Proton therapy: A therapeutic opportunity for aggressive pediatric meningioma

Rombi, Barbara; Ruggi, Alessandro; Sardi, Iacopo; Zucchelli, Mino; Scagnet, Mirko; Toni, Francesco; Cammelli, Silvia; Giulietti, Giulia; Fabbri, Viscardo Paolo; Gianno, Francesca; Amichetti, Maurizio; Yock, Torunn I.; Morganti, Alessio Giuseppe; Pession, Andrea; Melchionda, Fraia

doi:10.1002/pbc.28919

Cited by 3 publications

(2 citation statements)

References 40 publications

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“…As meningiomas are frequently in a close relationship with important OARs such as the optic apparatus or brainstem [ 27 ], a highly conformal radiotherapy such as stereotactic photon RT or PBS PT is preferred. In a number of selected patients, especially in younger patients and/or those with challenging tumors, PBS PT can be advantageous in reducing the integral brain dose [ 28 , 29 ]. On the other hand, despite the steep dose gradient, care must be taken that the RBE can be higher than 1.1 in some cases [ 30 ], which is particularly relevant in the vicinity of sensitive OAR.…”

Section: Discussionmentioning

confidence: 99%

Long Term Outcome and Quality of Life of Intracranial Meningioma Patients Treated with Pencil Beam Scanning Proton Therapy

Krcek

Leiser

García-Marqueta

et al. 2023

Cancers

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The aim of this study was to assess the clinical outcome, including QoL, of patients with intracranial meningiomas WHO grade 1–3 who were treated with Pencil Beam Scanning Proton Therapy (PBS PT) between 1997 and 2022. Two hundred patients (median age 50.4 years, 70% WHO grade 1) were analyzed. Acute and late side effects were classified according to CTCAE version 5.0. Time to event data were calculated. QoL was assessed descriptively by the EORTC-QLQ-C30 and BN20 questionnaires. With a median follow-up of 65 months (range: 3.8–260.8 months) the 5 year OS was 95.7% and 81.8% for WHO grade 1 and grade 2/3, respectively (p < 0.001). Twenty (10%) local failures were observed. Failures occurred significantly (p < 0.001) more frequent in WHO grade 2 or 3 meningioma (WHO grade 1: n = 7, WHO grade 2/3: n = 13), in patients with multiple meningiomas (p = 0.005), in male patients (p = 0.005), and when PT was initiated not as upfront therapy (p = 0.011). There were no high-grade toxicities in the majority (n = 176; 88%) of patients. QoL was assessed for 83 (41.5%) patients and for those patients PT did not impacted QoL negatively during the follow-up. In summary, we observed very few local recurrences of meningiomas after PBS PT, a stable QoL, and a low rate of high-grade toxicity.

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Section: Discussionmentioning

confidence: 99%

Long Term Outcome and Quality of Life of Intracranial Meningioma Patients Treated with Pencil Beam Scanning Proton Therapy

Krcek

Leiser

García-Marqueta

et al. 2023

Cancers

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“…Stereotactic radiosurgery (SRS) such as Gamma Knife (GK) or CyberKnife, has been favored as a treatment option for small recurrences, aiming to minimize radiation-related side effects in children [ 20 , 22 , 23 ]. However, there is a limited amount of data available on the use of proton therapy (PT), where published data mostly comprises case reports involving various tumor types and different age groups [ 24 , 25 ]. Treatment with protons, and particularly with pencil beam scanning (PBS-PT), allows a significant reduction in the integral dose in surrounding healthy tissues due to the distinctive physical properties of protons in contrast to conventional photon RT [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

Quality of Life, Clinical, and Patient-Reported Outcomes after Pencil Beam Scanning Proton Therapy Delivered for Intracranial Grade WHO 1–2 Meningioma in Children and Adolescents

García-Marqueta,

Vázquez,

Krcek

et al. 2023

Cancers

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Purpose: The purpose of this study was to report the clinical and patient-reported outcomes of children and adolescents with intracranial meningioma treated with pencil beam scanning proton therapy (PBS-PT). Material and methods: Out of a total cohort of 207 intracranial meningioma patients treated with PBS-PT between 1999 and 2022, 10 (4.8%) were children or adolescents aged < 18 years. Median age was 13.9 years (range, 3.2–17.2). Six (60%) children were treated as primary treatment (postoperative PT, n = 4; exclusive PT, n = 2) and four (40%) at the time of tumor recurrence. Acute and late toxicities were registered according to Common Terminology Criteria of Adverse Events (CTCAE). Quality of life (QoL) before PBS-PT was assessed using PEDQOL questionnaires. Educational, functional, and social aspects after PT were assessed through our in-house developed follow-up surveys. Median follow-up time was 71.1 months (range, 2.5–249.7), and median time to last questionnaire available was 37.6 months (range, 5.75–112.6). Results: Five (50%) children developed local failure (LF) at a median time of 32.4 months (range, 17.7–55.4) after PBS-PT and four (80%) were considered in-field. One patient died of T-cell lymphoma 127.1 months after PBS-PT. Estimated 5-year local control (LC) and overall survival (OS) rates were 19.4% and 100.0%, respectively. Except for one patient who developed a cataract requiring surgery, no grade ≥3 late toxicities were reported. Before PT, patients rated their QoL lower than their parents in most domains. During the first year after PT, one child required educational support, one needed to attend to a special school, one had social problems and another three children required assistance for daily basic activities (DBA). Three years after PT, only one child required assistance for DBA. Conclusions: The outcome of children with intracranial meningioma treated with PBS-PT is in line with other centers who have reported results of radiation therapy delivered to this particular patient group. This therapy provides acceptable functional status profiles with no high-grade adverse radiation-induced events.

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