Clinical outcome after particle therapy for meningiomas of the skull base: toxicity and local control in patients treated with active rasterscanning

Abstract

BackgroundMeningiomas of the skull base account for 25–30% of all meningiomas. Due to the complex structure of the cranial base and its close proximity to critical structures, surgery is often associated with substantial morbidity. Treatment options include observation, aggressive surgical intervention, stereotactic or conventional radiotherapy.In this analysis we evaluate the outcome of 110 patients with meningiomas of the skull base treated with particle therapy. It was performed within the framework of the “clinical research group heavy ion therapy” and supported by the German Research Council (DFG, KFO 214).MethodsBetween May 2010 and November 2014, 110 Patients with skull base meningioma were treated with particle radiotherapy at the Heidelberg Ion Therapy Center (HIT). Primary localizations included the sphenoid wing (n = 42), petroclival region (n = 23), cavernous sinus (n = 4), sella (n = 10) and olfactory nerve (n = 4). Sixty meningiomas were benign (WHO °I); whereas 8 were high-risk (WHO °II (n = 7) and °III (n = 1)). In 42 cases histology was not examined, since no surgery was performed.Proton (n = 104) or carbon ion (n = 6) radiotherapy was applied at Heidelberg Ion Therapy Center (HIT) using raster-scanning technique for active beam delivery. Fifty one patients (46.4%) received radiotherapy due to tumor progression, 17 (15.5%) after surgical resection and 42 (38.2%) as primary treatment.ResultsMedian follow-up in this analysis was 46,8 months (95% CI 39,9–53,7; Q1-Q3 34,3–61,7). Particle radiotherapy could be performed safely without toxicity-related interruptions. No grade IV or V toxicities according to CTCAE v4.0 were observed. Particle RT offered excellent overall local control rates with 100% progression-free survival (PFS) after 36 months and 96.6% after 60 months. Median PFS was not reached due to the small number of events. Histology significantly impacted PFS with superior PFS after 5 years for low-risk tumors (96.6% vs. 75.0%, p = 0,02). Overall survival was 96.2% after 60 months and 92.0% after 72 months from therapy. Of six documented deaths, five were definitely not and the sixth probably not meningioma-related.ConclusionParticle radiotherapy is an excellent treatment option for patients with meningiomas of the skull base and can lead to long-term tumor control with minimal side effects. Other prospective studies with longer follow-up will be necessary to further confirm the role of particle radiotherapy in skull base meningioma.

Trends in the utilization of radiotherapy for spinal meningiomas: insights from the 2004–2015 National Cancer Database

“…Radiation toxicity and related patient-reported outcomes are important measures to assess the feasibility of radiation use in any oncological condition. 9,10 Radiation-induced myelopathy is an important complication that warrants further Boldface type indicates statistical significance. No more than one predictor was added for every 10 outcome events.…”

Proton therapy for brain tumours in the area of evidence-based medicine

“…43 In two studies a combination of photons and carbon ions was given to patients with Grade 2-3 meningioma whereas patients with Grad one tumours received proton therapy only. 42,45 Five-year local control rates for low-risk meningioma were better (94-100%) when compared with high-risk meningioma (49-88%) and tumor grading was found to be of prognostic significance in univariate analysis in four studies. 39,40,44,45 Proton therapy induced toxicity was moderate with a rate of 3.6-12.8% Grade ≥ 3 late effects.…”

“…42,45 Five-year local control rates for low-risk meningioma were better (94-100%) when compared with high-risk meningioma (49-88%) and tumor grading was found to be of prognostic significance in univariate analysis in four studies. 39,40,44,45 Proton therapy induced toxicity was moderate with a rate of 3.6-12.8% Grade ≥ 3 late effects. The results stemming from these small PT series are in line with modern photon series and cannot prove that proton are superior to conventional radiotherapy.…”

“…[38][39][40][41][42][43][44][45] The sample size within the studies ranged from 39 to 170 participants (Table 2). Four studies included meningioma Grad 1-3, 40,42,44,45 while two included Grade 1-2 39,41 and one Grade one meningioma only. 43 In two studies a combination of photons and carbon ions was given to patients with Grade 2-3 meningioma whereas patients with Grad one tumours received proton therapy only.…”

Neues zur Einteilung und Therapie von Meningeomen

“…An entsprechend ausgestatteten Zentren wird vermehrt auf eine Partikelstrahlentherapie mit Protonen oder Kohlenstoffionen zur Behandlung rezidivierter, atypischer oder anaplastischer Meningeome zurückgegriffen. Bei der Partikeltherapie soll das dem Tumor umliegende Gehirngewebe besser als bei einer konventionellen Photonenbestrahlung geschont werden, was insbesondere auch bei chirurgisch schlecht zugänglichen Meningeomen der Schädelbasis von Interesse ist [26].…”