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Hoffmann E, Clasen K, Frey B, et al. Retrospective analysis of recurrence patterns and clinical outcome of grade II meningiomas following postoperative radiotherapy. Radiat Oncol. 2021;16(1):116doi: 10.1186/s13014-021-01825-2.
Hoffmann, E., Clasen, K., Frey, B., Ehlers, J., Behling, F., Skardelly, M., Bender, B., Schittenhelm, J., Reimold, M., Tabatabai, G., Zips, D., Eckert, F., & Paulsen, F. (2021). Retrospective analysis of recurrence patterns and clinical outcome of grade II meningiomas following postoperative radiotherapy. Radiation oncology (London, England), 16(1), 116. https://doi.org/10.1186/s13014-021-01825-2
Hoffmann, Elgin, et al. "Retrospective analysis of recurrence patterns and clinical outcome of grade II meningiomas following postoperative radiotherapy." Radiation oncology (London, England) vol. 16,1 (2021): 116. doi: https://doi.org/10.1186/s13014-021-01825-2
Hoffmann E, Clasen K, Frey B, Ehlers J, Behling F, Skardelly M, Bender B, Schittenhelm J, Reimold M, Tabatabai G, Zips D, Eckert F, Paulsen F. Retrospective analysis of recurrence patterns and clinical outcome of grade II meningiomas following postoperative radiotherapy. Radiat Oncol. 2021 Jun 25;16(1):116. doi: 10.1186/s13014-021-01825-2. PMID: 34172069; PMCID: PMC8235826.
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Radiat Oncol. 2021 Jun 25;16(1):116. doi: 10.1186/s13014-021-01825-2.

Retrospective analysis of recurrence patterns and clinical outcome of grade II meningiomas following postoperative radiotherapy.

Radiation oncology (London, England)

Elgin Hoffmann, Kerstin Clasen, Bettina Frey, Jakob Ehlers, Felix Behling, Marco Skardelly, Benjamin Bender, Jens Schittenhelm, Matthias Reimold, Ghazaleh Tabatabai, Daniel Zips, Franziska Eckert, Frank Paulsen

Affiliations

  1. Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. [email protected].
  2. Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. [email protected].
  3. Department of Radiation Oncology, Eberhard-Karls-University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. [email protected].
  4. Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
  5. Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
  6. Department of Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
  7. Clinic for Neurosurgery, Hospital Reutlingen, Reutlingen, Germany.
  8. Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
  9. Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital Tuebingen, Calwerstr. 3, 72076, Tuebingen, Germany.
  10. Department of Nuclear Medicine, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
  11. Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tuebingen, Hertie Institute for Clinical Brain Research, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
  12. Department of Neurooncology, Department of Neurology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
  13. German Cancer Consortium (DKTK) Partnersite Tuebingen, German Cancer Research Center (DKFZ), Heidelberg, Germany.

PMID: 34172069 PMCID: PMC8235826 DOI: 10.1186/s13014-021-01825-2

Abstract

BACKGROUND: Atypical meningiomas exhibit a high tendency for tumor recurrence even after multimodal therapy. Information regarding recurrence patterns after additive radiotherapy is scarce but could improve radiotherapy planning and therapy decision. We conducted an analysis of recurrence patterns with regard to target volumes and dose coverage assessing target volume definition and postulated areas of tumor re-growth origin. Prognostic factors contributing to relapse were evaluated.

METHODS: The clinical outcome of patients who had completed additive, somatostatin receptor (SSTR)-PET/CT-based fractionated intensity-modulated radiotherapy for atypical meningioma between 2007 and 2017 was analyzed. In case of tumor recurrence/progression, treatment planning was evaluated for coverage of the initial target volumes and the recurrent tumor tissue. We proposed a model evaluating the dose distribution in postulated areas of tumor re-growth origin. The median of proliferation marker MIB-1 was assessed as a prognostic factor for local progression and new distant tumor lesions.

RESULTS: Data from 31 patients who had received adjuvant (n = 11) or salvage radiotherapy (n = 20) were evaluated. Prescribed dose ranged from 54.0 to 60.0 Gy. Local control at five years was 67.9%. Analysis of treatment plans of the eight patients experiencing local failure proved sufficient extent of target volumes and coverage of the prescribed dose of at least 50.0 Gy as determined by mean dose, D98, D2, and equivalent uniform dose (EUD) of all initial target volumes, postulated growth-areas, and areas of recurrent tumor tissue. In all cases, local failure occurred in high-dose volumes. Tumors with a MIB-1 expression above the median (8%) showed a higher tendency for re-growth.

CONCLUSIONS: The model showed adequate target volume and relative dose distribution but absolute dose appears lower in recurrent tumors without reaching statistical significance. This might provide a rationale for dose escalation studies. Biological factors such as MIB-1 might aid patients' stratification for dose escalation.

Keywords: Additive radiotherapy; Atypical meningioma; MIB-1; Recurrence pattern analysis; SSTR-PET/CT; Treatment planning

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