Preliminary Results of Helical Tomotherapy in Patients with Complex-Shaped Meningiomas Close to the Optic Pathway

Helical Tomotherapy Based Image-Guided Intensity-Modulated Radiation Therapy for Complex, Irregular, Residual, Recurrent, Progressive Benign/ Low-Grade Meningiomas

“…Although the number of patients included in our study was relatively small (n=19), its strength lies in the demonstration of excellent intermediate to long-term efficacy (5-year PFS of around 90%) and safety (5% severe late toxicity) of HT-based IMRT in meningiomas at a relatively mature follow-up (median of 32 months) as opposed to comparatively shorter follow-up times reported by the others [27,28]. A critical appraisal of contemporary advanced photon irradiation techniques coupled with encouraging clinical outcome data favours the adoption of HT for large, irregularly-shaped, and complex benign brain tumors (such as meningiomas) in routine clinical practice.…”

“…The safety and efficacy of IMRT in benign/low-grade meningiomas has now been firmly established by several prospective clinical outcome studies (Table 4) [23][24][25][26][27][28]. Most series report excellent disease outcomes at 3-5 years with Kaplan-Meier estimates of local control and/or PFS well over 90% and acceptable significant late toxicity (around 5%).…”

“…All patients were alive at the time of reporting, although 4 of 12 patients (2 of 5 with atypical and 2 of 2 with anaplastic histology) developed progression at 2, 4, 17, and 29 months after radiotherapy, reflecting the poor biology of higher grade meningiomas. Schiappacasse et al [28] recently reported their preliminary experience of treating 28 consecutive patients with complex-shaped meningiomas close to the optic pathway on HT as primary (36%), adjuvant (32%), or rescue (32%) treatment after postsurgical progression. Acute toxicity was mild (grade I) and transitory that included headache (36%), ocular pain/dryness (29%), dermatitis (25%), and somnolence (20%).…”

Radiation Therapy in the Management of Meningiomas

“…A narrow beam is rotating through the target whilst the couch onto which the patient is lying is moving perpendicular to the plane of rotation. This technique is mainly used to deliver intensity modulated radiotherapy (IMRT) and limited literature is available concerning its use for intracranial meningiomas (15). All the above techniques use photons, also called gamma rays, to deliver the dose.…”

Hypofractionated stereotactic radiation therapy in skull base meningiomas

“…In case of large residual tumors or progressive growing mass, conventional radiotherapy is associated with a 10-years control rates of more than 80 %, a good profile of toxicity and an improvement of neurological symptoms in a significant number of patients [13][14][15].…”