Jacob S Witt1, Hima B Musunuru1, R Adam Bayliss2, Steven P Howard3. 1. Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA. 2. Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 3. Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA. Howard@humonc.wisc.edu.
Abstract
PURPOSE: Meningiomas comprise up to 30% of primary brain tumors. The majority of meningioma patients enjoy high rates of control after conventional therapies. However, patients with recurrent disease previously treated with radiotherapy have few options for salvage treatment, and systemic interventions have proven largely ineffective. The aim of this study was to determine whether pulsed reduced dose rate radiotherapy (PRDR) was well tolerated in a small cohort of patients with recurrent meningioma. METHODS: We retrospectively identified eight patients with recurrent intracranial meningioma treated with PRDR from April 2013 to August of 2017 at a single institution. All patients had radiographic and/or pathologic evidence of progression prior to treatment and had previously completed conventional radiotherapy. Acute and late toxicities were graded based on CTCAE 4.0. RESULTS: Of eight patients, six had histologically confirmed atypical meningiomas upon recurrence. All patients were re-treated with IMRT at an apparent dose rate of 0.0667 Gy/min. Median time between radiation courses was 7.7 years. Median PRDR dose was 54 Gy in 27 fractions to a median volume of 261.6 cm3. Two patients (25%) had in field failure with a median follow up of 23.3 months. PFS at 6 months was 100%. All but one (87.5%) patient was still alive at last follow up. No patient experienced grade ≥ 2 acute or late toxicities. CONCLUSIONS: PRDR re-irradiation was well tolerated and appeared effective for a small cohort of patients with recurrent meningioma previously treated with radiotherapy. A phase II trial to assess this prospectively is in development.
PURPOSE:Meningiomas comprise up to 30% of primary brain tumors. The majority of meningiomapatients enjoy high rates of control after conventional therapies. However, patients with recurrent disease previously treated with radiotherapy have few options for salvage treatment, and systemic interventions have proven largely ineffective. The aim of this study was to determine whether pulsed reduced dose rate radiotherapy (PRDR) was well tolerated in a small cohort of patients with recurrent meningioma. METHODS: We retrospectively identified eight patients with recurrent intracranial meningioma treated with PRDR from April 2013 to August of 2017 at a single institution. All patients had radiographic and/or pathologic evidence of progression prior to treatment and had previously completed conventional radiotherapy. Acute and late toxicities were graded based on CTCAE 4.0. RESULTS: Of eight patients, six had histologically confirmed atypical meningiomas upon recurrence. All patients were re-treated with IMRT at an apparent dose rate of 0.0667 Gy/min. Median time between radiation courses was 7.7 years. Median PRDR dose was 54 Gy in 27 fractions to a median volume of 261.6 cm3. Two patients (25%) had in field failure with a median follow up of 23.3 months. PFS at 6 months was 100%. All but one (87.5%) patient was still alive at last follow up. No patient experienced grade ≥ 2 acute or late toxicities. CONCLUSIONS: PRDR re-irradiation was well tolerated and appeared effective for a small cohort of patients with recurrent meningioma previously treated with radiotherapy. A phase II trial to assess this prospectively is in development.
Authors: Tugce Kutuk; Ranjini Tolakanahalli; Nicole C McAllister; Matthew D Hall; Martin C Tom; Muni Rubens; Haley Appel; Alonso N Gutierrez; Yazmin Odia; Alexander Mohler; Manmeet S Ahluwalia; Minesh P Mehta; Rupesh Kotecha Journal: Cancers (Basel) Date: 2022-06-15 Impact factor: 6.575
Authors: Farshad Nassiri; Justin Z Wang; Karolyn Au; Jill Barnholtz-Sloan; Michael D Jenkinson; Kate Drummond; Yueren Zhou; James M Snyder; Priscilla Brastianos; Thomas Santarius; Suganth Suppiah; Laila Poisson; Francesco Gaillard; Mark Rosenthal; Timothy Kaufmann; Derek S Tsang; Kenneth Aldape; Gelareh Zadeh Journal: Neuro Oncol Date: 2022-05-04 Impact factor: 13.029
Authors: Adam R Burr; Henry Ian Robins; Robert Adam Bayliss; Andrew M Baschnagel; James S Welsh; Wolfgang A Tomé; Steven P Howard Journal: Adv Radiat Oncol Date: 2020-07-08