Proton therapy for atypical meningiomas

McDonald, Mark W.; Plankenhorn, David A.; McMullen, Kevin P.; Henderson, M.; Dropcho, Edward J.; Shah, Mitesh V.; Cohen-Gadol, Aaron

doi:10.1007/s11060-015-1770-9

Cited by 41 publications

(31 citation statements)

References 25 publications

(29 reference statements)

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“…Multiple retrospective series have suggested that dose escalation beyond 60 Gy is correlated with improved long-term tumor control in patients with atypical or malignant meningiomas (6–8). In addition, prior series have reported varying rates of toxicity and have suggested that recurrent tumors portend a worse prognosis than de novo BM (9, 10).…”

Section: Introductionmentioning

confidence: 99%

Prospective, Randomized Study of Radiation Dose Escalation With Combined Proton-Photon Therapy for Benign Meningiomas

Sanford

Yeap

Larvie

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Purpose Fractionated radiotherapy is commonly used to treat benign meningiomas (BM) however the optimal dose and late adverse effects are not well defined. We aimed to assess the outcomes of BM treated to two radiation dose levels. Methods and Materials We randomly assigned patients (1:1) with incompletely resected or recurrent BM to two radiation doses, 55.8 Gy(RBE) and 63.0 Gy(RBE) of fractionated combined proton-photon radiotherapy. The primary endpoint was local control with hypothesis of improved tumor control with higher dose. Secondary endpoints included progression-free survival (PFS), overall survival (OS), and rates of treatment-related toxicities. Results Between 1991 and 2000, 47 patients were randomized. Three patients were excluded for non-benign histology therefore 44 patients were analyzed, 22 who received 55.8 Gy(RBE) and 22 who received 63.0 Gy(RBE). The median follow-up was 17.1 years. Local control for the entire cohort was 98% at 10 years and 90% at 15 years. Of the five patients with local recurrence, 4 occurred after 10 years of follow-up and 3 were in the lower dose group (p=0.322). In the modified intention to treat analysis, there was no difference in PFS (p=0.234) and OS (p=0.271) between arms. A total of 26 patients (59%) experienced a Grade 2 or higher late toxicity including 9 patients (20%) incurring a cerebrovascular accident (CVA), seven of which were deemed at least possibly attributable to irradiation. The median time between completion of radiation therapy and CVA was 5.6 years (range 1.4–14.0). Conclusion Fractionated combined proton-photon radiotherapy is effective for BM with no apparent benefit in dose escalation. Further investigation is needed to better define the risk of late toxicities including CVA after cranial radiation therapy.

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Section: Introductionmentioning

confidence: 99%

Prospective, Randomized Study of Radiation Dose Escalation With Combined Proton-Photon Therapy for Benign Meningiomas

Sanford

Yeap

Larvie

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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“…Autoři uzavírají, že stutrolou 85-95 % s minimální pozdní toxicitou. Bylo realizováno 6 studií fáze II s cílem testovat potenciál protonové terapie, redukovat toxicitu u meningeomů stupně 1 a zlepšit kontrolu nádoru u stupně 2 a 3 [11][12][13][14][15][16]. Výsledky byly srovnatelné s fotonovou terapií [17].…”

Section: Cena Protonové Terapieunclassified

Controversy over the Use of Proton Therapy for the Treatment of Tumors of Central Nervous Systém

Petera¹

2018

Klin Onkol

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Východiska: Protonová terapie (proton beam ther apy -PBT) je v současnosti jedním z nejvíce diskutovaných onkologických témat. PBT se vyznačuje ně kte rými fyzikálními charakteristikami, které ji teoreticky zvýhodňují oproti standardní fotonové léčbě. Na druhé straně ji provázejí nejistoty v lokalizaci dávkového maxima (Braggův peak) v reálných klinických situacích a v radiobio logické účinnosti v oblasti distálního konce protonového paprsku. Dosavadní klinické výsledky PBT bohužel zatím neodpovídají vkládaným nadějím. Cíl: V článku jsou prezentovány výsledky protonové léčby v porovnání s výsledky standardní fotonové terapie u low-a high-grade gliomů, pituitárních adenomů, vestibulárních schwannomů, chordomů a chondrosarkomů a pediatrických nádorů centrálního nervového systému. V žádné z těchto indikací neprokázala PBT vyšší kontrolu nádoru ani menší toxicitu než moderní fotonová léčba. Alarmující je vyšší riziko postradiačních nekróz mozkové tkáně. Nejvíce se PBT zvažuje u pediatrických tumorů, protože radiobio logické modely predikují nižší poškození neurokognitivních funkcí a redukci rizika sekundárních malignit. Tato hypotéza však má své odpůrce a dostatečná klinická data nejsou dostupná. Cena PBT je několikanásobně vyšší v porovnání s léčbou fotonovou. Závěr: PBT představuje převratnou technologii v moderní léčbě zářením, doposud však klinická data nepotvrdila její superioritu oproti moderním technikám fotonové léčby. Indikace PBT by měly být individuálně zvažovány u pa cientů, kde standardní techniky moderní fotonové terapie neumožňují dodržení dávkových limitů na zdravé tkáně. Klíčová slovaprotonová léčba -nádory -centrální nervový systém SummaryBackground: Proton beam ther apy (PBT) is one of the most discussed topics in contemporary oncology. PBT is characterized by certain physical properties that make it theoretically better as a treatment than standard photon ther apy. On the other hand, there are some uncertainties regard ing the localization of the dose peak (Bragg peak) in real clinical situations and the value of radiobio logical effectiveness at the end of proton beam. Unfortunately, the high expectations of PBT have not been fulfilled in published clinical studies. Aim: In the present article, the results of PBT are compared with those of standard photon ther apy for the treatment of low-and high--grade gliomas, pituitary adenomas, vestibular schwannomas, chordomas and chondrosarcomas, and pediatric central nervous system tumors. PBT was not better in tumor control or in reduc ing toxicity than photon ther apy. The higher risk of post-radiation brain tissue necrosis after PBT is alarming. PBT is mostly considered for pediatric tumors, because the radiobio logical models predict lower damage to neurocognitive functions and a reduction in secondary malignancies. However, this hypothesis has its opponents and sufficient clinical data to justify the models are still lacking. The cost of PBT is several times higher than that of photon ther apy. Results: PBT is a revolutionary technology in modern ra...

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“…A few articles describe also the use of a mixed proton/photon beam (Table 5 [9][10][11][91][92][93][94][95][96][97][98][99][100][101][102]. From the methodological point of view, the large majority of the studies are retrospective and may include different tumour types: chordoma, chondrosarcoma, and meningioma of grade I-III.…”

Section: Proton Radiotherapymentioning

confidence: 99%

“…Local control and overall survival at 5 years were obtained in 59% and 79%, respectively, for chordoma and 75% and 100% for chondrosarcoma. 91 The review on chordoma and chondrosarcoma includes the results of proton radiotherapy delivered after one or more surgical resections (Table 5 [9][10][11][91][92][93][94][95][96][97][98][99][100][101][102] ). All series were treated to very high doses of up to 83 Gy (RBE).…”

Section: Proton Radiotherapymentioning

confidence: 99%

Review of photon and proton radiotherapy for skull base tumours

Fossati

Vavassori²,

Deantonio

et al. 2016

Reports of Practical Oncology & Radiotherapy

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a b s t r a c tAn extremely large variety of benign and malignant tumours occur at skull base; these tumour lesions are in the proximity to structures deputed to relevant physiologic functions, limiting extensive surgical approaches to this body district. Most recent progresses of surgery and radiotherapy have allowed to improve local control with acceptable rates of side effects. Various photon radiotherapy techniques are employed, including 3-dimensional conformal radiotherapy, intensity modulated radiotherapy (IMRT), stereotactic radiotherapy (SRT) and brachytherapy that is manly limited to the treatment of primary or recurrent nasopharyngeal carcinoma. Proton beam radiotherapy is also extensively used thanks to its physical characteristics. Our review, focusing in particular on meningioma, chordoma, and chondrosarcoma, suggests that proton therapy plays a major role in the treatment of malignant tumours whereas photon therapy still plays a relevant role in the treatment of benign tumour lesions.

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Proton therapy for atypical meningiomas

Cited by 41 publications

References 25 publications

Prospective, Randomized Study of Radiation Dose Escalation With Combined Proton-Photon Therapy for Benign Meningiomas

Prospective, Randomized Study of Radiation Dose Escalation With Combined Proton-Photon Therapy for Benign Meningiomas

Controversy over the Use of Proton Therapy for the Treatment of Tumors of Central Nervous Systém

Review of photon and proton radiotherapy for skull base tumours

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