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Long-term Outcomes of Patients with Unresectable Benign Meningioma Treated with Proton Beam Therapy

佐藤, 弘茂 筑波大学 DOI:10.15068/0002000872

2021.08.02

概要

Meningioma is the most common nonglial primary intracranial tumor, accounting for approximately 30% of all primary central nervous system tumors [1-3]. Its incidence increases with age, with a peak at 40 years of age and a female-to-male ratio of approximately 2:1[4, 5]. Regarding the location of tumors, 90% are within the supratentorial compartment; the sagittal sinus, the falx, the convexity, and the sphenoid ridge are the most common sites in descending order [4, 5].

　Most meningiomas are benign; however, up to 15% are atypical and 2% are anaplastic according to the World Health Organization (WHO) histological criteria [6]. Surgical removal is the mainstay treatment [7,8]; however, it is sometimes difficult to achieve complete removal because of its complex shape or difficult location, especially given that it may involve vital structures such as the brain stem, cranial nerves, or major vessels [7,8,9]. Actually, cranial nerve deficits have been reported in 22-91% of patients who underwent surgical removal for petroclival meningiomas [10, 11, 12]. For the preservation of neurological functions in these difficult cases, intentional subtotal resection may be performed; however, it has been reported that the local recurrence rates are approximately 10%, 20%, and 25% at 5,10, and 15 years after complete resection, and approximately 50%, 60%, and 70% at 5, 10, and 15 years after subtotal resection, respectively [13,14].

　Postoperative radiotherapy has been reported to improve local control and overall survival rates in patients who undergo incomplete resection [15,16,17]. However, the long-term effects are not yet clear. It has been reported that proton beam therapy (PBT) can provide an excellent dose localization for relatively large or irregularly shaped tumors with a higher rate of preservation of healthy brain tissue compared to other photon therapies [18,19]. Here, we analyzed the clinical data of patients with unresectable benign meningiomas treated with PBT at our institute to verify its long-term efficacy.

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