Clinical outcome after particle therapy for meningiomas of the skull base: toxicity and local control in patients treated with active rasterscanning
Abstract Background Meningiomas of the skull base account for 25–30% of all meningiomas. Due to the complex structure of the cranial base and its close proximity to critical structures, surgery is often associated with substantial morbidity. Treatment options include observation, aggressive surgical...
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BioMed Central
2018-03-01
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| Series: | Radiation Oncology |
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| Online Access: | http://link.springer.com/article/10.1186/s13014-018-1002-5 |
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doaj-art-d27dd28716614ec28926b41af0c153822018-08-21T10:30:41ZengBioMed CentralRadiation Oncology1748-717X2018-03-0113111110.1186/s13014-018-1002-5Clinical outcome after particle therapy for meningiomas of the skull base: toxicity and local control in patients treated with active rasterscanningRami A. El Shafie0Maja Czech1Kerstin A. Kessel2Daniel Habermehl3Dorothea Weber4Stefan Rieken5Nina Bougatf6Oliver Jäkel7Jürgen Debus8Stephanie E. Combs9Department of Radiation Oncology, University Hospital of HeidelbergDepartment of Radiation Oncology, University Hospital of HeidelbergDepartment of Radiation Oncology, University Hospital of HeidelbergDepartment of Radiation Oncology, University Hospital of HeidelbergInstitute for Medical Biometry and Informatics (IMBI), Heidelberg University HospitalDepartment of Radiation Oncology, University Hospital of HeidelbergDepartment of Radiation Oncology, University Hospital of HeidelbergDeutsches Krebsforschungszentrum (dkfz), Abteilung MedizinphysikDepartment of Radiation Oncology, University Hospital of HeidelbergDepartment of Radiation Oncology, University Hospital of HeidelbergAbstract Background Meningiomas of the skull base account for 25–30% of all meningiomas. Due to the complex structure of the cranial base and its close proximity to critical structures, surgery is often associated with substantial morbidity. Treatment options include observation, aggressive surgical intervention, stereotactic or conventional radiotherapy. In this analysis we evaluate the outcome of 110 patients with meningiomas of the skull base treated with particle therapy. It was performed within the framework of the “clinical research group heavy ion therapy” and supported by the German Research Council (DFG, KFO 214). Methods Between May 2010 and November 2014, 110 Patients with skull base meningioma were treated with particle radiotherapy at the Heidelberg Ion Therapy Center (HIT). Primary localizations included the sphenoid wing (n = 42), petroclival region (n = 23), cavernous sinus (n = 4), sella (n = 10) and olfactory nerve (n = 4). Sixty meningiomas were benign (WHO °I); whereas 8 were high-risk (WHO °II (n = 7) and °III (n = 1)). In 42 cases histology was not examined, since no surgery was performed. Proton (n = 104) or carbon ion (n = 6) radiotherapy was applied at Heidelberg Ion Therapy Center (HIT) using raster-scanning technique for active beam delivery. Fifty one patients (46.4%) received radiotherapy due to tumor progression, 17 (15.5%) after surgical resection and 42 (38.2%) as primary treatment. Results Median follow-up in this analysis was 46,8 months (95% CI 39,9–53,7; Q1-Q3 34,3–61,7). Particle radiotherapy could be performed safely without toxicity-related interruptions. No grade IV or V toxicities according to CTCAE v4.0 were observed. Particle RT offered excellent overall local control rates with 100% progression-free survival (PFS) after 36 months and 96.6% after 60 months. Median PFS was not reached due to the small number of events. Histology significantly impacted PFS with superior PFS after 5 years for low-risk tumors (96.6% vs. 75.0%, p = 0,02). Overall survival was 96.2% after 60 months and 92.0% after 72 months from therapy. Of six documented deaths, five were definitely not and the sixth probably not meningioma-related. Conclusion Particle radiotherapy is an excellent treatment option for patients with meningiomas of the skull base and can lead to long-term tumor control with minimal side effects. Other prospective studies with longer follow-up will be necessary to further confirm the role of particle radiotherapy in skull base meningioma.http://link.springer.com/article/10.1186/s13014-018-1002-5Proton therapyCarbon ion therapyActive raster-scanningSkull baseToxicityQuality of life |
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| format |
Article |
| author |
Rami A. El Shafie Maja Czech Kerstin A. Kessel Daniel Habermehl Dorothea Weber Stefan Rieken Nina Bougatf Oliver Jäkel Jürgen Debus Stephanie E. Combs |
| spellingShingle |
Rami A. El Shafie Maja Czech Kerstin A. Kessel Daniel Habermehl Dorothea Weber Stefan Rieken Nina Bougatf Oliver Jäkel Jürgen Debus Stephanie E. Combs Clinical outcome after particle therapy for meningiomas of the skull base: toxicity and local control in patients treated with active rasterscanning Radiation Oncology Proton therapy Carbon ion therapy Active raster-scanning Skull base Toxicity Quality of life |
| author_facet |
Rami A. El Shafie Maja Czech Kerstin A. Kessel Daniel Habermehl Dorothea Weber Stefan Rieken Nina Bougatf Oliver Jäkel Jürgen Debus Stephanie E. Combs |
| author_sort |
Rami A. El Shafie |
| title |
Clinical outcome after particle therapy for meningiomas of the skull base: toxicity and local control in patients treated with active rasterscanning |
| title_short |
Clinical outcome after particle therapy for meningiomas of the skull base: toxicity and local control in patients treated with active rasterscanning |
| title_full |
Clinical outcome after particle therapy for meningiomas of the skull base: toxicity and local control in patients treated with active rasterscanning |
| title_fullStr |
Clinical outcome after particle therapy for meningiomas of the skull base: toxicity and local control in patients treated with active rasterscanning |
| title_full_unstemmed |
Clinical outcome after particle therapy for meningiomas of the skull base: toxicity and local control in patients treated with active rasterscanning |
| title_sort |
clinical outcome after particle therapy for meningiomas of the skull base: toxicity and local control in patients treated with active rasterscanning |
| publisher |
BioMed Central |
| series |
Radiation Oncology |
| issn |
1748-717X |
| publishDate |
2018-03-01 |
| description |
Abstract Background Meningiomas of the skull base account for 25–30% of all meningiomas. Due to the complex structure of the cranial base and its close proximity to critical structures, surgery is often associated with substantial morbidity. Treatment options include observation, aggressive surgical intervention, stereotactic or conventional radiotherapy. In this analysis we evaluate the outcome of 110 patients with meningiomas of the skull base treated with particle therapy. It was performed within the framework of the “clinical research group heavy ion therapy” and supported by the German Research Council (DFG, KFO 214). Methods Between May 2010 and November 2014, 110 Patients with skull base meningioma were treated with particle radiotherapy at the Heidelberg Ion Therapy Center (HIT). Primary localizations included the sphenoid wing (n = 42), petroclival region (n = 23), cavernous sinus (n = 4), sella (n = 10) and olfactory nerve (n = 4). Sixty meningiomas were benign (WHO °I); whereas 8 were high-risk (WHO °II (n = 7) and °III (n = 1)). In 42 cases histology was not examined, since no surgery was performed. Proton (n = 104) or carbon ion (n = 6) radiotherapy was applied at Heidelberg Ion Therapy Center (HIT) using raster-scanning technique for active beam delivery. Fifty one patients (46.4%) received radiotherapy due to tumor progression, 17 (15.5%) after surgical resection and 42 (38.2%) as primary treatment. Results Median follow-up in this analysis was 46,8 months (95% CI 39,9–53,7; Q1-Q3 34,3–61,7). Particle radiotherapy could be performed safely without toxicity-related interruptions. No grade IV or V toxicities according to CTCAE v4.0 were observed. Particle RT offered excellent overall local control rates with 100% progression-free survival (PFS) after 36 months and 96.6% after 60 months. Median PFS was not reached due to the small number of events. Histology significantly impacted PFS with superior PFS after 5 years for low-risk tumors (96.6% vs. 75.0%, p = 0,02). Overall survival was 96.2% after 60 months and 92.0% after 72 months from therapy. Of six documented deaths, five were definitely not and the sixth probably not meningioma-related. Conclusion Particle radiotherapy is an excellent treatment option for patients with meningiomas of the skull base and can lead to long-term tumor control with minimal side effects. Other prospective studies with longer follow-up will be necessary to further confirm the role of particle radiotherapy in skull base meningioma. |
| topic |
Proton therapy Carbon ion therapy Active raster-scanning Skull base Toxicity Quality of life |
| url |
http://link.springer.com/article/10.1186/s13014-018-1002-5 |
| _version_ |
1612682570715103232 |