Preliminary results of helical tomotherapy in patients with complex-shaped meningiomas close to the optic pathway.
ABSTRACT Meningiomas are the most common benign intracranial tumor. Meningiomas close to the optic pathway represent a treatment challenge both for surgery and radiotherapy. The aim of this article is to describe early results of helical tomotherapy treatment in complex-shaped meningiomas close to the optic pathway. Twenty-eight patients were consecutively treated. All patients were immobilized with a thermoplastic head mask and planned with the aid of a magnetic resonance imaging-computed tomography fusion. All treatments included daily image guidance. Pretreatment symptoms and acute toxicity were recorded. Median age was 57.5 years, and 92.8% patients had Eastern Cooperative Oncology Group performance status scale ≤1. The most common localizations were the sella turcica, followed by the cavernous sinus and the sphenoid. The most common symptoms were derived from cranial nerve deficits. Tomotherapy was administered as primary treatment in 35.7% of patients, as an adjuvant treatment in 32.4%, and as a rescue treatment after postsurgical progression in 32.1% patients. Most patients were either inoperable or Simpson IV. Total dose varied between 5000 and 5400 cGy; fractionation varied between 180 and 200 cGy. Median dose to the planning target volume was 51.7 Gy (range, 50.2-55.9 Gy). Median coverage index was 0.89 (range, 0.18-0.97). Median homogeneity index was 1.05 (range, 1-1.12). Acute transient toxicity was grade 1 and included headache in 35.7% patients, ocular pain/dryness in 28.5%, and radiation dermatitis in 25%. Thus far, with a maximal follow-up of 3 years, no late effects have been seen and all patients have a radiological stabilization of the disease. Helical tomotherapy offered a safe and effective therapeutic alternative for patients with inoperable or subtotally resected complex-shaped meningiomas close to the optic pathway. Acceptable coverage and homogeneity indexes were achieved with appropriate values for maximal doses delivered to the eyes, lenses, and chiasm, despite the proximity of the tumor to these structures.
- SourceAvailable from: Frederik VernimmenMeningiomas - Management and Surgery, 03/2012; , ISBN: 978-953-51-0175-8
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ABSTRACT: Objectives Helical tomotherapy (HT) can be applied to treat complex malignant cancer with high-precise radiotherapy, and it can reduce the damage to normal tissues and improve treatment effects. But the procurement of HT must be approved by relevant departments of administration affairs. This study, appointed by the National Health and Family Planning Commission of China and undertook by the National Health Development Research Center and the Chinese Evidence-Based Medicine Centre, was aimed to rapidly assess the effectiveness, safety, costs and applicability of HT, so as to provide currently-available best evidence for decision makers of health policies.Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP, CBM and other professional websites. Two reviewer independently screened literature according to the inclusion and exclusion criteria, extracted data, assessed quality, and then performed descriptive analysis.Resultsi. We finally included 150 studies, encompassing 5 HTAs, 18 CCTs, and 127 observational studies. ii. The included HTAs were published during 2006–2009, providing fairly less evidence of low quality and the results of 145 primary studies showed that: HT had been used mainly in the treatments of 14 kinds of cancer, with low total toxicity and high survival rates. Although the quality of the included studies was poor, there was much evidence about prostate cancer, head and neck cancer, nasopharynx cancer, cervical cancer, lung cancer and liver cancer, with enough sample and fairly reliable results in HT efficacy and safety. And iii. a total of 56 clinical trials were registered in Clinicaltrials.gov, most of which were registered by the occident. Among them, 9 were completed but the results had not been published yet.Conclusions The evidence of this study showed that, HT is safe and effective in clinic. But the abovementioned conclusion needs to be verified by conducting more high quality studies with long-term follow-up. The costs of HT in procurement, maintenance and application are high; and the skills, training and qualification of operators are required. We suggest that the procurement of HT should be reduced; it should be allocated rationally and effectively used after comprehensive assessment in China's cancer epidemiology characteristics, health resource allocation, disease burden, medical service level, etc.; and also high quality studies with long-term follow-up should be financially supported on the basis of establishing projects, so as to provide local evidence and consistently guide and improve scientific decision making.This article is protected by copyright. All rights reserved.Journal of Evidence-Based Medicine 06/2014; 7(3). DOI:10.1111/jebm.12109