Ядерная медицина и лучевая терапия

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

Abstract

Tejpal Gupta, Tabassum Wadasadawala, Reena Phurailatpam, Siji Nojin Paul and Rakesh Jalali

Abstract Aim: To report mature outcomes of helical Tomotherapy (HT)-based image-guided intensity-modulated radiation therapy (IMRT) in benign/low-grade meningiomas.

Methods: Nineteen consecutive patients with 22 complex, irregular, residual, recurrent, or progressive benign/ low-grade meningiomas were treated on HT and followed up clinico-radiologically. Tumor control was defined as lack of evidence of tumor progression on serial imaging. Progression-free survival (PFS) was calculated from date of initiation of HT till imaging-defined progression or sustained neurologic worsening whichever occurred earlier.

Results: The median age of the study cohort was 40 years (range 15-72 years) and included 13 (68%) females. HT achieved excellent target volume coverage, good high-dose conformality and homogeneity with exquisite sparing of surrounding normal critical structures. Acute toxicity of HT was mild and self-limiting. Using standard response evaluation criteria, 18 of 22 (83%) lesions were stable on first response assessment, while 4 (17%) lesions showed partial response. Pre-existent neuro-deficits present in 13 patients prior to HT either improved or remained stable following irradiation in all but one patient. Only 1 patient (5%) developed cataract necessitating extraction. Two (10.5%) patients had clinical and/or radiological progression on follow-up. With a median follow-up of 32 months (inter-quartile range 27-45 months), the 5-year clinico-radiological PFS was 89.2%. All 19 patients were alive for a 5-year overall survival of 100%.

Conclusion: HT-based image-guided IMRT for benign/low-grade meningiomas achieves excellent high-dose conformality with minimal acute and late morbidity resulting in excellent long-term outcomes prompting its use in routine clinical practice