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The “Combo” radiotherapy treatment for high-risk grade 2 meningiomas: dose escalation and initial safety and efficacy analysis

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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.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Author notes

  1. Antonio Pontoriero, Paola Critelli and Alfredo Conti have contributed equally to this study.

Authors and Affiliations

  1. Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy

    Antonio Pontoriero, Paola Critelli, Sara Lillo, Silvana Parisi & Stefano Pergolizzi

  2. Department of Neurosurgery, Dipartimento Di Scienze Biomediche E Neuromotorie (DIBINEM), Alma MaterStudiorum University of Bologna, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy

    Alfredo Conti & Alessandro Carretta

  3. Neurosurgery Unit – A.O. “Papardo”, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy

    Salvatore Cardali

  4. Neurosurgery Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy

    Filippo Flavio Angileri & Antonino Germanò

  5. Medical Physics Unit - A.O.U. “G. Martino”, Radiotherapy Unit - Messina, University of Messina, Messina, Italy

    Anna Brogna

  6. Radiation Oncology Unit – A.O. “Papardo”, University of Messina, Messina, Italy

    Anna Santacaterina

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  1. Antonio Pontoriero
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Contributions

Conceptualization, Methodology, Project administration, Visualization, Writing—original draft. Validation. Data curation [AP], Data curation, Visualization, Writing—original draft. Formal analysis, Investigation, Validation [PC], Conceptualization, Methodology, Project administration, Supervision, Writing—review & editing [AC], Validation [SC], Validation [FFA], Validation, Supervision [AG], Data curation [SL], Formal analysis, Investigation, Validation [AC], Data curation [AB], Validation [AS], Validation [SP],Supervision, Writing—review & editing [SP].

Corresponding author

Correspondence to Paola Critelli.

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The authors declare no conflict of interest.

Ethical approval

The study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) of “A.O.U. G. Martino” Messina-Italy University Hospital (IRB number: 5321).

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Informed consent was obtained from all subjects involved in the study. Written informed consent has been obtained from the patient(s) to publish this paper.

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Pontoriero, A., Critelli, P., Conti, A. et al. The “Combo” radiotherapy treatment for high-risk grade 2 meningiomas: dose escalation and initial safety and efficacy analysis. J Neurooncol 161, 203–214 (2023). https://doi.org/10.1007/s11060-022-04107-3

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