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Proton therapy for intracranial meningioma: a single-institution retrospective analysis of efficacy, survival and toxicity outcomes

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Abstract

Purpose

To report the outcomes of a large series of intracranial meningiomas (IMs) submitted to proton therapy (PT) with curative intent.

Methods

We conducted a retrospective analysis on all consecutive IM patients treated between 2014 and 2021. The median PT prescription dose was 55.8 Gy relative biological effectiveness (RBE) and 66 GyRBE for benign/radiologically diagnosed and atypical/anaplastic IMs, respectively. Local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), overall survival (OS), and radionecrosis-free survival (RNFS) were evaluated with the Kaplan-Meier method. Univariable analysis was performed to identify potential prognostic factors for clinical outcomes. Toxicity was reported according to the latest Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

Results

Overall, 167 patients were included. With a median follow-up of 41 months (range, 6–99), twelve patients (7%) developed tumor local recurrence after a median time of 39 months. The 5-year LRFS was 88% for the entire cohort, with a significant difference between benign/radiologically diagnosed and atypical/anaplastic IMs (98% vs. 47%, p < 0.001); this significant difference was maintained also for the 5-year OS and the 5-year DRFS rates. Patients aged ≤ 56 years reported significantly better outcomes, whereas lower prescription doses and skull base location were associated with better RNFS rates. Two patients experienced G3 acute toxicities (1.2%), and three patients G3 late toxicities (1.8%). There were no G4-G5 adverse events.

Conclusion

PT proved to be effective with an acceptable toxicity profile. To the best of our knowledge this is one of the largest series including IM patients submitted to PT.

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Data availability

The dataset generated and analysed during the current study is available from the corresponding author on reasonable request.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy

    Alberto Iannalfi, Giulia Riva, Sara Lillo, Lucia Ciccone & Ester Orlandi

  2. Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy

    Giulia Fontana

  3. Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy

    Silvia Molinelli, Luca Trombetta & Mario Ciocca

  4. Radiology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy

    Sara Imparato & Mattia Pecorilla

  5. Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, 27100, Italy

    Ester Orlandi

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  1. Alberto Iannalfi
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Contributions

All authors contributed to the study conception and design. Data collection was performed by AI, GR, LC, SM, LT, MC. Statistical analysis was conducted by GF. Results were interpreted by AI, GR, SL, LC, GF, EO. The first draft of the manuscript was written by AI, GR, LC, GF, EO, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sara Lillo.

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Competing interests

The authors declare no competing interests.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Pavia (Date November 15, 2022 / No CNAO OSS 54 2022).

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Informed consent was obtained from all individual participants included in the study.

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Iannalfi, A., Riva, G., Lillo, S. et al. Proton therapy for intracranial meningioma: a single-institution retrospective analysis of efficacy, survival and toxicity outcomes. J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04751-x

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