Objective Atypical and malignant meningiomas are at high risk for local failure. The role of radiation therapy (RT) and dose levels required to improve tumor control are poorly defined. This study reviews our experience with RT.
Material and methods Thirty-one patients underwent fractionated RT for atypical (AM, 15 patients) or malignant meningioma (MM, 16 patients) of the cranium. Sixteen patients presented with primary and 15 with recurrent disease. Eight patients received RT following total resection, 21 patients after subtotal resection and 2 patient following biopsy only. RT was given using megavoltage photons in 15 patients and combined photons and 160 MeV protons in 16 patients. Total target doses ranged from 50 to 68 (AM, mean 62) and from 40 to 72 (MM, mean 58) Gy or CGE (= cobalt-gray-equivalent).
Results With mean observation time of 59 months (range: 7–155 months) actuarial local control rates at 5- and 8-years were similar for both histologies (38% and 19% for AM and 52 and 17% for MM). However, significantly improved local control was observed for proton versus photon RT (80% versus 17% at 5 years, p = 0.003) and target doses ≥60 Gy for both, atypical (p = 0.025) and malignant meningioma (p = 0.0006).
At time of analysis, 14/15 patients (93%) with AM and 6/16 (38%) with MM were alive. Three patients (19%) with MM developed distant metastasis. Actuarial 5- and 8-year survival rates for MM were significantly improved by use of proton over photon RT and radiation doses ≥60 CGE. Three patients developed symptomatic radiation damage after 59.3, 68.4 and 72 Gy/CGE.
Conclusion Conformal, high dose RT resulted in significant improvement of local control for atypical and malignant meningiomas. Increased local control resulted also in improved rates of survival for patients with malignant meningioma.
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Quest DO: Meningiomas: an update. Neurosurgery 3: 219-225, 1978
Solan MJ, Kramer S: The role of radiation therapy in the management of intracranial meningiomas. Int J Radiat Oncol Biol Phys 11: 675, 1985
Kleihues P, Burger PC, Scheithauer BW: Histological Typing of Tumors of the Central Nervous System. 2nd edn., Geneva: World Health Organization, Springer Verlag, 1993
Zuelch KJ, Mennel HD: Malignant meningiomas. In Advances in Neurosurgery. Klug et al. (eds). Springer Verlag, New York, 2: 3-11, 1975
Zuelch KJ (ed): Histological Typing of Tumors of the Central Nervous System. Geneva: World Health Organization, Springer Verlag, 1979
Jaaskelainen J, Haltia M, Servo A: Atypical and anaplastic meningiomas: radiology, surgery, radiotherapy and outcome. Surg Neurol 25: 233-242, 1986
Mahmood A, Caccamo DV, Tomecek FJ, Malik GM: Atypical and malignant meningiomas: a clinicopathological review. neurosurgery 33: 955-963, 1993
Fabiani A, Trebini F, Favero M, Peres B, Palmucci L: The significance of atypical mitoses in malignant meningioma. Acta Neuropathol (Berlin) 38: 229-231, 1977
Turner OA, Craig WMcK, Kernohan JW: Malignant meningioma: a clinical and pathologic study. Surgery 11: 81-100, 1942
MacCarty CS, Taylor WF: Intracranial meningiomas: experiences at the Mayo Clinic. Neurol Med Chir 19: 569-574, 1979
Al-Mefty O, Kersh JE, Routh A, Smith RR: The long-term side effects of radiation therapy for benign brain tumors in adults. J Neurosurg 73: 502-512, 1990
Alvarez F, Roda JM, Romero MP, Morales C, Sarmiento MA, Blazquez MG: Malignant and atypical meningiomas: re-appraisal of clinical, histological and computer tomographic features. Neurosurgery 20: 688-693, 1978
Kepes JJ: Review of the WHO's new proposed classification of brain tumors. In: Proceedings of the 11th International Congress of Neuropathology, Kyoto, Japan, pp 87-97, 1990
Austin-Seymour M, Munzenrider J, Goitein M, Verhey L, Urie M, Gantry R, Birnbaum S, Ruotolo D, McManus P, Skates S, Ojemann R, Rosenberg A, Schiller A, Koehler A, Suit H: Fractionated proton radiation therapy of chordoma and low-grade chondrosarcoma of the base of skull. J Neurosurg 70: 13-17, 1989
Goitein M, Abrams M: Multidimensional treatment planning: beam's eye view, back projection and projection through CT sections. Int J Radiat Oncol Biol Phys 9: 789-797, 1983
Kaplan EL, Meier P: Nonparametric estimation from incomplete observation. J Am Stat Assoc 53: 547-581, 1958
Cox DR, Oakes N: Analysis of Survival Data. Chapman and Hall, New York, NY, 1988
Harrison MJ, Wolfe DE, Lau TS, Mitnick RJ, Sachdev VP: Radiation-induced meningiomas: experience at the Mount Sinai Hospital and review of the literature. J Neurosurg 75: 564-574, 1991
Modan B, Baidatz D, Mart H, Stinitz R, Levin SG: Radiation induced head and neck tumors. Lancet 1: 277-279, 1974
Mack EE, Wilson CB: Meningiomas induced by high-dose cranial irradiation. J Neurosurg 79: 28-31, 1993
Black PMcL: Meningiomas. Neurosurgery 32: 643-657, 1993
Kepes JJ: Meningiomas: Biology, Pathology, and Differential Diagnosis. Masson, New York, 1982
Goldsmith BJ, Wara WM, Wilson CB, Larson DA: Postoperative irradiation for subtotally resected meningiomas: the UCSF 23 year experience with 140 patients treated from 1967 to 1990. J Neurosurg 80: 195-202, 1994
Carella RJ, Ransohoff J, Newall J: Role of radiation therapy in the management of meningioma. Neurosurgery 10: 332-339, 1982
Forbes AR, Goldberg ID: Radiation therapy in the treatment of meningioma: The Joint Center for Radiation Therapy experience 1970 to 1982. J Clin Oncol 2: 1139, 1984
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Hug, E.B., DeVries, A., Thornton, A.F. et al. Management of Atypical and Malignant Meningiomas: Role of High-dose, 3D-conformal Radiation Therapy. J Neurooncol 48, 151–160 (2000). https://doi.org/10.1023/A:1006434124794
- atypical meningioma
- malignant meningioma
- brain neoplasm
- proton radiation therapy
- charged particle therapy