Proton therapy for atypical meningiomas

We report clinical outcomes of proton therapy in patients with World Health Organization grade 2 (atypical) meningiomas. Between 2005 and 2013, 22 patients with atypical meningiomas were treated to a median dose of 63 Gy (RBE) using proton therapy, as an adjuvant therapy after surgery (n = 12) or for recurrence or progression of residual tumor (n = 10). Six patients had presumed radiation-induced meningiomas, but none had received prior radiotherapy for their meningioma. The median follow-up time after radiation was 39 months (range 7–104) and all patients remain alive at last follow-up. The 5-year estimate of local control was 71.1 % (95 % CI 49.3–92.9 %). The 5-year estimate of local control was 87.5 % following a radiation dose >60 Gy (RBE), compared to 50.0 % for ≤60 Gy (RBE) (p = 0.038). The 5-year estimate of neuraxis dissemination was 5 % (95 % CI 0–14.6 %) and 6.2 % (95 % CI 0–18.2 %) for metastases outside of the central nervous system. Radiation necrosis was observed in one patient with a history of prior cranial irradiation. Fractionated proton therapy was associated with favorable tumor control rates for grade 2 meningiomas. Prospective studies are needed to define the optimal radiation dose for high-grade meningiomas.