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Open Access 01-12-2017 | Clinical Article - Brain Tumors

Hypofractionated high-energy proton-beam irradiation is an alternative treatment for WHO grade I meningiomas

Authors: Pavlos Vlachogiannis, Olafur Gudjonsson, Anders Montelius, Erik Grusell, Ulf Isacsson, Kristina Nilsson, Erik Blomquist

Published in: Acta Neurochirurgica | Issue 12/2017

Abstract

Background

Radiation treatment is commonly employed in the treatment of meningiomas. The aim of this study was to evaluate the effectiveness and safety of hypofractionated high-energy proton therapy as adjuvant or primary treatment for WHO grade I meningiomas.

Method

A total of 170 patients who received irradiation with protons for grade I meningiomas between 1994 and 2007 were included in the study. The majority of the tumours were located at the skull base (n = 155). Eighty-four patients were treated post subtotal resection, 42 at tumour relapse and 44 with upfront radiotherapy after diagnosis based on the typical radiological image. Irradiation was given in a hypofractionated fashion (3–8 fractions, usually 5 or 6 Gy) with a mean dose of 21.9 Gy (range, 14–46 Gy). All patients were planned for follow-up with clinical controls and magnetic resonance imaging scans at 6 months and 1, 2, 3, 5, 7 and 10 years after treatment. The median follow-up time was 84 months. Age, gender, tumour location, Simpson resection grade and target volume were assessed as possible prognostic factors for post-irradiation tumour progression and radiation related complications.

Results

The actuarial 5- and 10-year progression-free survival rates were 93% and 85% respectively. Overall mortality rate was 13.5%, while disease-specific mortality was 1.7% (3/170 patients). Older patients and patients with tumours located in the middle cranial fossa had a lower risk for tumour progression. Radiation-related complications were seen in 16 patients (9.4%), with pituitary insufficiency being the most common. Tumour location in the anterior cranial fossa was the only factor that significantly increased the risk of complications.

Conclusions

Hypofractionated proton-beam radiation therapy may be used particularly in the treatment of larger World Health Organisation grade I meningiomas not amenable to total surgical resection. Treatment is associated with high rates of long-term tumour growth control and acceptable risk for complications.

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Title: Hypofractionated high-energy proton-beam irradiation is an alternative treatment for WHO grade I meningiomas
Authors: Pavlos Vlachogiannis
Olafur Gudjonsson
Anders Montelius
Erik Grusell
Ulf Isacsson
Kristina Nilsson
Erik Blomquist
Publication date: 01-12-2017
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 12/2017
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-017-3352-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Hypofractionated high-energy proton-beam irradiation is an alternative treatment for WHO grade I meningiomas

Abstract

Background

Method

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Method

Results

Conclusions

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