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Hypofractionated high-energy proton-beam irradiation is an alternative treatment for WHO grade I meningiomas

BACKGROUND: Radiation treatment is commonly employed in the treatment of meningiomas. The aim of this study was to evaluate the effectiveness and safety of hypofractionated high-energy proton therapy as adjuvant or primary treatment for WHO grade I meningiomas. METHOD: A total of 170 patients who re...

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Autores principales: Vlachogiannis, Pavlos, Gudjonsson, Olafur, Montelius, Anders, Grusell, Erik, Isacsson, Ulf, Nilsson, Kristina, Blomquist, Erik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5686253/
https://www.ncbi.nlm.nih.gov/pubmed/29064038
http://dx.doi.org/10.1007/s00701-017-3352-4
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author Vlachogiannis, Pavlos
Gudjonsson, Olafur
Montelius, Anders
Grusell, Erik
Isacsson, Ulf
Nilsson, Kristina
Blomquist, Erik
author_facet Vlachogiannis, Pavlos
Gudjonsson, Olafur
Montelius, Anders
Grusell, Erik
Isacsson, Ulf
Nilsson, Kristina
Blomquist, Erik
author_sort Vlachogiannis, Pavlos
collection PubMed
description BACKGROUND: Radiation treatment is commonly employed in the treatment of meningiomas. The aim of this study was to evaluate the effectiveness and safety of hypofractionated high-energy proton therapy as adjuvant or primary treatment for WHO grade I meningiomas. METHOD: A total of 170 patients who received irradiation with protons for grade I meningiomas between 1994 and 2007 were included in the study. The majority of the tumours were located at the skull base (n = 155). Eighty-four patients were treated post subtotal resection, 42 at tumour relapse and 44 with upfront radiotherapy after diagnosis based on the typical radiological image. Irradiation was given in a hypofractionated fashion (3–8 fractions, usually 5 or 6 Gy) with a mean dose of 21.9 Gy (range, 14–46 Gy). All patients were planned for follow-up with clinical controls and magnetic resonance imaging scans at 6 months and 1, 2, 3, 5, 7 and 10 years after treatment. The median follow-up time was 84 months. Age, gender, tumour location, Simpson resection grade and target volume were assessed as possible prognostic factors for post-irradiation tumour progression and radiation related complications. RESULTS: The actuarial 5- and 10-year progression-free survival rates were 93% and 85% respectively. Overall mortality rate was 13.5%, while disease-specific mortality was 1.7% (3/170 patients). Older patients and patients with tumours located in the middle cranial fossa had a lower risk for tumour progression. Radiation-related complications were seen in 16 patients (9.4%), with pituitary insufficiency being the most common. Tumour location in the anterior cranial fossa was the only factor that significantly increased the risk of complications. CONCLUSIONS: Hypofractionated proton-beam radiation therapy may be used particularly in the treatment of larger World Health Organisation grade I meningiomas not amenable to total surgical resection. Treatment is associated with high rates of long-term tumour growth control and acceptable risk for complications.
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spelling pubmed-56862532017-11-28 Hypofractionated high-energy proton-beam irradiation is an alternative treatment for WHO grade I meningiomas Vlachogiannis, Pavlos Gudjonsson, Olafur Montelius, Anders Grusell, Erik Isacsson, Ulf Nilsson, Kristina Blomquist, Erik Acta Neurochir (Wien) Clinical Article - Brain Tumors BACKGROUND: Radiation treatment is commonly employed in the treatment of meningiomas. The aim of this study was to evaluate the effectiveness and safety of hypofractionated high-energy proton therapy as adjuvant or primary treatment for WHO grade I meningiomas. METHOD: A total of 170 patients who received irradiation with protons for grade I meningiomas between 1994 and 2007 were included in the study. The majority of the tumours were located at the skull base (n = 155). Eighty-four patients were treated post subtotal resection, 42 at tumour relapse and 44 with upfront radiotherapy after diagnosis based on the typical radiological image. Irradiation was given in a hypofractionated fashion (3–8 fractions, usually 5 or 6 Gy) with a mean dose of 21.9 Gy (range, 14–46 Gy). All patients were planned for follow-up with clinical controls and magnetic resonance imaging scans at 6 months and 1, 2, 3, 5, 7 and 10 years after treatment. The median follow-up time was 84 months. Age, gender, tumour location, Simpson resection grade and target volume were assessed as possible prognostic factors for post-irradiation tumour progression and radiation related complications. RESULTS: The actuarial 5- and 10-year progression-free survival rates were 93% and 85% respectively. Overall mortality rate was 13.5%, while disease-specific mortality was 1.7% (3/170 patients). Older patients and patients with tumours located in the middle cranial fossa had a lower risk for tumour progression. Radiation-related complications were seen in 16 patients (9.4%), with pituitary insufficiency being the most common. Tumour location in the anterior cranial fossa was the only factor that significantly increased the risk of complications. CONCLUSIONS: Hypofractionated proton-beam radiation therapy may be used particularly in the treatment of larger World Health Organisation grade I meningiomas not amenable to total surgical resection. Treatment is associated with high rates of long-term tumour growth control and acceptable risk for complications. Springer Vienna 2017-10-24 2017 /pmc/articles/PMC5686253/ /pubmed/29064038 http://dx.doi.org/10.1007/s00701-017-3352-4 Text en © The Author(s) 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Clinical Article - Brain Tumors
Vlachogiannis, Pavlos
Gudjonsson, Olafur
Montelius, Anders
Grusell, Erik
Isacsson, Ulf
Nilsson, Kristina
Blomquist, Erik
Hypofractionated high-energy proton-beam irradiation is an alternative treatment for WHO grade I meningiomas
title Hypofractionated high-energy proton-beam irradiation is an alternative treatment for WHO grade I meningiomas
title_full Hypofractionated high-energy proton-beam irradiation is an alternative treatment for WHO grade I meningiomas
title_fullStr Hypofractionated high-energy proton-beam irradiation is an alternative treatment for WHO grade I meningiomas
title_full_unstemmed Hypofractionated high-energy proton-beam irradiation is an alternative treatment for WHO grade I meningiomas
title_short Hypofractionated high-energy proton-beam irradiation is an alternative treatment for WHO grade I meningiomas
title_sort hypofractionated high-energy proton-beam irradiation is an alternative treatment for who grade i meningiomas
topic Clinical Article - Brain Tumors
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5686253/
https://www.ncbi.nlm.nih.gov/pubmed/29064038
http://dx.doi.org/10.1007/s00701-017-3352-4
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