Prospective, Randomized Study of Radiation Dose Escalation With Combined Proton-Photon Therapy for Benign Meningiomas
To assess the outcomes of benign meningiomas (BM) treated to two radiation dose levels. We randomly assigned patients (1:1) with incompletely resected or recurrent BM to 2 radiation doses: 55.8 Gy(relative biological effectiveness [RBE]) and 63.0 Gy(RBE) of fractionated combined proton–photon radiat...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2017-11, Vol.99 (4), p.787-796 |
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| container_title | International journal of radiation oncology, biology, physics |
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| creator | Sanford, Nina N. Yeap, Beow Y. Larvie, Mykol Daartz, Juliane Munzenrider, John E. Liebsch, Norbert J. Fullerton, Barbara Pan, Elizabeth Loeffler, Jay S. Shih, Helen A. |
| description | To assess the outcomes of benign meningiomas (BM) treated to two radiation dose levels.
We randomly assigned patients (1:1) with incompletely resected or recurrent BM to 2 radiation doses: 55.8 Gy(relative biological effectiveness [RBE]) and 63.0 Gy(RBE) of fractionated combined proton–photon radiation therapy. The primary endpoint was local control with hypothesis of improved tumor control with higher dose. Secondary endpoints included progression-free survival, overall survival, and rates of treatment-related toxicities.
Between 1991 and 2000, 47 patients were randomized. Three patients were excluded for nonbenign histology; therefore, 44 patients were analyzed: 22 who received 55.8 Gy(RBE) and 22 who received 63.0 Gy(RBE). The median follow-up was 17.1 years. Local control for the entire cohort was 98% at 10 years and 90% at 15 years. Of the 5 patients with local recurrence, 4 occurred after 10 years of follow-up, and 3 were in the lower dose group (P=.322). In the modified intention to treat analysis, there was no difference in progression-free survival (P=.234) and overall survival (P=.271) between arms. A total of 26 patients (59%) experienced a grade 2 or higher late toxicity, including 9 patients (20%) incurring a cerebrovascular accident (CVA), 7 of which were deemed at least possibly attributable to irradiation. The median time between completion of radiation therapy and CVA was 5.6 years (range, 1.4-14.0 years).
Fractionated combined proton–photon radiation therapy is effective for BM, with no apparent benefit in dose escalation. Further investigation is needed to better define the risk of late toxicities, including CVA after cranial radiation therapy. |
| doi_str_mv | 10.1016/j.ijrobp.2017.07.008 |
| format | Article |
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We randomly assigned patients (1:1) with incompletely resected or recurrent BM to 2 radiation doses: 55.8 Gy(relative biological effectiveness [RBE]) and 63.0 Gy(RBE) of fractionated combined proton–photon radiation therapy. The primary endpoint was local control with hypothesis of improved tumor control with higher dose. Secondary endpoints included progression-free survival, overall survival, and rates of treatment-related toxicities.
Between 1991 and 2000, 47 patients were randomized. Three patients were excluded for nonbenign histology; therefore, 44 patients were analyzed: 22 who received 55.8 Gy(RBE) and 22 who received 63.0 Gy(RBE). The median follow-up was 17.1 years. Local control for the entire cohort was 98% at 10 years and 90% at 15 years. Of the 5 patients with local recurrence, 4 occurred after 10 years of follow-up, and 3 were in the lower dose group (P=.322). In the modified intention to treat analysis, there was no difference in progression-free survival (P=.234) and overall survival (P=.271) between arms. A total of 26 patients (59%) experienced a grade 2 or higher late toxicity, including 9 patients (20%) incurring a cerebrovascular accident (CVA), 7 of which were deemed at least possibly attributable to irradiation. The median time between completion of radiation therapy and CVA was 5.6 years (range, 1.4-14.0 years).
Fractionated combined proton–photon radiation therapy is effective for BM, with no apparent benefit in dose escalation. Further investigation is needed to better define the risk of late toxicities, including CVA after cranial radiation therapy.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2017.07.008</identifier><identifier>PMID: 28865924</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Disease-Free Survival ; Dose Fractionation, Radiation ; Female ; Follow-Up Studies ; Humans ; Intention to Treat Analysis - methods ; Male ; Meningeal Neoplasms - diagnostic imaging ; Meningeal Neoplasms - mortality ; Meningeal Neoplasms - radiotherapy ; Meningioma - diagnostic imaging ; Meningioma - mortality ; Meningioma - radiotherapy ; Middle Aged ; Neoplasm Recurrence, Local - radiotherapy ; Photons - adverse effects ; Photons - therapeutic use ; Prospective Studies ; Proton Therapy - adverse effects ; Proton Therapy - methods ; Radiotherapy, Intensity-Modulated ; Relative Biological Effectiveness ; Stroke - etiology ; Time Factors</subject><ispartof>International journal of radiation oncology, biology, physics, 2017-11, Vol.99 (4), p.787-796</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c463t-e06213d2624bd5147d26e0bd32d5266923afe83c030beea137af62f7489ce4f03</citedby><cites>FETCH-LOGICAL-c463t-e06213d2624bd5147d26e0bd32d5266923afe83c030beea137af62f7489ce4f03</cites><orcidid>0000-0003-4235-3624</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijrobp.2017.07.008$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28865924$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sanford, Nina N.</creatorcontrib><creatorcontrib>Yeap, Beow Y.</creatorcontrib><creatorcontrib>Larvie, Mykol</creatorcontrib><creatorcontrib>Daartz, Juliane</creatorcontrib><creatorcontrib>Munzenrider, John E.</creatorcontrib><creatorcontrib>Liebsch, Norbert J.</creatorcontrib><creatorcontrib>Fullerton, Barbara</creatorcontrib><creatorcontrib>Pan, Elizabeth</creatorcontrib><creatorcontrib>Loeffler, Jay S.</creatorcontrib><creatorcontrib>Shih, Helen A.</creatorcontrib><title>Prospective, Randomized Study of Radiation Dose Escalation With Combined Proton-Photon Therapy for Benign Meningiomas</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>To assess the outcomes of benign meningiomas (BM) treated to two radiation dose levels.
We randomly assigned patients (1:1) with incompletely resected or recurrent BM to 2 radiation doses: 55.8 Gy(relative biological effectiveness [RBE]) and 63.0 Gy(RBE) of fractionated combined proton–photon radiation therapy. The primary endpoint was local control with hypothesis of improved tumor control with higher dose. Secondary endpoints included progression-free survival, overall survival, and rates of treatment-related toxicities.
Between 1991 and 2000, 47 patients were randomized. Three patients were excluded for nonbenign histology; therefore, 44 patients were analyzed: 22 who received 55.8 Gy(RBE) and 22 who received 63.0 Gy(RBE). The median follow-up was 17.1 years. Local control for the entire cohort was 98% at 10 years and 90% at 15 years. Of the 5 patients with local recurrence, 4 occurred after 10 years of follow-up, and 3 were in the lower dose group (P=.322). In the modified intention to treat analysis, there was no difference in progression-free survival (P=.234) and overall survival (P=.271) between arms. A total of 26 patients (59%) experienced a grade 2 or higher late toxicity, including 9 patients (20%) incurring a cerebrovascular accident (CVA), 7 of which were deemed at least possibly attributable to irradiation. The median time between completion of radiation therapy and CVA was 5.6 years (range, 1.4-14.0 years).
Fractionated combined proton–photon radiation therapy is effective for BM, with no apparent benefit in dose escalation. Further investigation is needed to better define the risk of late toxicities, including CVA after cranial radiation therapy.</description><subject>Adult</subject><subject>Aged</subject><subject>Disease-Free Survival</subject><subject>Dose Fractionation, Radiation</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Intention to Treat Analysis - methods</subject><subject>Male</subject><subject>Meningeal Neoplasms - diagnostic imaging</subject><subject>Meningeal Neoplasms - mortality</subject><subject>Meningeal Neoplasms - radiotherapy</subject><subject>Meningioma - diagnostic imaging</subject><subject>Meningioma - mortality</subject><subject>Meningioma - radiotherapy</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - radiotherapy</subject><subject>Photons - adverse effects</subject><subject>Photons - therapeutic use</subject><subject>Prospective Studies</subject><subject>Proton Therapy - adverse effects</subject><subject>Proton Therapy - methods</subject><subject>Radiotherapy, Intensity-Modulated</subject><subject>Relative Biological Effectiveness</subject><subject>Stroke - etiology</subject><subject>Time Factors</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UdtuEzEQtRCIpoU_QMgfwIbxZb2bFyQILSAVUUERvFleezZxlLVX9iZS-Po6ChR4qTTS8Yx9zoznEPKCwZwBU683c79JsRvnHFgzhxLQPiIz1jaLStT1z8dkBkJBJcrjM3Ke8wYAGGvkU3LG21bVCy5nZHeTYh7RTn6Pr-hXE1wc_C909Nu0cwca-1Jz3kw-Bvo-ZqSX2ZrtKf_hpzVdxqHzoRCK0BRDdbM-Ar1dYzLjgfYx0XcY_CrQzwXCysfB5GfkSW-2GZ__xgvy_erydvmxuv7y4dPy7XVlpRJThaA4E44rLjtXM9mUI0LnBHc1V2rBhemxFRYEdIiGicb0iveNbBcWZQ_igrw56Y67bkBnMUzJbPWY_GDSQUfj9f83wa_1Ku51rWqpVFME5EnAljXlhP09l4E-2qA3-mSDPtqgoQS0hfby3773pD97_zsYlt_vPSadrcdg0flUzNAu-oc73AGy7p5k</recordid><startdate>20171115</startdate><enddate>20171115</enddate><creator>Sanford, Nina N.</creator><creator>Yeap, Beow Y.</creator><creator>Larvie, Mykol</creator><creator>Daartz, Juliane</creator><creator>Munzenrider, John E.</creator><creator>Liebsch, Norbert J.</creator><creator>Fullerton, Barbara</creator><creator>Pan, Elizabeth</creator><creator>Loeffler, Jay S.</creator><creator>Shih, Helen A.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4235-3624</orcidid></search><sort><creationdate>20171115</creationdate><title>Prospective, Randomized Study of Radiation Dose Escalation With Combined Proton-Photon Therapy for Benign Meningiomas</title><author>Sanford, Nina N. ; Yeap, Beow Y. ; Larvie, Mykol ; Daartz, Juliane ; Munzenrider, John E. ; Liebsch, Norbert J. ; Fullerton, Barbara ; Pan, Elizabeth ; Loeffler, Jay S. ; Shih, Helen A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c463t-e06213d2624bd5147d26e0bd32d5266923afe83c030beea137af62f7489ce4f03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Disease-Free Survival</topic><topic>Dose Fractionation, Radiation</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Intention to Treat Analysis - methods</topic><topic>Male</topic><topic>Meningeal Neoplasms - diagnostic imaging</topic><topic>Meningeal Neoplasms - mortality</topic><topic>Meningeal Neoplasms - radiotherapy</topic><topic>Meningioma - diagnostic imaging</topic><topic>Meningioma - mortality</topic><topic>Meningioma - radiotherapy</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - radiotherapy</topic><topic>Photons - adverse effects</topic><topic>Photons - therapeutic use</topic><topic>Prospective Studies</topic><topic>Proton Therapy - adverse effects</topic><topic>Proton Therapy - methods</topic><topic>Radiotherapy, Intensity-Modulated</topic><topic>Relative Biological Effectiveness</topic><topic>Stroke - etiology</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sanford, Nina N.</creatorcontrib><creatorcontrib>Yeap, Beow Y.</creatorcontrib><creatorcontrib>Larvie, Mykol</creatorcontrib><creatorcontrib>Daartz, Juliane</creatorcontrib><creatorcontrib>Munzenrider, John E.</creatorcontrib><creatorcontrib>Liebsch, Norbert J.</creatorcontrib><creatorcontrib>Fullerton, Barbara</creatorcontrib><creatorcontrib>Pan, Elizabeth</creatorcontrib><creatorcontrib>Loeffler, Jay S.</creatorcontrib><creatorcontrib>Shih, Helen A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sanford, Nina N.</au><au>Yeap, Beow Y.</au><au>Larvie, Mykol</au><au>Daartz, Juliane</au><au>Munzenrider, John E.</au><au>Liebsch, Norbert J.</au><au>Fullerton, Barbara</au><au>Pan, Elizabeth</au><au>Loeffler, Jay S.</au><au>Shih, Helen A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prospective, Randomized Study of Radiation Dose Escalation With Combined Proton-Photon Therapy for Benign Meningiomas</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2017-11-15</date><risdate>2017</risdate><volume>99</volume><issue>4</issue><spage>787</spage><epage>796</epage><pages>787-796</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>To assess the outcomes of benign meningiomas (BM) treated to two radiation dose levels.
We randomly assigned patients (1:1) with incompletely resected or recurrent BM to 2 radiation doses: 55.8 Gy(relative biological effectiveness [RBE]) and 63.0 Gy(RBE) of fractionated combined proton–photon radiation therapy. The primary endpoint was local control with hypothesis of improved tumor control with higher dose. Secondary endpoints included progression-free survival, overall survival, and rates of treatment-related toxicities.
Between 1991 and 2000, 47 patients were randomized. Three patients were excluded for nonbenign histology; therefore, 44 patients were analyzed: 22 who received 55.8 Gy(RBE) and 22 who received 63.0 Gy(RBE). The median follow-up was 17.1 years. Local control for the entire cohort was 98% at 10 years and 90% at 15 years. Of the 5 patients with local recurrence, 4 occurred after 10 years of follow-up, and 3 were in the lower dose group (P=.322). In the modified intention to treat analysis, there was no difference in progression-free survival (P=.234) and overall survival (P=.271) between arms. A total of 26 patients (59%) experienced a grade 2 or higher late toxicity, including 9 patients (20%) incurring a cerebrovascular accident (CVA), 7 of which were deemed at least possibly attributable to irradiation. The median time between completion of radiation therapy and CVA was 5.6 years (range, 1.4-14.0 years).
Fractionated combined proton–photon radiation therapy is effective for BM, with no apparent benefit in dose escalation. Further investigation is needed to better define the risk of late toxicities, including CVA after cranial radiation therapy.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28865924</pmid><doi>10.1016/j.ijrobp.2017.07.008</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-4235-3624</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Adult Aged Disease-Free Survival Dose Fractionation, Radiation Female Follow-Up Studies Humans Intention to Treat Analysis - methods Male Meningeal Neoplasms - diagnostic imaging Meningeal Neoplasms - mortality Meningeal Neoplasms - radiotherapy Meningioma - diagnostic imaging Meningioma - mortality Meningioma - radiotherapy Middle Aged Neoplasm Recurrence, Local - radiotherapy Photons - adverse effects Photons - therapeutic use Prospective Studies Proton Therapy - adverse effects Proton Therapy - methods Radiotherapy, Intensity-Modulated Relative Biological Effectiveness Stroke - etiology Time Factors |
| title | Prospective, Randomized Study of Radiation Dose Escalation With Combined Proton-Photon Therapy for Benign Meningiomas |
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