title: Prospective evaluation of early treatment outcome in patients with meningiomas treated with particle therapy based on target volume definition with MRI and 68Ga-DOTATOC-PET.
abstract: OBJECTIVE
  To evaluate early treatment results and toxicity in patients with meningiomas treated with particle therapy.
  
  
  METHODS
  Seventy patients with meningiomas were treated with protons (n = 38) or carbon ion radiotherapy (n = 26). Median age was 49 years. Median age at treatment was 55 years, 24 were male (34%), and 46 were female (66%). Histology was benign meningioma in 26 patients (37%), atypical in 23 patients (33%) and anaplastic in four patients (6%). In 17 patients (24%) with skull base meningiomas diagnosis was based on the typical appearance of a meningioma. For benign meningiomas, total doses of 52.2-57.6 GyE were applied with protons. For high-grade lesions, the boost volume was 18 GyE carbon ions, with a median dose of 50 GyE applied as highly conformal radiation therapy. Nineteen patients were treated as re-irradiation. Treatment planning with MRI and 68-Ga-DOTATOC-PET was evaluated.
  
  
  RESULTS
  Very low rates of side effects developed, including headaches, nausea and dizziness. No severe treatment-related toxicity was observed. Local control for benign meningiomas was 100%. Five of 27 patients (19%) developed tumor recurrence during follow-up. Of these, four patients had been treated as re-irradiation for recurrent high-risk meningiomas. Actuarial local control after re-irradiation of high-risk meningiomas was therefore 67% at six and 12 months. In patients treated with primary radiotherapy, only one of 13 patients (8%) developed tumor recurrence 17 months after radiation therapy (photon and carbon ion boost).
  
  
  CONCLUSIONS
  Continuous prospective follow-up and development of novel study concepts are required to fully exploit the long-term clinical data after particle therapy for meningiomas. To date, it may be concluded that when proton therapy is available, meningioma patients can be offered a treatment at least comparable to high-end photon therapy.
authors: Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany.
authors: Stephanie E
authors: SE
authors: Combs
authors: Thomas
authors: T
authors: Welzel
authors: Daniel
authors: D
authors: Habermehl
authors: Stefan
authors: S
authors: Rieken
authors: Jan-Oliver
authors: JO
authors: Dittmar
authors: Kerstin
authors: K
authors: Kessel
authors: Oliver
authors: O
authors: Jäkel
authors: Uwe
authors: U
authors: Haberkorn
authors: Jürgen
authors: J
authors: Debus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D063193:Heavy Ion Radiotherapy; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D015282:Octreotide / Q000031:analogs & derivatives; D009942:Organometallic Compounds; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D061766:Proton Therapy; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
chemical_list: C499142:Ga(III)-DOTATOC; D009942:Organometallic Compounds; D015282:Octreotide