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Sanikommu S, Panchawagh S, Eatz T, Lu VM, Rodrigues PB, Abdelsalam A, Gurses ME, Cummings A, Uppalapati V, Akurati S, Kondoor V, Komotar RJ, Ivan ME. Recurrence of atypical and anaplastic intracranial Meningiomas: A meta-analysis of risk factors. Clin Neurol Neurosurg 2024; 244:108450. [PMID: 39018991 DOI: 10.1016/j.clineuro.2024.108450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Accepted: 07/11/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND The predictive role of multiple risk factors for intracranial atypical and anaplastic meningioma recurrence is convoluted. This meta-analysis assessed the predictive value of selected factors for recurrence in these Meningiomas. METHODS Studies encompassing risk factor data including gross total resection (GTR), subtotal resection (STR), post-op radiotherapy, Ki-67 % index >3 %, and location were searched for in PubMed, Embase, and Web of Science, and thereafter analyzed using robust Bayesian meta-analysis. RESULTS Eighteen observational studies involving 1589 patients met inclusion criteria for analysis. GTR was identified as a good prognostic factor for recurrence (OR = 0.212; 95 % CI (-1.972, -1.002); heterogeneity BF=0.702), and STR had a significantly higher risk of recurrence (OR = 4.43; 95 % CI 0.658-2.011; heterogeneity BF=0.724). Post-operative radiotherapy did not statistically significantly affect the recurrence process (OR = 1.02; 95 % CI (-1.848, 0.626); heterogeneity (BF=1.034)). Ki67 % index >3 % had an augmented chance of recurrence (OR = 2.38; 95 % CI (-0.220, 2.355); heterogeneity (BF=1.162)). A meta-regression analysis showed that WHO grade III Meningiomas had a higher chance of recurring than grade II Meningiomas. CONCLUSION Among the selected factors, STR and Ki67 % index > 3 % were associated with a higher risk of recurrence, with post-operative radiotherapy making no difference. GTR appeared to inversely impact recurrence. Compared to grade II, grade III Meningiomas had higher odds of recurring.
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Affiliation(s)
- Sai Sanikommu
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA.
| | - Suhrud Panchawagh
- Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Tiffany Eatz
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
| | | | - Ahmed Abdelsalam
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
| | - Muhammet Enes Gurses
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
| | | | - Venkat Uppalapati
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
| | - Sneha Akurati
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
| | - Vishaal Kondoor
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Ricardo Jorge Komotar
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
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Iannalfi A, Riva G, Lillo S, Ciccone L, Fontana G, Molinelli S, Trombetta L, Ciocca M, Imparato S, Pecorilla M, Orlandi E. Proton therapy for intracranial meningioma: a single-institution retrospective analysis of efficacy, survival and toxicity outcomes. J Neurooncol 2024; 169:683-692. [PMID: 38918319 DOI: 10.1007/s11060-024-04751-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE To report the outcomes of a large series of intracranial meningiomas (IMs) submitted to proton therapy (PT) with curative intent. METHODS We conducted a retrospective analysis on all consecutive IM patients treated between 2014 and 2021. The median PT prescription dose was 55.8 Gy relative biological effectiveness (RBE) and 66 GyRBE for benign/radiologically diagnosed and atypical/anaplastic IMs, respectively. Local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), overall survival (OS), and radionecrosis-free survival (RNFS) were evaluated with the Kaplan-Meier method. Univariable analysis was performed to identify potential prognostic factors for clinical outcomes. Toxicity was reported according to the latest Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. RESULTS Overall, 167 patients were included. With a median follow-up of 41 months (range, 6-99), twelve patients (7%) developed tumor local recurrence after a median time of 39 months. The 5-year LRFS was 88% for the entire cohort, with a significant difference between benign/radiologically diagnosed and atypical/anaplastic IMs (98% vs. 47%, p < 0.001); this significant difference was maintained also for the 5-year OS and the 5-year DRFS rates. Patients aged ≤ 56 years reported significantly better outcomes, whereas lower prescription doses and skull base location were associated with better RNFS rates. Two patients experienced G3 acute toxicities (1.2%), and three patients G3 late toxicities (1.8%). There were no G4-G5 adverse events. CONCLUSION PT proved to be effective with an acceptable toxicity profile. To the best of our knowledge this is one of the largest series including IM patients submitted to PT.
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Affiliation(s)
- Alberto Iannalfi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy
| | - Giulia Riva
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy
| | - Sara Lillo
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy.
| | - Lucia Ciccone
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy
| | - Giulia Fontana
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy
| | - Silvia Molinelli
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy
| | - Luca Trombetta
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy
| | - Mario Ciocca
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy
| | - Sara Imparato
- Radiology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy
| | - Mattia Pecorilla
- Radiology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy
- Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, 27100, Italy
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Chhabra AM, Snider JW, Kole AJ, Stock M, Holtzman AL, Press R, Wang CJ, Li H, Lin H, Shi C, McDonald M, Soike M, Zhou J, Sabouri P, Mossahebi S, Colaco R, Albertini F, Simone CB. Proton Therapy for Spinal Tumors: A Consensus Statement From the Particle Therapy Cooperative Group. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00507-8. [PMID: 39181272 DOI: 10.1016/j.ijrobp.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/29/2024] [Accepted: 04/03/2024] [Indexed: 08/27/2024]
Abstract
PURPOSE Proton beam therapy (PBT) plays an important role in the management of primary spine tumors. The purpose of this consensus statement was to summarize safe and optimal delivery of PBT for spinal tumors. METHODS AND MATERIALS The Particle Therapy Cooperative Group Skull Base/Central nervous system/Sarcoma Subcommittee consisting of radiation oncologists and medical physicists with specific expertise in spinal irradiation developed expert recommendations discussing treatment planning considerations and current approaches in the treatment of primary spinal tumors. RESULTS Computed tomography simulation: factors that require significant consideration include (1) patient comfort, (2) setup reproducibility and stability, and (3) accessibility of appropriate beam angles. SPINE STABILIZATION HARDWARE If present, hardware should be placed with cross-links well above/below the level of the primary tumor to reduce the metal burden at the level of the tumor bed. New materials that can reduce uncertainties include polyether-ether-ketone and composite polyether-ether-ketone-carbon fiber implants. FIELD ARRANGEMENT Appropriate beam selection is required to ensure robust target coverage and organ at risk sparing. Commonly, 2 to 4 treatment fields, typically from posterior and/or posterior-oblique directions, are used. TREATMENT PLANNING METHODOLOGY Robust optimization is recommended for all pencil beam scanning plans (the preferred treatment modality) and should consider setup uncertainty (between 3 and 7 mm) and range uncertainty (3%-3.5%). In the presence of metal hardware, use of an increased range uncertainty up to 5% is recommended. CONCLUSIONS The Particle Therapy Cooperative Group Skull Base/Central nervous system/Sarcoma Subcommittee has developed recommendations to enable centers to deliver PBT safely and effectively for the management of primary spinal tumors.
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Affiliation(s)
- Arpit M Chhabra
- Department of Radiation Oncology, New York Proton Center, New York, New York.
| | - James W Snider
- Department of Radiation Oncology, South Florida Proton Therapy Institute, Delray Beach, Florida
| | - Adam J Kole
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama
| | - Markus Stock
- Department of Medical Physics, EBG MedAustron, Wiener Neustadt, Austria
| | - Adam L Holtzman
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Robert Press
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
| | - C Jake Wang
- Department of Radiation Oncology, Willis Knighton Cancer Center, Shreveport, Louisiana
| | - Heng Li
- Department of Medical Physics, Johns Hopkins, Baltimore, Maryland
| | - Haibo Lin
- Department of Radiation Oncology, New York Proton Center, New York, New York
| | - Chengyu Shi
- Department of Medical Physics, City of Hope, Irvine, California
| | - Mark McDonald
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Michael Soike
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama
| | - Jun Zhou
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Pouya Sabouri
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sina Mossahebi
- Department of Medical Physics, Maryland Proton Treatment Center, Baltimore, Maryland
| | - Rovel Colaco
- Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Francesca Albertini
- Department of Medical Physics, Paul Scherrer Institut, Würenlingen, Switzerland
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
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Hsieh AL, Bi WL, Ramesh V, Brastianos PK, Plotkin SR. Evolving concepts in meningioma management in the era of genomics. Cancer 2024; 130:2586-2600. [PMID: 38753473 PMCID: PMC11260245 DOI: 10.1002/cncr.35279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 01/31/2024] [Accepted: 02/19/2024] [Indexed: 05/18/2024]
Abstract
Meningioma is the most common type of primary brain tumor. Surgical resection followed by surveillance is the first-line treatment for the majority of symptomatic meningiomas; however, recent advances in molecular sequencing, DNA methylation, proteomics, and single-cell sequencing provide insights into further characterizing this heterogeneous group of tumors with a wide range of prognoses. A subset of these tumors are highly aggressive and cause severe morbidity and mortality. Therefore, identifying those individuals with a poor prognosis and intervening are critical. This review aims to help readers interpret the molecular profiling of meningiomas to identify patients with worse prognoses and guide the management and strategy for surveillance.
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Affiliation(s)
- Annie L. Hsieh
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Vijaya Ramesh
- Department of Neurology and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Priscilla K Brastianos
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Central Nervous System Metastasis Program, Massachusetts General Hospital, Boston, MA, United States
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott R. Plotkin
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Nesteruk KP, Bradley SG, Kooy HM, Clasie BM. Beam Position Projection Algorithms in Proton Pencil Beam Scanning. Cancers (Basel) 2024; 16:2098. [PMID: 38893217 PMCID: PMC11171160 DOI: 10.3390/cancers16112098] [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: 04/24/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Beam position uncertainties along the beam trajectory arise from the accelerator, beamline, and scanning magnets (SMs). They can be monitored in real time, e.g., through strip ionization chambers (ICs), and treatments can be paused if needed. Delivery is more reliable and accurate if the beam position is projected from monitored nozzle parameters to the isocenter, allowing for accurate online corrections to be performed. Beam position projection algorithms are also used in post-delivery log file analyses. In this paper, we investigate the four potential algorithms that can be applied to all pencil beam scanning (PBS) nozzles. For some combinations of nozzle configurations and algorithms, however, the projection uses beam properties determined offline (e.g., through beam tuning or technical commissioning). The best algorithm minimizes either the total uncertainty (i.e., offline and online) or the total offline uncertainty in the projection. Four beam position algorithms are analyzed (A1-A4). Two nozzle lengths are used as examples: a large nozzle (1.5 m length) and a small nozzle (0.4 m length). Three nozzle configurations are considered: IC after SM, IC before SM, and ICs on both sides. Default uncertainties are selected for ion chamber measurements, nozzle entrance beam position and angle, and scanning magnet angle. The results for other uncertainties can be determined by scaling these results or repeating the error propagation. We show the propagation of errors from two locations and the SM angle to the isocenter for all the algorithms. The best choice of algorithm depends on the nozzle length and is A1 and A3 for the large and small nozzles, respectively. If the total offline uncertainty is to be minimized (a better choice if the offline uncertainty is not stable), the best choice of algorithm changes to A1 for the small nozzle for some hardware configurations. Reducing the nozzle length can help to reduce the gantry size and make proton therapy more accessible. This work is important for designing smaller nozzles and, consequently, smaller gantries. This work is also important for log file analyses.
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Affiliation(s)
- Konrad P. Nesteruk
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA; (K.P.N.); (S.G.B.); (H.M.K.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Stephen G. Bradley
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA; (K.P.N.); (S.G.B.); (H.M.K.)
| | - Hanne M. Kooy
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA; (K.P.N.); (S.G.B.); (H.M.K.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Benjamin M. Clasie
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA; (K.P.N.); (S.G.B.); (H.M.K.)
- Harvard Medical School, Boston, MA 02115, USA
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6
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Dang DD, Mugge LA, Awan OK, Gong AD, Fanous AA. Spinal Meningiomas: A Comprehensive Review and Update on Advancements in Molecular Characterization, Diagnostics, Surgical Approach and Technology, and Alternative Therapies. Cancers (Basel) 2024; 16:1426. [PMID: 38611105 PMCID: PMC11011121 DOI: 10.3390/cancers16071426] [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: 02/04/2024] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Spinal meningiomas are the most common intradural, extramedullary tumor in adults, yet the least common entity when accounting for all meningiomas spanning the neuraxis. While traditionally considered a benign recapitulation of their intracranial counterpart, a paucity of knowledge exists regarding the differences between meningiomas arising from these two anatomic compartments in terms of histopathologic subtypes, molecular tumor biology, surgical principles, long-term functional outcomes, and recurrence rates. To date, advancements at the bench have largely been made for intracranial meningiomas, including the discovery of novel gene targets, DNA methylation profiles, integrated diagnoses, and alternative systemic therapies, with few exceptions reserved for spinal pathology. Likewise, evolving clinical research offers significant updates to our understanding of guiding surgical principles, intraoperative technology, and perioperative patient management for intracranial meningiomas. Nonetheless, spinal meningiomas are predominantly relegated to studies considering non-specific intradural extramedullary spinal tumors of all histopathologic types. The aim of this review is to comprehensively report updates in both basic science and clinical research regarding intraspinal meningiomas and to provide illustrative case examples thereof, thereby lending a better understanding of this heterogenous class of central nervous system tumors.
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Affiliation(s)
- Danielle D. Dang
- Department of Neurosurgery, Inova Fairfax Medical Campus, Falls Church, VA 22042, USA; (D.D.D.); (L.A.M.); (O.K.A.); (A.D.G.)
| | - Luke A. Mugge
- Department of Neurosurgery, Inova Fairfax Medical Campus, Falls Church, VA 22042, USA; (D.D.D.); (L.A.M.); (O.K.A.); (A.D.G.)
| | - Omar K. Awan
- Department of Neurosurgery, Inova Fairfax Medical Campus, Falls Church, VA 22042, USA; (D.D.D.); (L.A.M.); (O.K.A.); (A.D.G.)
| | - Andrew D. Gong
- Department of Neurosurgery, Inova Fairfax Medical Campus, Falls Church, VA 22042, USA; (D.D.D.); (L.A.M.); (O.K.A.); (A.D.G.)
| | - Andrew A. Fanous
- Department of Neurosurgery, Inova Alexandria Hospital, Alexandria, VA 22304, USA
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Wilson TA, Kang Jr JI, Huang L, Vacaru A, Martins KN, Boling WW. Adjuvant proton beam therapy in patients with grade 2 meningiomas. Surg Neurol Int 2024; 15:62. [PMID: 38468681 PMCID: PMC10927181 DOI: 10.25259/sni_485_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/25/2024] [Indexed: 03/13/2024] Open
Abstract
Background The World Health Organization (WHO) grade 2 meningiomas behave aggressively with a high proclivity toward recurrence despite maximal surgical resection. Our institution, a pioneer of proton therapy, uses exclusively proton beam radiation, and thus, we present a retrospective cohort analysis of patients with WHO grade 2 meningiomas treated with adjuvant proton beam therapy (PBT) at our institution between 2007 and 2019. The effects of adjuvant PBT were evaluated. Methods Data collected include diagnosis, gender, histological subtype, WHO grade, the extent of surgical resection, adjuvant PBT radiation, details of the PBT radiation, recurrence, any additional PBT radiation, systemic medical therapy, and disease-specific survival. Results Among the WHO grade 2 meningiomas (n = 50) recommended PBT, 80% and 78% of patients with gross-total resection (GTR) and subtotal resection (STR), respectively, followed through with PBT. The median radiation dose of PBT was 59.5 Gy and 59.92 Gy for patients with GTR and STR, respectively, with a median of 33 fractions delivered in 1.8 Gy doses for both groups. Combined 3-year progression-free survival (PFS) was 96%, and 5-year PFS was 92%. Combined overall survival was 95% at five years. Minimal radiation side effects were reported with no grade 3 or higher toxicities. Conclusion Our results suggest that adjuvant PBT is well tolerated with minimal radiation toxicity. Alternative to photon radiation, PBT may be considered at least as safe and effective for adjuvant treatment of WHO grade 2 meningiomas when it is available.
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Affiliation(s)
- Taylor Anne Wilson
- Department of Neurology, Loma Linda University Medical Center, Loma Linda, California, United States
| | | | - Lei Huang
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California, United States
| | - Alexandra Vacaru
- School of Medicine, Loma Linda University, Loma Linda, California, United States
| | | | - Warren W. Boling
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California, United States
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Gaito S, Burnet NG, Aznar MC, Marvaso G, Jereczek-Fossa BA, Crellin A, Indelicato D, Pan S, Colaco R, Rieu R, Smith E, Whitfield G. Proton Beam Therapy in the Reirradiation Setting of Brain and Base of Skull Tumour Recurrences. Clin Oncol (R Coll Radiol) 2023; 35:673-681. [PMID: 37574418 DOI: 10.1016/j.clon.2023.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/04/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023]
Abstract
The therapeutic management of local tumour recurrence after a first course of radical radiotherapy is always complex. Surgery and reirradiation carry increased morbidity due to radiation-induced tissue changes. Proton beam therapy (PBT) might be advantageous in the reirradiation setting, thanks to its distinct physical characteristics. Here we systematically reviewed the use of PBT in the management of recurrent central nervous system (CNS) and base of skull (BoS) tumours, as published in the literature. The research question was framed following the Population, Intervention, Comparison and Outcomes (PICO) criteria: the population of the study was cancer patients with local disease recurrence in the CNS or BoS; the intervention was radiation treatment with PBT; the outcomes of the study focused on the clinical outcomes of PBT in the reirradiation setting of local tumour recurrences of the CNS or BoS. The identification stage resulted in 222 records in Embase and 79 in Medline as of March 2023. Sixty-eight duplicates were excluded at this stage and 56 were excluded after screening as not relevant, not in English or not full-text articles. Twelve full-text articles were included in the review and are presented according to the site of disease, namely BoS, brain or both brain and BoS. This review showed that reirradiation of brain/BoS tumour recurrences with PBT can provide good local control with acceptable toxicity rates. However, reirradiation of tumour recurrences in the CNS or BoS setting needs to consider several factors that can increase the risk of toxicities. Therefore, patient selection is crucial. Randomised evidence is needed to select the best radiation modality in this group of patients.
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Affiliation(s)
- S Gaito
- Proton Clinical Outcomes Unit, The Christie NHS Proton Beam Therapy Centre, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK.
| | - N G Burnet
- Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
| | - M C Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - G Marvaso
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20126 Milan, Italy
| | - B A Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20126 Milan, Italy
| | - A Crellin
- National Lead Proton Beam Therapy NHSe, UK
| | - D Indelicato
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida, USA
| | - S Pan
- Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
| | - R Colaco
- Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
| | - R Rieu
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital, London, UK
| | - E Smith
- Proton Clinical Outcomes Unit, The Christie NHS Proton Beam Therapy Centre, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
| | - G Whitfield
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
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García-Marqueta M, Vázquez M, Krcek R, Kliebsch UL, Baust K, Leiser D, van Heerden M, Pica A, Calaminus G, Weber DC. 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. Cancers (Basel) 2023; 15:4447. [PMID: 37760417 PMCID: PMC10526222 DOI: 10.3390/cancers15184447] [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: 07/25/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
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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Affiliation(s)
- Marta García-Marqueta
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Miriam Vázquez
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Reinhardt Krcek
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Ulrike L. Kliebsch
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Katja Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Dominic Leiser
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Michelle van Heerden
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
- Department of Radiation Oncology, University of Zürich, 8091 Zürich, Switzerland
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10
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De Pietro R, Zaccaro L, Marampon F, Tini P, De Felice F, Minniti G. The evolving role of reirradiation in the management of recurrent brain tumors. J Neurooncol 2023; 164:271-286. [PMID: 37624529 PMCID: PMC10522742 DOI: 10.1007/s11060-023-04407-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
Despite aggressive management consisting of surgery, radiation therapy (RT), and systemic therapy given alone or in combination, a significant proportion of patients with brain tumors will experience tumor recurrence. For these patients, no standard of care exists and management of either primary or metastatic recurrent tumors remains challenging.Advances in imaging and RT technology have enabled more precise tumor localization and dose delivery, leading to a reduction in the volume of health brain tissue exposed to high radiation doses. Radiation techniques have evolved from three-dimensional (3-D) conformal RT to the development of sophisticated techniques, including intensity modulated radiation therapy (IMRT), volumetric arc therapy (VMAT), and stereotactic techniques, either stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT). Several studies have suggested that a second course of RT is a feasible treatment option in patients with a recurrent tumor; however, survival benefit and treatment related toxicity of reirradiation, given alone or in combination with other focal or systemic therapies, remain a controversial issue.We provide a critical overview of the current clinical status and technical challenges of reirradiation in patients with both recurrent primary brain tumors, such as gliomas, ependymomas, medulloblastomas, and meningiomas, and brain metastases. Relevant clinical questions such as the appropriate radiation technique and patient selection, the optimal radiation dose and fractionation, tolerance of the brain to a second course of RT, and the risk of adverse radiation effects have been critically discussed.
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Affiliation(s)
- Raffaella De Pietro
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Lucy Zaccaro
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Francesco Marampon
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Paolo Tini
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Francesca De Felice
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Giuseppe Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
- IRCCS Neuromed, Pozzilli (IS), Isernia, Italy.
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11
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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.
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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
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12
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Iannalfi A, Riva G, Ciccone L, Orlandi E. The role of particle radiotherapy in the treatment of skull base tumors. Front Oncol 2023; 13:1161752. [PMID: 37350949 PMCID: PMC10283010 DOI: 10.3389/fonc.2023.1161752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/19/2023] [Indexed: 06/24/2023] Open
Abstract
The skull base is an anatomically and functionally critical area surrounded by vital structures such as the brainstem, the spinal cord, blood vessels, and cranial nerves. Due to this complexity, management of skull base tumors requires a multidisciplinary approach involving a team of specialists such as neurosurgeons, otorhinolaryngologists, radiation oncologists, endocrinologists, and medical oncologists. In the case of pediatric patients, cancer management should be performed by a team of pediatric-trained specialists. Radiation therapy may be used alone or in combination with surgery to treat skull base tumors. There are two main types of radiation therapy: photon therapy and particle therapy. Particle radiotherapy uses charged particles (protons or carbon ions) that, due to their peculiar physical properties, permit precise targeting of the tumor with minimal healthy tissue exposure. These characteristics allow for minimizing the potential long-term effects of radiation exposure in terms of neurocognitive impairments, preserving quality of life, and reducing the risk of radio-induced cancer. For these reasons, in children, adolescents, and young adults, proton therapy should be an elective option when available. In radioresistant tumors such as chordomas and sarcomas and previously irradiated recurrent tumors, particle therapy permits the delivery of high biologically effective doses with low, or however acceptable, toxicity. Carbon ion therapy has peculiar and favorable radiobiological characteristics to overcome radioresistance features. In low-grade tumors, proton therapy should be considered in challenging cases due to tumor volume and involvement of critical neural structures. However, particle radiotherapy is still relatively new, and more research is needed to fully understand its effects. Additionally, the availability of particle therapy is limited as it requires specialized equipment and expertise. The purpose of this manuscript is to review the available literature regarding the role of particle radiotherapy in the treatment of skull base tumors.
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13
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Holtzman AL, Dagan R, Mendenhall WM. Proton Radiotherapy for Skull-Base Malignancies. Oral Maxillofac Surg Clin North Am 2023:S1042-3699(23)00005-5. [PMID: 37005171 DOI: 10.1016/j.coms.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Proton therapy (PT) is a form of highly conformal external-beam radiotherapy used to mitigate acute and late effects following radiotherapy. Indications for treatment include both benign and malignant skull-base and central nervous system pathologies. Studies have demonstrated that PT shows promising results in minimizing neurocognitive decline and reducing second malignancies with low rates of central nervous system necrosis. Future directions and advances in biologic optimization may provide additional benefits beyond the physical properties of particle dosimetry.
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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
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, 2015 North Jefferson Street, Jacksonville, FL 32206, USA
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14
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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.
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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
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15
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Giammattei L, Passeri T, di Russo P, Froelich S. Anterolateral (juxtacondylar) approach with limited mastoidectomy to resect a jugular foramen meningioma. Acta Neurochir (Wien) 2023; 165:1309-1314. [PMID: 36609565 DOI: 10.1007/s00701-022-05482-6] [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: 10/04/2022] [Accepted: 12/27/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND The anterolateral (juxtacondylar) approach with limited mastoidectomy is a suitable option to expose the postero-inferior part of the jugular foramen (JF). It is particularly indicated for tumors extending in the neck beyond the jugular foramen, especially in those cases necessitating both neck control as well as control of the mastoid segment of facial nerve. METHOD We describe here the steps to safely perform an anterolateral approach with mastoidectomy along with a brief description of its indications and limits. CONCLUSION This approach represents a valid option to reach the JF. Its knowledge can improve the process of optimal approach selection when dealing with complex pathology involving the JF.
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Affiliation(s)
- L Giammattei
- Department of Neurosurgery, Lariboisière Hospital, Paris, France.
| | - T Passeri
- Department of Neurosurgery, Lariboisière Hospital, Paris, France
| | - P di Russo
- Department of Neurosurgery, Lariboisière Hospital, Paris, France
| | - S Froelich
- Department of Neurosurgery, Lariboisière Hospital, Paris, France.,University of Paris, Paris, France
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16
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Hopper A, Salans M, Karunamuni R, Hattangadi-Gluth JA. Neurocognitive considerations in the treatment of meningioma with radiation therapy: applications for quantitative neuroimaging and precision radiation medicine. J Neurooncol 2023; 161:277-286. [PMID: 36572802 DOI: 10.1007/s11060-022-04175-5] [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: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 12/27/2022]
Abstract
This article focuses on the role of radiotherapy in the management of meningioma, in the definitive and adjuvant setting and across the spectrum of meningioma grade. Treatment paradigms, informed by clinical evidence, are discussed. Notably, we focus on the impact of radiotherapy on normal brain tissues and neurocognitive function, particularly the dose-dependent changes in white matter and cerebral cortex thickness. Novel imaging techniques have allowed the identification of microstructural changes to eloquent white matter, cortex, and subcortical regions as biomarkers for understanding RT-induced changes in cognitive functioning. Deficits in multiple domains including attention, memory, language and executive function can become more pronounced following radiation. Longitudinal assessment with imaging and neurocognitive testing pre- and post-radiation have allowed correlation between dose to specific regions of the brain and decline in associated domains of neurocognitive function. These findings suggest incorporation of areas at higher risk for neurocognitive sequelae into precision radiation planning. Volumetric arc therapy, advanced planning with cortical sparing, proton therapy and stereotactic radiosurgery are reviewed as options for delivering therapeutic dose to target volumes while minimizing risk to adjacent sensitive regions. The treatment of meningioma is an evolving area, with improving outcomes for higher grade disease in modern trials, where care must be taken to maximize both disease control as well as quality of life for patients.
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Affiliation(s)
- Austin Hopper
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, 9500 Gilman Dr., La Jolla, Mail Code 0861, San Diego, CA, 92093-0861, USA
| | - Mia Salans
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, 9500 Gilman Dr., La Jolla, Mail Code 0861, San Diego, CA, 92093-0861, USA
| | - Roshan Karunamuni
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, 9500 Gilman Dr., La Jolla, Mail Code 0861, San Diego, CA, 92093-0861, USA
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, 9500 Gilman Dr., La Jolla, Mail Code 0861, San Diego, CA, 92093-0861, USA.
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17
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Primary Benign Tumors of the Spinal Canal. World Neurosurg 2022; 164:178-198. [PMID: 35552036 DOI: 10.1016/j.wneu.2022.04.135] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 11/23/2022]
Abstract
Benign tumors that grow in the spinal canal are heterogeneous neoplasms with low incidence; from these, meningiomas and nerve sheath tumors (neurofibromas and schwannomas) account for 60%-70% of all primary spinal tumors. Benign spinal canal tumors provoke nonspecific clinical manifestations, mostly related to the affected level of the spinal cord. These tumors present a challenge for the patient and healthcare professionals, for they are often difficult to diagnose and the high frequency of posttreatment complications. In this review, we describe the epidemiology, risk factors, clinical features, diagnosis, histopathology, molecular biology, and treatment of extramedullary benign meningiomas, osteoid osteomas, osteoblastomas, aneurysmal bone cysts, osteochondromas, neurofibromas, giant cell tumors of the bone, eosinophilic granulomas, hemangiomas, lipomas, and schwannomas located in the spine, as well as possible future targets that could lead to an improvement in their management.
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