Functional outcome of patients with benign meningioma treated by 3D conformal irradiation with a combination of photons and protons.
OBJECTIVE
To evaluate efficacy and tolerance of external fractionated combination of photon and proton radiation therapy (RT) for intracranial benign meningiomas.


METHODS
Between 1994 and 2002, 51 patients with intracranial meningiomas of the base of the skull were treated with a combination of photon and proton RT. Median total dose was 60.6 cobalt Gy equivalent (54-64). One hundred eight eye-related symptoms were collected; 80 other symptoms were noted and followed up.


RESULTS
Mean follow-up was 25.4 months. Acute tolerance was excellent. Out of the 108 eye-related symptoms, 106 (96%) were evaluated. Improvements were reported for 73 (68.8%) of them. Out of the 88 other miscellaneous symptoms, 81 (92%) were evaluated. Improvements were reported in 54 cases (67%). Median time to improvement ranged from 1 to 24 months after completion of the radiotherapy, depending on the symptom. We did not observe any worsening of primary clinical signs. Radiologically, 1 patient relapsed 4 months after the end of irradiation. Pathology revealed a malignant (Grade 3) transformation of the initial Grade 1 meningioma. Four-year local control and overall survival rates were, respectively, 98% and 100%. Stabilization of the tumor was observed in 38 cases (72%), volume reduction in 10 cases (20%), and intratumor necrosis in 3 cases. Two patients complained of Grade 3 side effects: 1 unilateral hearing loss requiring aid and 1 case of complete pituitary deficiency.


CONCLUSIONS
These results stressed the clinical efficacy of fractionated-associated photon-proton RT in the treatment of meningiomas, especially on cranial nerve palsies, without severe toxicity in almost all patients.
Noël
Georges
G
Institut Curie, Orsay, France. noel@ipno.in2p3.fr
Bollet
Marc A
MA
Calugaru
Valentin
V
Feuvret
Loïc
L
Haie-Meder
Christine
C
Dhermain
Frédéric
F
Ferrand
Régis
R
Boisserie
Gilbert
G
Beaudré
Anne
A
Mazeron
Jean-Jacques
JJ
Habrand
Jean-Louis
JL
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D019583:Dose Fractionation, Radiation; D005094:Exophthalmos / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000503:physiopathology / Q000532:radiotherapy*; D008579:Meningioma / Q000503:physiopathology / Q000532:radiotherapy*; D008875:Middle Aged; D017785:Photons / Q000627:therapeutic use*; D061766:Proton Therapy; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D014792:Visual Acuity; D011522:Protons
D011522:Protons