title: Fractionated proton radiotherapy for benign cavernous sinus meningiomas.
abstract: OBJECTIVE
  To evaluate the efficacy of fractionated proton radiotherapy for a population of patients with benign cavernous sinus meningiomas.
  
  
  METHODS
  Between 1991 and 2002, 72 patients were treated at Loma Linda University Medical Center with proton therapy for cavernous sinus meningiomas. Fifty-one patients had biopsy or subtotal resection; 47 had World Health Organization grade 1 pathology. Twenty-one patients had no histologic verification. Twenty-two patients received primary proton therapy; 30 had 1 previous surgery; 20 had more than 1 surgery. The mean gross tumor volume was 27.6 cm(3); mean clinical target volume was 52.9 cm(3). Median total doses for patients with and without histologic verification were 59 and 57 Gy, respectively. Mean and median follow-up periods were 74 months.
  
  
  RESULTS
  The overall 5-year actuarial control rate was 96%; the control rate was 99% in patients with grade 1 or absent histologic findings and 50% for those with atypical histology. All 21 patients who did not have histologic verification and 46 of 47 patients with histologic confirmation of grade 1 tumor demonstrated disease control at 5 years. Control rates for patients without previous surgery, 1 surgery, and 2 or more surgeries were 95%, 96%, and 95%, respectively.
  
  
  CONCLUSIONS
  Fractionated proton radiotherapy for grade 1 cavernous sinus meningiomas achieves excellent control rates with minimal toxicities, regardless of surgical intervention or use of histologic diagnosis. Disease control for large lesions can be achieved by primary fractionated proton therapy.
authors: Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA. jdslater@dominion.llumc.edu
authors: Jerry D
authors: JD
authors: Slater
authors: Lilia N
authors: LN
authors: Loredo
authors: Arthur
authors: A
authors: Chung
authors: David A
authors: DA
authors: Bush
authors: Baldev
authors: B
authors: Patyal
authors: Walter D
authors: WD
authors: Johnson
authors: Frank P K
authors: FP
authors: Hsu
authors: James M
authors: JM
authors: Slater
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002426:Cavernous Sinus; D002648:Child; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008579:Meningioma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D061766:Proton Therapy; D011522:Protons / Q000009:adverse effects; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D011522:Protons