Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Radiation Oncology
Published in: Radiation Oncology 1/2015

Open Access 01-12-2015 | Research

Dose-painting intensity-modulated proton therapy for intermediate- and high-risk meningioma

Authors: Indira Madani, Antony J Lomax, Francesca Albertini, Petra Trnková, Damien C Weber

Published in: Radiation Oncology | Issue 1/2015

Login to get access

Abstract

Background

Newly diagnosed WHO grade II-III or any WHO grade recurrent meningioma exhibit an aggressive behavior and thus are considered as high- or intermediate risk tumors. Given the unsatisfactory rates of disease control and survival after primary or adjuvant radiation therapy, optimization of treatment strategies is needed. We investigated the potential of dose-painting intensity-modulated proton beam-therapy (IMPT) for intermediate- and high-risk meningioma.

Material and methods

Imaging data from five patients undergoing proton beam-therapy were used. The dose-painting target was defined using [68]Ga-[1,4,7,10-tetraazacyclododecane tetraacetic acid]– d-Phe1,Tyr3-octreotate ([68]Ga-DOTATATE)-positron emission tomography (PET) in target delineation. IMPT and photon intensity-modulated radiation therapy (IMRT) treatment plans were generated for each patient using an in-house developed treatment planning system (TPS) supporting spot-scanning technology and a commercial TPS, respectively. Doses of 66 Gy (2.2 Gy/fraction) and 54 Gy (1.8 Gy/fraction) were prescribed to the PET-based planning target volume (PTVPET) and the union of PET- and anatomical imaging-based PTV, respectively, in 30 fractions, using simultaneous integrated boost.

Results

Dose coverage of the PTVsPET was equally good or slightly better in IMPT plans: dose inhomogeneity was 10 ± 3% in the IMPT plans vs. 13 ± 1% in the IMRT plans (p = 0.33). The brain Dmean and brainstem D50 were small in the IMPT plans: 26.5 ± 1.5 Gy(RBE) and 0.002 ± 0.0 Gy(RBE), respectively, vs. 29.5 ± 1.5 Gy (p = 0.001) and 7.5 ± 11.1 Gy (p = 0.02) for the IMRT plans, respectively. The doses delivered to the optic structures were also decreased with IMPT.

Conclusions

Dose-painting IMPT is technically feasible using currently available planning tools and resulted in dose conformity of the dose-painted target comparable to IMRT with a significant reduction of radiation dose delivered to the brain, brainstem and optic apparatus. Dose escalation with IMPT may improve tumor control and decrease radiation-induced toxicity.
Literature
1.
Miralbell R, Linggood RM, De Las Monte S, Convery K, Munzenrider JE, Mirimanoff RO. The role of radiotherapy in the treatment of subtotally resected benign meningiomas. J Neuro-Oncol. 1992;13:157–64.CrossRef
2.
Louis DN, Scheithauer BW, Budka H, von Deimling A, Kepes JJ. Meningiomas. In: Kleihues P, Cavenee WK, editors. Pathology and genetics of tumours of the nervous system: World Health Organisation classification of tumours. Lyon: IARC Press; 2000. p. 176–84.
3.
Weber DC, Lovblad KO, Rogers L. New pathology classification, imagery techniques and prospective trials for meningiomas: the future looks bright. Curr Opin Neurol. 2010;23(6):563-70.
4.
Kallio M, Sankila R, Hakulinen T, Jääskeläinen J. Factors affecting operative and excess long-term mortality in 935 patients with intracranial meningioma. Neurosurgery. 1992;31:2–12.CrossRefPubMed
5.
Stafford SL, Pollock BE, Foote RL, Link MJ, Gorman DA, Schomberg PJ, et al. Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients. Neurosurgery. 2001;49:1029–37.PubMed
6.
Milker-Zabel S, Zabel-du Bois A, Henze M, Huber P, Schulz-Ertner D, Hoess A, et al. Improved target volume definition for fractionated stereotactic radiotherapy in patients with intracranial meningiomas by correlation of CT, MRI, and [68Ga]-DOTATOC-PET. Int J Radiat Oncol Biol Phys. 2006;65:222–7.CrossRefPubMed
7.
Uy NW, Woo SY, Teh BS, Mai WY, Carpenter LS, Chiu JK, et al. Intensity-modulated radiation therapy (IMRT) for meningioma. Int J Radiat Oncol Biol Phys. 2002;53:1265–70.CrossRefPubMed
8.
Milker-Zabel S, Zabel-du Bois A, Huber P, Schlegel W, Debus J. Intensity-modulated radiotherapy for complex-shaped meningioma of the skull base: long-term experience of a single institution. Int J Radiat Oncol Biol Phys. 2007;68:858–63.CrossRefPubMed
9.
Weber DC, Schneider R, Goitein G, Koch T, Ares C, Geismar JH, et al. Spot scanning-based proton therapy for intracranial meningioma: long-term results from the Paul Scherrer Institute. Int J Radiat Oncol Biol Phys. 2012;83:865–71.CrossRefPubMed
10.
Hug EB, Devries A, Thornton AF, Munzenride JE, Pardo FS, Hedley-Whyte ET, et al. Management of atypical and malignant meningiomas: role of high-dose, 3D-conformal radiation therapy. J Neurooncol. 2000;48:151–60.CrossRefPubMed
11.
Boskos C, Feuvret L, Noel G, Habrand JL, Pommier P, Alapetite C, et al. Combined proton and photon conformal radiotherapy for intracranial atypical and malignant meningioma. Int J Radiat Oncol Biol Phys. 2009;75:399–406.CrossRefPubMed
12.
Chan AW, Bernstein KD, Adams JA, Parambi RJ, Loeffler JS. Dose escalation with proton radiation therapy for high-grade meningiomas. Technol Cancer Res Treat. 2012;11:607–14.PubMed
13.
Kollová A, Liscák R, Novotný Jr J, Vladyka V, Simonova G, Janouskova L. Gamma Knife surgery for benign meningioma. J Neurosurg. 2007;107:325–36.CrossRefPubMed
14.
Ling CC, Humm J, Larson S, Amols H, Fuks Z, Leibel S, et al. Towards multidimensional radiotherapy (MD-CRT): biological imaging and biological conformality. Int J Radiat Oncol Biol Phys. 2000;47:551–60.CrossRefPubMed
15.
Bentzen SM. Theragnostic imaging for radiation oncology: dose-painting by numbers. Lancet Oncol. 2005;6:112–7.CrossRefPubMed
16.
Dutour A, Kumar U, Panetta R, Ouafik L, Fina F, Sasi R, et al. Expression of somatostatin receptor subtypes in human brain tumors. Int J Cancer. 1998;76:620–7.CrossRefPubMed
17.
Arena S, Barbieri F, Thellung S, Pirani P, Corsaro A, Villa V, et al. Expression of somatostatin receptor mRNA in human meningiomas and their implication in in vitro antiproliferative activity. J Neurooncol. 2004;66:155–66.CrossRefPubMed
18.
Henze M, Schuhmacher J, Hipp P, Kowalski J, Becker DW, Doll J, et al. PET imaging of somatostatin receptors using [68GA]DOTA-D-Phe1-Tyr3-octreotide: first results in patients with meningiomas. J Nucl Med. 2001;42:1053–6.PubMed
19.
Afshar-Oromieh A, Giesel FL, Linhart HG, Haberkorn U, Haufe S, Combs SE, et al. Detection of cranial meningiomas: comparison of 68Ga-DOTATOC PET/CT and contrast-enhanced MRI. Eur J Nucl Med Mol Imaging. 2012;39:1409–15.CrossRefPubMed
20.
Gehler B, Paulsen F, Oksüz MO, Hauser TK, Eschmann SM, Bares R, et al. [68Ga]-DOTATOC-PET/CT for meningioma IMRT treatment planning. Radiat Oncol. 2009;4:56.CrossRefPubMedCentralPubMed
21.
Graf R, Nyuyki F, Steffen IG, Michel R, Fahdt D, Wust P, et al. Contribution of 68Ga-DOTATOC PET/CT to target volume delineation of skull base meningiomas treated with stereotactic radiation therapy. Int J Radiat Oncol Biol Phys. 2013;85:68–73.CrossRefPubMed
22.
Henze M, Dimitrakopoulou-Strauss A, Milker-Zabel S, Schuhmacher J, Strauss LG, Doll J, et al. Characterization of 68Ga-DOTA-D-Phe1-Tyr3-octreotide kinetics in patients with meningiomas. J Nucl Med. 2005;46:763–9.PubMed
23.
Barresi V, Alafaci C, Salpietro F, Tuccari G. Sstr2A immunohistochemical expression in human meningiomas: is there a correlation with the histological grade, proliferation or microvessel density? Oncol Rep. 2008;20:485–92.PubMed
24.
Barresi V, Cerasoli S, Vitarelli E, Tuccari G. Density of microvessels positive for CD105 (endoglin) is related to prognosis in meningiomas. Acta Neuropathol. 2007;114:147–56.CrossRefPubMed
25.
Perry A, Scheithauer BW, Stafford SL, Lohse CM, Wollan PC. "Malignancy" in meningiomas: a clinicopathologic study of 116 patients, with grading implications. Cancer. 1999;85:2046–56.PubMed
26.
Mohan R, Wu Q, Manning M, Schmidt-Ullrich R. Radiobiological considerations in the design of fractionation strategies for intensity-modulated radiation therapy of head and neck cancers. Int J Radiat Oncol Biol Phys. 2000;46:619–30.CrossRefPubMed
27.
Vees H, Senthamizhchelvan S, Miralbell R, Weber DC, Ratib O, Zaidi H. Assessment of various strategies for 18 F-FET PET-guided delineation of target volumes in high-grade glioma patients. Eur J Nucl Med Mol Imaging. 2009;36:182–93.CrossRefPubMed
28.
Pedroni E, Bacher R, Blattmann H, Bohringer T, Coray A, Lomax A, et al. The 200-MeV proton therapy project at the Paul Scherrer Institute: Conceptual design and practical realization. Med Phys. 1995;22:37–53.CrossRefPubMed
29.
Scheib S, Pedroni E. Dose calculation and optimization for 3D conformal voxel scanning. Radiat Environ Biophys. 1992;31:251–6.CrossRefPubMed
30.
Schaffner B, Pedroni E, Lomax A. Dose calculation models for proton treatment planning using a dynamic beam delivery system: An attempt to include density heterogeneity effects in the analytical dose calculation. Phys Med Biol. 1999;44:27–41.CrossRefPubMed
31.
Petti PL. Differential-pencil-beam dose calculations for charged particles. Med Phys. 1992;19:137–49.CrossRefPubMed
32.
33.
Coskun M, Straube W, Hurkmans CW, Melidis C, de Haan PF, Villa S, et al. Quality assurance of radiotherapy in the ongoing EORTC 22042-26042 trial for atypical and malignant meningioma: results from the dummy runs and prospective individual case Reviews. Radiat Oncol. 2013;8:23.CrossRefPubMedCentralPubMed
34.
Mock U, Georg D, Solkner L, Suppan C, Vatnitsky SM, Flechl B, et al. Assessment of improved organ at risk sparing for meningioma: light ion beam therapy as boost versus sole treatment option. Radiother Oncol. 2014;111:451–6.CrossRefPubMed
35.
Combs SE, Welzel T, Habermehl D, Rieken S, Dittmar JO, Kessel K, et al. Prospective evaluation of early treatment outcome in patients with meningiomas treated with particle therapy based on target volume definition with MRI and 68Ga-DOTATOC-PET. Acta Oncol. 2013;52:514–20.CrossRefPubMed
36.
Zhu XR, Poenisch F, Li H, Sahoo N, Wu RY, Li X, et al. A single-field integrated boost treatment planning technique for spot scanning proton therapy. Radiat Oncol. 2014;9:202.CrossRefPubMedCentralPubMed
37.
Lehde A. Initial clinical evaluation of PSIPLAN2 and Gantry2: a planning comparison study in proton therapy. Master thesis. Bern University of Applied Sceince. 2013
Metadata
Title
Dose-painting intensity-modulated proton therapy for intermediate- and high-risk meningioma
Authors
Indira Madani
Antony J Lomax
Francesca Albertini
Petra Trnková
Damien C Weber
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2015
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-015-0384-x

Other articles of this Issue 1/2015

Radiation Oncology 1/2015 Go to the issue

Erratum

Erratum: Attenuation measurements show that the presence of a TachoSil surgical patch will not compromise target irradiation in intra-operative electron radiation therapy or high-dose-rate brachytherapy

Research

Treatment of T3 laryngeal cancer in the Netherlands: a national survey

Study protocol

Evaluation of inter- and intrafractional motion of liver tumors using interstitial markers and implantable electromagnetic radiotransmitters in the context of image-guided radiotherapy (IGRT) – the ESMERALDA trial

Research

Radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome in breast cancer patients is associated with age

Research

Hippocampal dosimetry correlates with the change in neurocognitive function after hippocampal sparing during whole brain radiotherapy: a prospective study

Case report

Miliary pattern of brain metastases – a case report of a hyperacute onset in a patient with malignant melanoma documented by magnetic resonance imaging