Antonio Pontoriero1, Paola Critelli2, Alfredo Conti3, Salvatore Cardali4, Filippo Flavio Angileri5, Antonino Germanò5, Sara Lillo1, Alessandro Carretta3, Anna Brogna6, Anna Santacaterina7, Silvana Parisi1, Stefano Pergolizzi1. 1. Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy. 2. Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy. paolacritelli@outlook.com. 3. Department of Neurosurgery, Dipartimento Di Scienze Biomediche E Neuromotorie (DIBINEM), Alma MaterStudiorum University of Bologna, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy. 4. Neurosurgery Unit - A.O. "Papardo", Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy. 5. Neurosurgery Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy. 6. Medical Physics Unit - A.O.U. "G. Martino", Radiotherapy Unit - Messina, University of Messina, Messina, Italy. 7. Radiation Oncology Unit - A.O. "Papardo", University of Messina, Messina, Italy.
Abstract
PURPOSE: The subgroup "high-risk" WHO grade 2 (hRG2) meningiomas may benefit from adjuvant radiation therapy (RT), but results are still suboptimal with high rates of local progression. A dose escalation using high-conformal RT techniques needs to be evaluated in terms of efficacy and safety. We report the results of a dose-escalation study, named "Combo-RT", combining Intensity Modulated Radiotherapy (IMRT) or Volumetric Arc Therapy (VMAT) with Hypofractionated Stereotactic Radiotherapy (hSRT) boost. PATIENTS AND METHODS: From November 2015 to January 2019, we prospectively enrolled 16 patients with hRG2. Seven patients had subtotal resection (STR) and 9 patients had a recurrent tumor. All patients received Combo-RT: LINAC-IMRT/ VMAT on the surgical bed and CyberKnife-hSRT boost on residual/recurrent meningioma Toxicity and initial efficacy were evaluated. RESULTS: The median age was 62 years (range, 31-80 years). The median cumulative dose delivered was 46 Gy For IMRT or VMAT and 15 Gy in 3 fractions at a median isodose line of 77% for hSRT. The median cumulative BED and EQD2 were 108.75 Gy and 72.5 Gy respectively. 3-year-PFS was 75% for the whole cohort,100% for patients with STR, and 55.5% for recurrent patients. Negligible toxicities, and stable or improved symptoms during long-term follow-up were observed. Salvage treatment for recurrence was an independent predictor of treatment failure (P = 0.025). CONCLUSIONS: With the limitation of a small series of patients, our results suggest that a dose escalation for hRG2 meningiomas, using a Combo-RT approach, is safe and particularly effective in the subgroup of patients with STR. Further studies are warranted.
PURPOSE: The subgroup "high-risk" WHO grade 2 (hRG2) meningiomas may benefit from adjuvant radiation therapy (RT), but results are still suboptimal with high rates of local progression. A dose escalation using high-conformal RT techniques needs to be evaluated in terms of efficacy and safety. We report the results of a dose-escalation study, named "Combo-RT", combining Intensity Modulated Radiotherapy (IMRT) or Volumetric Arc Therapy (VMAT) with Hypofractionated Stereotactic Radiotherapy (hSRT) boost. PATIENTS AND METHODS: From November 2015 to January 2019, we prospectively enrolled 16 patients with hRG2. Seven patients had subtotal resection (STR) and 9 patients had a recurrent tumor. All patients received Combo-RT: LINAC-IMRT/ VMAT on the surgical bed and CyberKnife-hSRT boost on residual/recurrent meningioma Toxicity and initial efficacy were evaluated. RESULTS: The median age was 62 years (range, 31-80 years). The median cumulative dose delivered was 46 Gy For IMRT or VMAT and 15 Gy in 3 fractions at a median isodose line of 77% for hSRT. The median cumulative BED and EQD2 were 108.75 Gy and 72.5 Gy respectively. 3-year-PFS was 75% for the whole cohort,100% for patients with STR, and 55.5% for recurrent patients. Negligible toxicities, and stable or improved symptoms during long-term follow-up were observed. Salvage treatment for recurrence was an independent predictor of treatment failure (P = 0.025). CONCLUSIONS: With the limitation of a small series of patients, our results suggest that a dose escalation for hRG2 meningiomas, using a Combo-RT approach, is safe and particularly effective in the subgroup of patients with STR. Further studies are warranted.
Authors: Alfredo Conti; Antonio Pontoriero; Giuseppe Iatì; Felice Esposito; Enrico Nastro Siniscalchi; Salvatore Crimi; Sergio Vinci; Anna Brogna; Francesco De Ponte; Antonino Germanò; Stefano Pergolizzi; Francesco Tomasello Journal: World Neurosurg Date: 2017-04-26 Impact factor: 2.104
Authors: C Leland Rogers; Minhee Won; Michael A Vogelbaum; Arie Perry; Lynn S Ashby; Jignesh M Modi; Anthony M Alleman; James Galvin; Shannon E Fogh; Emad Youssef; Nimisha Deb; Young Kwok; Clifford G Robinson; Hui-Kuo Shu; Barbara J Fisher; Valerie Panet-Raymond; William G McMillan; John F de Groot; Peixin Zhang; Minesh P Mehta Journal: Int J Radiat Oncol Biol Phys Date: 2019-11-29 Impact factor: 7.038
Authors: David N Louis; Arie Perry; Pieter Wesseling; Daniel J Brat; Ian A Cree; Dominique Figarella-Branger; Cynthia Hawkins; H K Ng; Stefan M Pfister; Guido Reifenberger; Riccardo Soffietti; Andreas von Deimling; David W Ellison Journal: Neuro Oncol Date: 2021-08-02 Impact factor: 13.029