proton total dose of 34.05 CGE and a mean photon total dose 30.96 CGE. RESULTS The median (range) follow-up interval was 32.2 (1-72) months. The overall mean local relapse-free interval was 27.2 (10-50) months, 28.3 (10-50) months for atypical meningioma and 23 (13-33) months for malignant meningioma. Ten tumors recurred locally. One-, 2-, 3-, 4-, 5-, and 8- year local control rates for the entire group of patients were 82.9% +/- 7.8%, 82.9% +/- 7.8%, 61.3% +/- 11%, 61.3% +/- 11%, 46.7% +/- 12.3%, and 46.7% +/- 12.3%, respectively. One-, 2-, 3-, 4-, 5-, and 8- year overall survival rates were 100%, 95.5% +/- 4.4%, 80.4% +/- 8.8%, 65.3% +/- 10.6%, 53.2% +/- 11.6%, and 42.6% +/- 13%, respectively. Survival was significantly associated with total dose. There was no acute morbidity of radiotherapy. One patient developed radiation necrosis 16 months after treatment. CONCLUSIONS Postoperative combination of conformal radiotherapy with protons and photons for atypical and malignant meningiomas is a well-tolerated treatment producing long-term tumor stabilization.

[1]  G. Barnett,et al.  Local control and overall survival in atypical meningioma: a retrospective study. , 2000, International journal of radiation oncology, biology, physics.

[2]  Y. Shibamoto,et al.  Efficacy of Conventional Radiotherapy for Recurrent Meningioma , 2000, Journal of Neuro-Oncology.

[3]  R. Chan,et al.  Morbidity, mortality, and quality of life following surgery for intracranial meningiomas. A retrospective study in 257 cases. , 1984, Journal of neurosurgery.

[4]  J. Leavitt,et al.  Meningioma Radiosurgery: Tumor Control, Outcomes, and Complications among 190 Consecutive Patients , 2001, Neurosurgery.

[5]  W. Friedman,et al.  The meningioma controversy: postoperative radiation therapy. , 1988, International journal of radiation oncology, biology, physics.

[6]  J. Habrand,et al.  Radiotherapeutic Factors in the Management of Cervical-basal Chordomas and Chondrosarcomas , 2004, Neurosurgery.

[7]  A. Lomax,et al.  Potential role of proton therapy in the treatment of pediatric medulloblastoma/primitive neuro-ectodermal tumors: spinal theca irradiation. , 1997, International journal of radiation oncology, biology, physics.

[8]  G. Noël,et al.  Comparaison par les histogrammes dose-volume de deux techniques d’irradiation conformationnelle des cancers du nasopharynx classés T4N0M0, l’une par photons et protons et l’autre par photons seuls , 2002 .

[9]  R. Ojemann,et al.  Management of Atypical and Malignant Meningiomas: Role of High-dose, 3D-conformal Radiation Therapy , 2000, Journal of Neuro-Oncology.

[10]  C. Rosen,et al.  Proposed grading system to predict the extent of resection and outcomes for cranial base meningiomas. , 1999, Neurosurgery.

[11]  M. McDermott,et al.  Surgical Resection and Permanent Brachytherapy for Recurrent Atypical and Malignant Meningioma , 2004, Neurosurgery.

[12]  A. Mahmood,et al.  Atypical and malignant meningiomas: a clinicopathological review. , 1993 .

[13]  J. Ransohoff,et al.  Role of radiation therapy in the management of meningioma. , 1982, Neurosurgery.

[14]  M. Urie,et al.  Potential improvement of three dimension treatment planning and proton beams in fractionated radiotherapy of large cerebral arteriovenous malformations. , 1993, International journal of radiation oncology, biology, physics.

[15]  U. Haberkorn,et al.  Improved target volume definition for fractionated stereotactic radiotherapy in patients with intracranial meningiomas by correlation of CT, MRI, and [68Ga]-DOTATOC-PET. , 2006, International journal of radiation oncology, biology, physics.

[16]  J. Janosky,et al.  Meningiomas involving the clivus: a six-year experience with 41 patients. , 1990, Neurosurgery.

[17]  Alexander deVries,et al.  Die rolle der strahlentherapie in der behandlung maligner meningiome , 1999, Strahlentherapie und Onkologie.

[18]  H. Rodolfo,et al.  Results of Linear Accelerator-based Radiosurgery for Intracranial Meningiomas , 1998 .

[19]  R. R. Smith,et al.  The long-term side effects of radiation therapy for benign brain tumors in adults. , 1990, Journal of neurosurgery.

[20]  M. Berger,et al.  Radiosurgery for malignant meningioma: results in 22 patients. , 2000, Journal of neurosurgery.

[21]  E. B. Butler,et al.  Malignant meningioma: An indication for initial aggressive surgery and adjuvant radiotherapy , 2004, Journal of Neuro-Oncology.

[22]  M. Urie,et al.  Comparative treatment planning: proton vs. x-ray beams against glioblastoma multiforme. , 1992, International journal of radiation oncology, biology, physics.

[23]  T. Bortfeld,et al.  Potential role of proton therapy in the treatment of pediatric medulloblastoma/primitive neuroectodermal tumors: reduction of the supratentorial target volume. , 1997, International journal of radiation oncology, biology, physics.

[24]  W. Schlegel,et al.  Fractionated Stereotactic Radiation Therapy in the Management of Benign Cavernous Sinus Meningiomas , 2006, Strahlentherapie und Onkologie.

[25]  B. Scheithauer,et al.  The New WHO Classification of Brain Tumours , 1993, Brain pathology.

[26]  C. Willett,et al.  3-D comparative study of proton vs. x-ray radiation therapy for rectal cancer. , 1992, International journal of radiation oncology, biology, physics.

[27]  H. Bloom,et al.  The Role of Radiotherapy in the Management of Intracranial Meningiomas , 2017 .

[28]  S. Paek,et al.  Long-term outcome and growth rate of subtotally resected petroclival meningiomas: experience with 38 cases. , 2000, Neurosurgery.

[29]  Damien C Weber,et al.  A treatment planning comparison of combined photon-proton beams versus proton beams-only for the treatment of skull base tumors. , 2007, International journal of radiation oncology, biology, physics.

[30]  H. Whitwell,et al.  Recurrence of meningiomas after operation. , 1986, Surgical neurology.

[31]  R. Martuza,et al.  Meningioma: analysis of recurrence and progression following neurosurgical resection. , 1985, Journal of neurosurgery.

[32]  C. Sainte-Rose,et al.  Proton therapy in pediatric skull base and cervical canal low-grade bone malignancies. , 2008, International journal of radiation oncology, biology, physics.

[33]  B J Goldsmith,et al.  Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990. , 1994, Journal of neurosurgery.

[34]  Damien C Weber,et al.  A treatment planning comparison of intensity modulated photon and proton therapy for paraspinal sarcomas. , 2003, International journal of radiation oncology, biology, physics.

[35]  D. Hasboun,et al.  [Comparison with dose-volume histograms of two conformal irradiation techniques used for the treatment of T2N0M0 nasopharyngeal cancer, one with association of photons and protons and another with photons alone]. , 2002, Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique.

[36]  A. Friedman,et al.  Fractionated external-beam radiation therapy for meningiomas of the cavernous sinus. , 1999, International journal of radiation oncology, biology, physics.

[37]  W. Simpson,et al.  Radiotherapy for atypical or malignant intracranial meningioma. , 1996, International journal of radiation oncology, biology, physics.

[38]  B. Corn,et al.  Atypical and malignant meningiomas: an outcome report of seventeen cases , 1998, Journal of Neuro-Oncology.

[39]  K. Jellinger,et al.  Histological subtypes and prognostic problems in meningiomas , 2004, Journal of Neurology.

[40]  J. Munzenrider,et al.  [The role of radiotherapy in the treatment of malignant meningiomas]. , 1999, Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al].

[41]  J. Roda,et al.  Malignant and atypical meningiomas: a reappraisal of clinical, histological, and computed tomographic features. , 1987, Neurosurgery.

[42]  R. Miralbell,et al.  Potential improvement of three dimension treatment planning and proton therapy in the outcome of maxillary sinus cancer. , 1992, International journal of radiation oncology, biology, physics.

[43]  G. Malik,et al.  Intracranial meningiomas: Analysis of recurrence after surgical treatment , 2005, Acta Neurochirurgica.