1
|
Krcek R, Leiser D, García-Marqueta M, Bolsi A, Weber DC. Long Term Outcome and Quality of Life of Intracranial Meningioma Patients Treated with Pencil Beam Scanning Proton Therapy. Cancers (Basel) 2023; 15:3099. [PMID: 37370709 DOI: 10.3390/cancers15123099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Reinhardt Krcek
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Dominic Leiser
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
| | - Marta García-Marqueta
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
| | - Damien Charles Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
- Department of Radiation Oncology, University Hospital of Zürich, 8091 Zürich, Switzerland
| |
Collapse
|
2
|
Kinaci-Tas B, Alderliesten T, Verbraak FD, Rasch CRN. Radiation-Induced Retinopathy and Optic Neuropathy after Radiation Therapy for Brain, Head, and Neck Tumors: A Systematic Review. Cancers (Basel) 2023; 15:cancers15071999. [PMID: 37046660 PMCID: PMC10093581 DOI: 10.3390/cancers15071999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
Background: Patients with brain, head, and neck tumors experience a decline in their quality of life due to radiation retinopathy and optic neuropathy. Little is known about the dose–response relationship and patient characteristics. We aimed to systematically review the prevalence of radiation retinopathy and optic neuropathy. Method: The primary outcome was the pooled prevalence of radiation retinopathy and optic neuropathy. The secondary outcome included the effect of the total radiation dose prescribed for the tumor according to the patient’s characteristics. Furthermore, we aimed to evaluate the radiation dose parameters for organs at risk of radiation retinopathy and optic neuropathy. Results: The pooled prevalence was 3.8%. No retinopathy was reported for the tumor’s prescribed dose of <50 Gy. Optic neuropathy was more prevalent for a prescribed dose of >50 Gy than <50 Gy. We observed a higher prevalence rate for retinopathy (6.0%) than optic neuropathy (2.0%). Insufficient data on the dose for organs at risk were reported. Conclusion: The prevalence of radiation retinopathy was higher compared to optic neuropathy. This review emphasizes the need for future studies considering retinopathy and optic neuropathy as primary objective parameters.
Collapse
Affiliation(s)
- Buket Kinaci-Tas
- Department of Radiation Oncology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
- Correspondence:
| | - Tanja Alderliesten
- Department of Radiation Oncology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Frank D. Verbraak
- Department of Ophthalmology, Amsterdam University Medical Centers, Location VU Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Coen R. N. Rasch
- Department of Radiation Oncology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| |
Collapse
|
3
|
Holtzman AL, Glassman GE, Dagan R, Rao D, Fiester PJ, Tavanaieour D, Morris CG, Indelicato DJ, Mendenhall WM. Long-term outcomes of fractionated proton beam therapy for benign or radiographic intracranial meningioma. J Neurooncol 2023; 161:481-489. [PMID: 36692832 DOI: 10.1007/s11060-022-04207-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/02/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Benign intracranial meningioma is one of the most common primary brain neoplasms. Proton therapy has been increasingly utilized for nonoperative management of this neoplasm, yet few long-term outcomes studies exist. METHODS The medical records of a total of 59 patients with 64 lesions were reviewed under a prospective outcomes tracking protocol for histologically proven or radiographically benign meningioma. The patients were treated with proton therapy at the University of Florida Proton Therapy Institute between 2007 and 2019 and given a median dose of 50.4 GyRBE at 1.8 GyRBE (relative biological effectiveness) (range 48.6-61.2 GyRBE) in once-daily treatments. RESULTS With a median clinical and imaging follow-up of 6.3 and 4.7 years, the rates of 5-year actuarial local progression and cumulative incidence of grade 3 or greater toxicity were 6% (95% confidence interval [CI] 1%-14%), and 2% (95% CI < 1%-15%), respectively. Two patients experienced local progression after 5 years. The 5-year actuarial overall survival rate was 87% (95% CI 74-94%). CONCLUSION Fractionated PBT up to 50.4 GyRBE is a safe and highly effective therapy for treating benign intracranial meningioma.
Collapse
Affiliation(s)
- Adam L Holtzman
- Department of Radiation Oncology, University of Florida College of Medicine, 2015 North Jefferson Street, Jacksonville, FL, 32206, USA.
| | | | - Roi Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, 2015 North Jefferson Street, Jacksonville, FL, 32206, USA
| | - Dinesh Rao
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
| | - Peter J Fiester
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
| | - Daryoush Tavanaieour
- Department of Neurosurgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, 2015 North Jefferson Street, Jacksonville, FL, 32206, USA
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, 2015 North Jefferson Street, Jacksonville, FL, 32206, USA
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, 2015 North Jefferson Street, Jacksonville, FL, 32206, USA
| |
Collapse
|
4
|
Hurley DJ, Whitlow S, O'Rourke D, Flitcroft I. Bilateral paediatric optic nerve sheath meningioma. BMJ Case Rep 2022. [DOI: 10.1136/bcr-2021-248613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
At birth, the patient was noted to have microphthalmia and optic atrophy in her left eye with no apparent cause. In early childhood, the vision in that eye began to deteriorate. A few years later, disc swelling was noted in the contralateral right eye. Neuroimaging was normal and a subsequent lumbar puncture found borderline high opening pressure. Vision and visual fields in the right eye remained stable until the patient was in early adolescence when she started to complain of blurred vision. Her pattern visual evoked potential showed a 75% reduction in P100 amplitude compared with the previous year. Repeat neuroimaging was suggestive of bilateral meningiomas and a biopsy was performed to confirm this. Subsequently, the patient was treated with proton beam therapy to salvage vision in her right eye. This is a novel case of meningioma presenting with enophthalmos due to contraction of the retrobulbar optic nerve.
Collapse
|
5
|
Vaishnav YJ, Singh R, Didwania P, Lehrer EJ, Bakaeva T, Harris TJ, Migliori ME, Sheehan JP, Trifiletti DM. Radiotherapy and Radiosurgery in the Management of Optic Nerve Sheath Meningiomas: An International Systematic Review and Meta-Analysis of Twenty Studies. World Neurosurg 2022; 164:e929-e944. [PMID: 35609728 DOI: 10.1016/j.wneu.2022.05.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Optic nerve sheath meningiomas (ONMs) are often managed with radiotherapy (RT) with the goal of achieving radiographic local control (LC) and preventing deterioration of visual acuity (VA). We aimed to perform a systematic review and meta-analysis of outcomes for patients with ONM treated with RT. METHODS The PICOS/PRISMA/MOOSE selection criteria were used to identify studies. Primary outcomes were stable or improved VA and radiographic LC at last follow-up. The secondary outcomes were incidences of radiation-induced retinopathy and xerophthalmia and stable or improved visual fields (VFs). Weighted random-effects meta-analyses using the DerSimonian and Laird methods were conducted to characterize effect sizes. Mixed-effects regression models were used to examine potential correlations between gross tumor volume (GTV) and outcomes. RESULTS In total, 444 patients with ONM across 20 published studies were included. The estimated LC rate was 99.8% (95% confidence interval [CI], 98.3%-100%), and the estimated proportion of patients with stable or improved VA or VF was 89.7% (95% CI, 86.2%-92.4%) and 93.3% (95% CI, 89.5%-95.8%), respectively. Estimated incidences of radiation-induced retinopathy and xerophthalmia were 7.2% and 10.1%, respectively. GTV was significantly associated with VA (P = 0.014) with estimated VA rates of 96.4%, 91.4%, and 80.5% for GTVs of 2.0, 3.0, and 4.0 cm3, respectively. CONCLUSIONS RT was well tolerated, with excellent LC achieved. Nearly 90% of patients noted either stability or improvement in VA and VF. Larger ONMs were associated with poorer VA.
Collapse
Affiliation(s)
- Yash J Vaishnav
- Department of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Raj Singh
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Prabhanjan Didwania
- Rady School of Management, University of California San Diego, San Diego, California, USA
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tatiana Bakaeva
- Department of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Timothy J Harris
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Michael E Migliori
- Department of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | | |
Collapse
|