title: Pushing the limits of radiotherapy for atypical and malignant meningioma.
abstract: OBJECTIVE
  The purpose of this study was to report the outcome of an extremely aggressive radiotherapy program in patients with atypical and malignant meningioma (60 Gy at 1.5 Gy per fraction twice daily +/- radiosurgery boost).
  
  
  METHODS
  Thirty-six patients received radiotherapy with curative intent between 1984 and 1999 for atypical (27 patients) or malignant (9 patients) meningioma. All patients had a minimum of 2 years follow up.
  
  
  RESULTS
  The overall 5-year local control, cause-specific survival, and absolute survival rates were 45%, 39%, and 36%, respectively. Accelerated hyperfractionated radiotherapy resulted in a local control rate of 45% compared with 50% for patients treated with less aggressive schedules (P = 0.99). A radiosurgery boost did not improve tumor control. The complication rate for those treated with accelerated hyperfractionated radiotherapy was dramatically higher (grade 3-5: 55% vs. 0%, grade 4-5: 27% vs. 0%. both P <0.05).
  
  
  CONCLUSIONS
  Our data suggests that 50 to 60 Gy delivered with conventional, once-daily fractionation is probably the optimal schedule for atypical and malignant meningioma. More aggressive radiotherapy fractionation schedules and radiosurgery are unlikely to improve outcome.
authors.affiliation: Departments of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.
authors.forename: Teri S
authors.initials: TS
authors.lastname: Katz
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Amdur
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Yachnis
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000532:radiotherapy*; D008579:Meningioma / Q000532:radiotherapy*; D008875:Middle Aged; D016634:Radiosurgery; D015996:Survival Rate