Table 2.
Recent proton therapy studies for meningioma in adult patients
| Author [ref] | year | Tumor type | # patients | Median Dose (GyRBE) (Range) |
Median FU (months) (range) |
Proton Therapy only |
PBS only | Outcome | Positive prognostic factors [Univariate analysis] |
Toxicity |
|---|---|---|---|---|---|---|---|---|---|---|
| Halasz et al.39 | 2011 | Menigioma WHO Grade 1–2 |
n = 50 Grade 1: n = 12 (24%) Grade 2: n = 6 (12%) Grade not known: n = 32 (64%) |
13 (10–15.5) in one fraction | 32 (6–133) | yes | Scattering (stereotactic) |
3y-LC: 94% |
WHO Grade one vs atypical histology (p = 0.03) Recurrent vs non-recurrent meningioma (p = 0.006) |
Acute Transient facial pain 4% Late Seizures associated with cerebral edema 12% Panhypopituitarism 2% |
| Weber et al.40 | 2012 | Menigioma WHO Grade 1–3 |
n = 39 (three re-irradiation) |
Grade 1–2: 52.2–56 Grade 3: 60.8 (±5.3) |
54.8 (6.2–146.8) | yes | yes |
5y-LC: Grad1: 100% Grade 2–3: 49.1% |
WHO Grade 1 vs 2/3 (p = 0.001) GTV < 21.5 vs.>=21.5 ml (p = 0.03) |
CTCA Acute: Grade 2: 12.5% Grade 3: 0% Late: Grade ≥ 3: 12.8% |
| Slater et al.41 | 2012 | Meningioma Grade 1–2 | Entire cohort n = 72 Grade 1: n = 47 (65%) Grade 2: n = 4 (6%) Grade not known: 21 (29%) |
Grade 1: 50.4–66.6 Grade 2: 54–70.2 |
74 (3–183) | yes | Scattering |
5y-LC Overall: 96% Grade 1: 99% Grade 2: 50% 5y-OS 99% (disease-specific) |
No significant differences for tumor size (GTV), dose, number of surgeries and WHO Grad | optic neurologic symptoms: 4.2% brain edema: 2.8% Transient diplopia 1.4% Panhypopituitarism 4.2% |
| Combs et al.42 | 2013 | Meningioma WHO Grade 1–3 | Entire cohort n = 107 WHO Grade 1: 71 (66%) WHO Grad 2/3: n = 36 (34%) |
Grade 1: 57.6 Grade 2/3: N.R. |
12 (2–39) | Grade 1: PT only Grade2/3: photons/carbon ion boost |
Grade 1. Yes Grade 2/3: combination of photon/carbon |
2y-LC: Grade 1: 100% Grade 2/3: 33% |
N.R. | N.R. |
| McDonald et al.38 | 2015 | Meningioma WHO Grade 2 |
n = 22 | 63 (54–68.4) | 39 (7–104) | yes | N.R. | 5y-LC: 71.1% | Dose > 60 Gy vs =<60 Gy (RBE) (p = 0.038) |
Acute ≥Grade III: 0% Late ≥Grade III: one pt. |
| Vlachogiannis et al.43 | 2017 | Meningioma WHO Grade 1 | n = 170 | 21.9 (14–46) 2–6 Gy/fx |
84 (range N.R) | yes | Scattering (stereotactic) |
5y-PFS: 93% 10y-PFS: 85% |
Multivariate analysis: Age: p = 0.009 Localization: middle fossa p = 0.04 |
Pituitary insuffiency: 3.5% Radiation necrosis: 2.9% Visual impairment: 2.9% Expansive tumour cyst: 0.5% |
| Murray et al.44 | 2018 | Menigioma WHO Grad 1–3 |
Entire cohort: n = 96 Grade 1: n = 61 (63%) Grade 2: n = 33 (34.1%) Grade 3: 2 (2.1%) |
Grade I: 54 (50.4–64) Grade II and II: 62 (54-68) |
56.9 (range, 12–207) |
Yes | Yes |
5y-LC: Entire cohort: 86,4% Grade 1: 95.7% Grade 2/3: 68% 5y-OS: entire cohort: 88.2% Grade 1: 92.1% Grad 2/3: 80.7% |
5y-LC WHO Grade 1 vs 2/3 (p < .001) Timing of PT: Initial vs recurrent (p = .006) Tumor site: Skull base vs non-skull base (p = 0.014) Gender: Female vs Male (p = 0.32) 5y-OS |
CTCA Acute ≥Grade III: 0.96% Late ≥Grade III overall: 10% optic toxicity: 6.7% brain edema: 0.96% brain necrosis: 1.9% |
| El Shafie et al.45 | 2018 | Meningioma WHO Grade 1–3 | Entire cohort: n = 110 Grade 1: 60 Grade 2: 7 Grade 3: 1 not known:42 |
Protons: 54 (50-60); 1.8–2.0/fx Carbon ion: 18; 3.0/fx |
46.8 (95%CI: 39,9–53.7) | Proton: n = 104 Photons/Carbon ion: n = 6 |
Yes Grade 2/3: combination of photon/carbon |
5y-PFS: Entire cohort: 96.6% Low risk: 96.6% High risk: 75%, 5y-OS: 96.2 % |
Histology: low vs high risk : p = 0.02 | CTCAE Acute: Grade III: 1.8% (mucositis, nausea) Late: Grade III:3.6% (hypopituitarism, radionecrosis) |
FU, follow-up; LC, local control; NR, not reported; OS, overall survival; PBT, proton beam therapy; PFS, progression free survival; fx, fraction.