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Efficacy and Tolerance of Intensity Modulated Radiation Therapy for Skull Base Meningioma

PURPOSE: The purpose of this study was to evaluate the efficacy and tolerance of normofractionated stereotactic radiation therapy (RT) and intensity modulated RT with helical tomotherapy for skull base meningioma. METHODS AND MATERIALS: Between January 2009 and 2014, 46 patients with skull base meni...

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Autores principales: Brahimi, Youssef, Antoni, Delphine, Srour, Robin, Proust, François, Thiery, Alicia, Wagner, Pierre, Noel, Georges
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817551/
https://www.ncbi.nlm.nih.gov/pubmed/31673652
http://dx.doi.org/10.1016/j.adro.2019.07.009
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author Brahimi, Youssef
Antoni, Delphine
Srour, Robin
Proust, François
Thiery, Alicia
Wagner, Pierre
Noel, Georges
author_facet Brahimi, Youssef
Antoni, Delphine
Srour, Robin
Proust, François
Thiery, Alicia
Wagner, Pierre
Noel, Georges
author_sort Brahimi, Youssef
collection PubMed
description PURPOSE: The purpose of this study was to evaluate the efficacy and tolerance of normofractionated stereotactic radiation therapy (RT) and intensity modulated RT with helical tomotherapy for skull base meningioma. METHODS AND MATERIALS: Between January 2009 and 2014, 46 patients with skull base meningioma were treated with normofractionated intensity modulated RT in stereotactic conditions (50%) or with helical tomotherapy (50%). Most of the lesions were localized in the cavernous sinus (59%). The mean planning target volume was 47.2 mL (range, 1.1-223 mL). RESULTS: After treatment, 5 lesions exhibited a partial response radiologically and 39 lesions were stable. At the time of treatment, 35 patients were symptomatic with a mean of 2 symptoms per patient. The most frequent symptoms were visual impairment (41%), cranial nerve dysfunction (20%), and headache (16%). The median follow-up time was 42 months (range, 10-76 months). After RT, 71% of patients exhibited an improvement of at least 1 symptom with a median interval of 15.6 months (range, 5.3-30.5 months). The most frequent improved symptoms were cranial nerve deficits (47%), visual impairment (45%), and headache (42%).The clinical response was correlated with the clinical target volume (CTV) margin (P = .06), extended clinical follow-up time (P = .004), and larger planning target volume (P = .05) by univariate analysis. Taking in account correlation factors, in the multivariate analysis, only CTV was a favorable significant factor of clinical improvement (P = .049; hazard ratio: 5 95%; confidence interval, 1.1-28). We observed 3 cases of trigeminal nerve dysfunction at 4.2, 5.7, and 24.6 months; 2 cases of visual disturbance at 10.1 and 24 months; 2 cases of neurocognitive disorders at 12.9 and 35.2 months; and 1 case of stroke at 20.3 months. CONCLUSIONS: RT for skull base meningiomas is an effective and safe treatment, leading in most cases to clinical improvement. The addition of a CTV margin to meningioma volume improved the symptoms of patients.
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spelling pubmed-68175512019-10-31 Efficacy and Tolerance of Intensity Modulated Radiation Therapy for Skull Base Meningioma Brahimi, Youssef Antoni, Delphine Srour, Robin Proust, François Thiery, Alicia Wagner, Pierre Noel, Georges Adv Radiat Oncol Central Nervous System PURPOSE: The purpose of this study was to evaluate the efficacy and tolerance of normofractionated stereotactic radiation therapy (RT) and intensity modulated RT with helical tomotherapy for skull base meningioma. METHODS AND MATERIALS: Between January 2009 and 2014, 46 patients with skull base meningioma were treated with normofractionated intensity modulated RT in stereotactic conditions (50%) or with helical tomotherapy (50%). Most of the lesions were localized in the cavernous sinus (59%). The mean planning target volume was 47.2 mL (range, 1.1-223 mL). RESULTS: After treatment, 5 lesions exhibited a partial response radiologically and 39 lesions were stable. At the time of treatment, 35 patients were symptomatic with a mean of 2 symptoms per patient. The most frequent symptoms were visual impairment (41%), cranial nerve dysfunction (20%), and headache (16%). The median follow-up time was 42 months (range, 10-76 months). After RT, 71% of patients exhibited an improvement of at least 1 symptom with a median interval of 15.6 months (range, 5.3-30.5 months). The most frequent improved symptoms were cranial nerve deficits (47%), visual impairment (45%), and headache (42%).The clinical response was correlated with the clinical target volume (CTV) margin (P = .06), extended clinical follow-up time (P = .004), and larger planning target volume (P = .05) by univariate analysis. Taking in account correlation factors, in the multivariate analysis, only CTV was a favorable significant factor of clinical improvement (P = .049; hazard ratio: 5 95%; confidence interval, 1.1-28). We observed 3 cases of trigeminal nerve dysfunction at 4.2, 5.7, and 24.6 months; 2 cases of visual disturbance at 10.1 and 24 months; 2 cases of neurocognitive disorders at 12.9 and 35.2 months; and 1 case of stroke at 20.3 months. CONCLUSIONS: RT for skull base meningiomas is an effective and safe treatment, leading in most cases to clinical improvement. The addition of a CTV margin to meningioma volume improved the symptoms of patients. Elsevier 2019-07-23 /pmc/articles/PMC6817551/ /pubmed/31673652 http://dx.doi.org/10.1016/j.adro.2019.07.009 Text en © 2019 The Author(s) http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Central Nervous System
Brahimi, Youssef
Antoni, Delphine
Srour, Robin
Proust, François
Thiery, Alicia
Wagner, Pierre
Noel, Georges
Efficacy and Tolerance of Intensity Modulated Radiation Therapy for Skull Base Meningioma
title Efficacy and Tolerance of Intensity Modulated Radiation Therapy for Skull Base Meningioma
title_full Efficacy and Tolerance of Intensity Modulated Radiation Therapy for Skull Base Meningioma
title_fullStr Efficacy and Tolerance of Intensity Modulated Radiation Therapy for Skull Base Meningioma
title_full_unstemmed Efficacy and Tolerance of Intensity Modulated Radiation Therapy for Skull Base Meningioma
title_short Efficacy and Tolerance of Intensity Modulated Radiation Therapy for Skull Base Meningioma
title_sort efficacy and tolerance of intensity modulated radiation therapy for skull base meningioma
topic Central Nervous System
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817551/
https://www.ncbi.nlm.nih.gov/pubmed/31673652
http://dx.doi.org/10.1016/j.adro.2019.07.009
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