@article{MTMT:34778612,
	title = {Adjuvant proton beam therapy in patients with grade 2 meningiomas},
	url = {https://m2.mtmt.hu/api/publication/34778612},
	author = {Wilson, T.A. and Kang, J.I. Jr and Huang, L. and Vacaru, A. and Martins, K.N. and Boling, W.W.},
	doi = {10.25259/SNI_485_2023},
	journal-iso = {SURG NEUR INT},
	journal = {SURGICAL NEUROLOGY INTERNATIONAL},
	volume = {15},
	unique-id = {34778612},
	issn = {2229-5097},
	abstract = {Background: The World Health Organization (WHO) grade 2 meningiomas behave aggressively with a high proclivity toward recurrence despite maximal surgical resection. Our institution, a pioneer of proton therapy, uses exclusively proton beam radiation, and thus, we present a retrospective cohort analysis of patients with WHO grade 2 meningiomas treated with adjuvant proton beam therapy (PBT) at our institution between 2007 and 2019. The effects of adjuvant PBT were evaluated. Methods: Data collected include diagnosis, gender, histological subtype, WHO grade, the extent of surgical resection, adjuvant PBT radiation, details of the PBT radiation, recurrence, any additional PBT radiation, systemic medical therapy, and disease-specific survival. Results: Among the WHO grade 2 meningiomas (n = 50) recommended PBT, 80% and 78% of patients with gross-total resection (GTR) and subtotal resection (STR), respectively, followed through with PBT. The median radiation dose of PBT was 59.5 Gy and 59.92 Gy for patients with GTR and STR, respectively, with a median of 33 fractions delivered in 1.8 Gy doses for both groups. Combined 3-year progression-free survival (PFS) was 96%, and 5-year PFS was 92%. Combined overall survival was 95% at five years. Minimal radiation side effects were reported with no grade 3 or higher toxicities. Conclusion: Our results suggest that adjuvant PBT is well tolerated with minimal radiation toxicity. Alternative to photon radiation, PBT may be considered at least as safe and effective for adjuvant treatment of WHO grade 2 meningiomas when it is available. ©2024 Published by Scientific Scholar on behalf of Surgical Neurology International.},
	keywords = {Aged; Adult; Female; Male; ARTICLE; human; Child; Treatment Outcome; cohort analysis; computer assisted tomography; Histology; cerebrovascular accident; nuclear magnetic resonance imaging; memory disorder; clinical article; fatigue; retrospective study; headache; heart arrest; Radiation therapy; cancer localization; cancer adjuvant therapy; cancer grading; tumor volume; cancer recurrence; radiation dose; overall survival; cancer radiotherapy; World Health Organization; proton therapy; hearing impairment; hair loss; neurosurgery; contrast enhancement; meningioma; meningioma; speech disorder; proton radiation; progression free survival; atypical meningioma; anaplastic meningioma; Proton beam therapy; disease specific survival; Radiation toxicity; clinical target volume; malignant meningioma; intraventricular meningioma; skull base cancer},
	year = {2024},
	eissn = {2152-7806}
}

@article{MTMT:33332904,
	title = {Assessment of Serum Hypoxia Biomarkers Pre- and Post-radiotherapy in Patients with Brain Tumors},
	url = {https://m2.mtmt.hu/api/publication/33332904},
	author = {El-Benhawy, Sanaa A. and Sakr, Ola A. and Fahmy, Enayat I and Ali, Raed A. and Hussein, Mohamed S. and Nassar, Esraa M. and Salem, Sherif M. and Abu-Samra, Nehal and Elzawawy, Sherif},
	doi = {10.1007/s12031-022-02065-z},
	journal-iso = {J MOL NEUROSCI},
	journal = {JOURNAL OF MOLECULAR NEUROSCIENCE},
	unique-id = {33332904},
	issn = {0895-8696},
	abstract = {Hypoxia is a prevalent hallmark of many malignant neoplasms. The aim was to assess the serum hypoxia biomarkers HIF-1 alpha, VEGF, osteopontin, erythropoietin, caveolin-1, GLUT-1, and LDH pre- and post-radiotherapy in patients with brain tumors. The study was conducted on 120 subjects were divided into two groups: group I: 40 healthy volunteers as control group. Group II: 80 brain tumor patients were subdivided into glioblastoma subgroup: 40 glioblastoma patients, meningioma subgroup: 40 malignant meningioma patients. Two venous blood samples were collected from every patient prior to and following RT and one sample from controls. Biomarkers were assayed by ELISA. In glioblastoma subgroup, HIF-1 alpha, VEGF, and LDH were significantly increased after RT. On the contrary, these biomarkers were significantly decreased after RT in malignant meningioma subgroup. Osteopontin was significantly increased after RT in both subgroups. Regarding erythropoietin, it was significantly decreased in both subgroups when compared to before RT. Caveolin-1 showed a significant increase in glioblastoma subgroup after RT comparing to before RT. GLUT-1 was significantly increased after RT in both subgroups comparing to before RT. Association of significant elevation of hypoxia biomarkers either pre- or post-RT with aggressive tumor such as glioblastoma indicates that, they are markers of malignancy and may have a role in tumor development and progression.},
	keywords = {Erythropoietin; HYPOXIA; Osteopontin; glioblastoma; meningioma; VEGF; HIF-1 alpha},
	year = {2022},
	eissn = {1559-1166}
}

@article{MTMT:33332905,
	title = {Reactor-based boron neutron capture therapy for 44 cases of recurrent and refractory high-grade meningiomas with long-term follow-up},
	url = {https://m2.mtmt.hu/api/publication/33332905},
	author = {Takai, Satoshi and Wanibuchi, Masahiko and Kawabata, Shinji and Takeuchi, Koji and Sakurai, Yoshinori and Suzuki, Minoru and Ono, Koji and Miyatake, Shin-Ichi},
	doi = {10.1093/neuonc/noab108},
	journal-iso = {NEURO-ONCOLOGY},
	journal = {NEURO-ONCOLOGY},
	volume = {24},
	unique-id = {33332905},
	issn = {1522-8517},
	abstract = {Background. High-grade meningioma (HGM) is difficult to treat, and recurrent HGM after radiotherapy has an especially poor prognosis. We retrospectively analyzed the cases of 44 consecutive patients with recurrent and refractory HGM who were treated by reactor-based boron neutron capture therapy (BNCT).Methods. In 2005-2019, we treated 44 recurrent and refractory HGMs by reactor-based BNCT. We analyzed the patients' tumor shrinkage, overall survival (OS) after initial diagnosis, OS after BNCT, progression-free survival (PFS) post-BNCT, and treatment failure patterns.Results. The median OS (mOS) after BNCT and mOS after initial diagnosis were 29.6 (95% CI: 16.1-40.4) and 98.4 (95% CI: 68.7-169.4) months, respectively. The median follow-up after BNCT was 26 (6.4-103) months. The grade 2 (20 cases) and 3 (24 cases) post-BNCT mOS values were 44.4 (95% CI: 27.4-not determined) and 21.55 (10.6-30.6) months, respectively (P = .0009). Follow-up images were obtained from 36 cases at >3 months post-BNCT; 35 showed tumor shrinkage during the observation period. The post-BNCT median PFS (mPFS) of 36 cases was 13.7 (95% CI: 8.3-28.6) months. The post-BNCT mPFS values in patients with grade 2 and 3 disease were 24.3 (95% CI: 9.8-not determined) and 9.4 (6.3-14.4) months, respectively (P = .0024). Local recurrence was observed in only 22.2% of cases. These results showed good local tumor control and prolonged survival for recurrent HGM cases.Conclusions. Most of these cases had relatively large tumor volumes. The proportion of grade 3 patients was extremely high. Our patients thus seemed to have poor prognoses. Nevertheless, reactor-based BNCT exerted relatively good local control and favorable survival for recurrent and refractory HGMs.},
	keywords = {RADIOTHERAPY; nuclear reactor; Boron Neutron Capture Therapy; high-grade meningioma},
	year = {2022},
	eissn = {1523-5866},
	pages = {90-98},
	orcid-numbers = {Kawabata, Shinji/0000-0001-5007-5279}
}

@article{MTMT:33804859,
	title = {Image-guided multisession radiosurgery of skull base meningiomas},
	url = {https://m2.mtmt.hu/api/publication/33804859},
	author = {Conti, A. and Pontoriero, A. and Iatì, G. and Cardali, S.M. and Brogna, A. and Friso, F. and Rosetti, V. and Zoli, M. and Parisi, S. and Cacciola, A. and Lillo, S. and Pergolizzi, S. and Mazzatenta, D.},
	doi = {10.3390/cancers12123569},
	journal-iso = {CANCERS},
	journal = {CANCERS},
	volume = {12},
	unique-id = {33804859},
	abstract = {Background: The efficacy of single-session stereotactic radiosurgery (sSRS) for the treatment of intracranial meningioma is widely recognized. However, sSRS is not always feasible in cases of large tumors and those lying close to critically radiation-sensitive structures. When surgery is not recommended, multi-session stereotactic radiosurgery (mSRS) can be applied. Even so, the efficacy and best treatment schedule of mSRS are not yet established. The aim of this study is to validate the role of mSRS in the treatment of skull base meningiomas. Methods: A retrospective analysis of patients with skull base meningiomas treated with mSRS (two to five fractions) at the University of Messina, Italy, from 2008 to 2018, was conducted. Results: 156 patients met the inclusion criteria. The median follow-up period was 36.2 ± 29.3 months. Progression-free survival at 2-, 5-, and 10-years was 95%, 90%, and 80.8%, respectively. There were no new visual or motor deficits, nor cranial nerves impairments, excluding trigeminal neuralgia, which was reported by 5.7% of patients. One patient reported carotid occlusion and one developed brain edema. Conclusion: Multisession radiosurgery is an effective approach for skull base meningiomas. The long-term control is comparable to that obtained with conventionally-fractionated radiotherapy, while the toxicity rate is very limited. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.},
	keywords = {Aged; Adult; Female; Male; PATIENT; ARTICLE; human; major clinical study; controlled study; clinical feature; Radiodiagnosis; Histopathology; Italy; image analysis; validation study; retrospective study; university hospital; radiation injury; cancer adjuvant therapy; carotid artery obstruction; follow up; radiosurgery; brain edema; neuroimaging; motor dysfunction; clinical effectiveness; visual disorder; medical record review; skull base tumor; skull base; Clinical outcome; meningioma; image reconstruction; trigeminus neuralgia; progression free survival; skull surgery; Cyberknife; stereotactic radiosurgery; cranial neuropathy; Hypofractionated radiotherapy; Image-guided radiotherapy; Hypofractionated stereotactic radiotherapy; image guided radiotherapy; multi session stereotactic radiosurgery},
	year = {2020},
	eissn = {2072-6694}
}

@{MTMT:33804854,
	title = {Emerging meningioma therapies II: Immunotherapies, novel radiotherapy techniques, and other experimental approaches},
	url = {https://m2.mtmt.hu/api/publication/33804854},
	author = {Gill, C.M. and Brastianos, P.K.},
	booktitle = {Meningiomas: Comprehensive Strategies for Management},
	doi = {10.1007/978-3-030-59558-6_15},
	unique-id = {33804854},
	abstract = {The success of checkpoint inhibitors has expanded the treatment regimens significantly for patients with solid tumors. As such, emerging data suggests that immunotherapy may play a role in the treatment of recurrent and high-grade meningiomas. There are several immunotherapy agents currently under active investigation in clinical trials. In addition to immunotherapy, novel radiotherapy techniques, including carbon ion therapy, brachytherapy, peptide receptor radionuclide therapy, and radiosensitizers may support improvements in clinical outcomes for meningioma patients. The efficacy of many of these techniques is being investigated in clinical trials. In this chapter, we will discuss these novel therapeutic approaches, as well as other novel experimental avenues, such as tumor treatment fields, and ideas for additional clinical trials that warrant investigation. © Springer Nature Switzerland AG 2020.},
	keywords = {Recurrence; immunotherapy; RADIOTHERAPY; Brachytherapy; skull base; meningioma; peptide receptor radionuclide therapy; carbon ion therapy; Tumor treatment fields},
	year = {2020},
	pages = {227-238}
}

@article{MTMT:33804860,
	title = {Review of Atypical and Anaplastic Meningiomas: Classification, Molecular Biology, and Management},
	url = {https://m2.mtmt.hu/api/publication/33804860},
	author = {Wilson, T.A. and Huang, L. and Ramanathan, D. and Lopez-Gonzalez, M. and Pillai, P. and De, Los Reyes K. and Kumal, M. and Boling, W.},
	doi = {10.3389/fonc.2020.565582},
	journal-iso = {FRONT ONCOL},
	journal = {FRONTIERS IN ONCOLOGY},
	volume = {10},
	unique-id = {33804860},
	issn = {2234-943X},
	abstract = {Although the majority of meningiomas are slow-growing and benign, atypical and anaplastic meningiomas behave aggressively with a penchant for recurrence. Standard of care includes surgical resection followed by adjuvant radiation in anaplastic and partially resected atypical meningiomas; however, the role of adjuvant radiation for incompletely resected atypical meningiomas remains debated. Despite maximum treatment, atypical, and anaplastic meningiomas have a strong proclivity for recurrence. Accumulating mutations over time, recurrent tumors behave more aggressively and often become refractory or no longer amenable to further surgical resection or radiation. Chemotherapy and other medical therapies are available as salvage treatment once standard options are exhausted; however, efficacy of these agents remains limited. This review discusses the risk factors, classification, and molecular biology of meningiomas as well as the current management strategies, novel therapeutic approaches, and future directions for managing atypical and anaplastic meningiomas. © Copyright © 2020 Wilson, Huang, Ramanathan, Lopez-Gonzalez, Pillai, De Los Reyes, Kumal and Boling.},
	keywords = {immunohistochemistry; review; human; sequence analysis; Histopathology; nuclear magnetic resonance imaging; functional magnetic resonance imaging; GENOME ANALYSIS; immunotherapy; protein expression; Cancer chemotherapy; ADJUVANT THERAPY; epidermal growth factor; Molecular Biology; DNA methylation; proton therapy; vasculotropin; Cytogenetics; platelet derived growth factor; genomic instability; meningioma; radiation dose distribution; epigenetics; multiple endocrine neoplasia; anaplastic carcinoma; Ion therapy; atypical meningioma; anaplastic meningioma; Whole genome sequencing; neurofibromin; programmed death 1 ligand 1; immune checkpoint inhibitor; stereotactic radiosurgery; programmed death 1 receptor; particle therapy; Stereotactic body radiation therapy; Intensity modulated radiation therapy; Neurophysiological monitoring; high grade meningiomas (HGMs); WHO grade II meningioma; WHO grade III meningioma},
	year = {2020},
	eissn = {2234-943X}
}

@article{MTMT:30981185,
	title = {Normofractionated stereotactic radiotherapy versus CyberKnife-based hypofractionation in skull base meningioma: a German and Italian pooled cohort analysis},
	url = {https://m2.mtmt.hu/api/publication/30981185},
	author = {Alfredo, Conti and Carolin, Senger and Guliz, Acker and Anne, Kluge and Antonio, Pontoriero and Alberto, Cacciola and Stefano, Pergolizzi and Antonino, Germano and Harun, Badakhshi and Markus, Kufeld and Franziska, Meinert and Phuong, Nguyen and Franziska, Loebel and Peter, Vajkoczy and Volker, Budach and David, Kaul},
	doi = {10.1186/s13014-019-1397-7},
	journal-iso = {RADIAT ONCOL},
	journal = {RADIATION ONCOLOGY},
	volume = {14},
	unique-id = {30981185},
	issn = {1748-717X},
	abstract = {Background This retrospective German and Italian multicenter analysis aimed to compare the role of normofractionated stereotactic radiotherapy (nFSRT) to CyberKnife-based hypofractionated stereotactic radiotherapy (CK-hFSRT) for skull base meningiomas. Methods Overall, 341 patients across three centers were treated with either nFSRT or CK-hFSRT for skull base meningioma. Treatment planning was based on computed tomography (CT) and magnetic resonance imaging (MRI) following institutional guidelines. Most nFSRT patients received 33 x 1.8 Gy, and most CK-hFSRT patients received 5 x 5 Gy. The median follow-up time was 36 months (range: 1-232 months). Results In the CK-hFSRT group, the 1-, 3-, and 10-year local control (LC) rates were 99.4, 96.8, and 80.3%, respectively. In the nFSRT group, the 1-, 3-, and 10-year LC rates were 100, 99, and 79.1%, respectively. There were no significant differences in LC rates between the nFSRT and CK-hFSRT groups (p = 0.56, hazard ratio = 0.76, 95% confidence interval, 0.3-1.9). In the CK-hFSRT group, only one case (0.49%) of severe toxicity (CTCAE 4.0 >= 3) was observed. In the nFSRT group, three cases (2.1%) of grade III toxicity were observed. Conclusion This analysis of pooled data from three centers showed excellent LC and low side effect rates for patients treated with CK-hFSRT or nFSRT. The efficacy, safety, and convenience of a shortened treatment period provide a compelling case for the use of CK-hFSRT in patients with moderate size skull base meningioma and provided that OAR constraints are met.},
	keywords = {radiosurgery; skull base; meningioma; Cyberknife; Fractionated stereotactic radiotherapy; Hypofractionated stereotactic radiotherapy},
	year = {2019},
	eissn = {1748-717X}
}

@article{MTMT:30981186,
	title = {Skull base meningioma: Clinical and radiological efficacy based on a quantitative volumetric analysis},
	url = {https://m2.mtmt.hu/api/publication/30981186},
	author = {Brahimi, Y. and Antoni, D. and Srour, R. and Wagner, P. and Proust, F. and Thiery, A. and Labani, A. and Noel, G.},
	doi = {10.1016/j.canrad.2018.11.005},
	journal-iso = {CANCER RADIOTHER},
	journal = {CANCER RADIOTHERAPIE},
	volume = {23},
	unique-id = {30981186},
	issn = {1278-3218},
	abstract = {Purpose.-To date, no correlation has been found between clinical and radiological efficacy after irradiation of skull base meningiomas. However, the evaluation of the radiological response was most often made by questionable methods that may have underestimated the radiological effectiveness of radiotherapy. The objective of this work is to verify this hypothesis by quantitative volumetric analysis.Material and methods.-Data from 35 patients treated with either helical tomotherapy (45.7%) or fractionated stereotactic radiotherapy (54.3%) were retrospectively analysed. These were mainly women (94%) aged 59 (43-81) with lesions mainly of the cavernous sinus (60%). There was a median of 2 (1-4) symptoms and the main symptoms were visual impairment (39%), cranial nerve deficits (23.4%) and headaches (17.2%).Results.-Median tumour volume decreased significantly (P<0.05) from 9.6 mL (0.3-36.6) to 6.8 mL (0.1-26.5) after median follow-up of 44 months (24-77). Sixty-three percent of patients had an improvement of at least one symptom. In univariate analysis, clinical efficacy (P<0.05), radiotherapy technique (P<0.05), tumor topography (P<0.05) and initial tumor volume (P<0.05) were predictive factors for radiological response. In multivariate analysis, only the inverse correlation between radiological response and initial tumor volume remained significant (rho: -0.47 95% CI -3.2 to 5.7; P<0.05).Conclusion.-The quantitative volumetric monitoring demonstrates a major radiological efficiency of radiotherapy. However, no clear correlation between clinical and radiological efficacy was found. (C) 2019 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.},
	keywords = {skull base; meningioma; Intensity modulated radiation therapy; stereotactic radiation; Volumetric analyses},
	year = {2019},
	eissn = {1769-6658},
	pages = {290-295}
}

@article{MTMT:30981184,
	title = {A Systematic Review of Ion Radiotherapy in Maintaining Local Control Regarding Atypical and Anaplastic Meningiomas},
	url = {https://m2.mtmt.hu/api/publication/30981184},
	author = {Coggins, William S. and Pham, Nguyen K. and Nguyen, Anthony and Branch, Daniel W. and Guillet, June Y. and Korst, Genevieve and Lall, Rishi R.},
	doi = {10.1016/j.wneu.2019.08.149},
	journal-iso = {WORLD NEUROSURG},
	journal = {WORLD NEUROSURGERY},
	volume = {132},
	unique-id = {30981184},
	issn = {1878-8750},
	abstract = {OBJECTIVE: Atypical and anaplastic meningiomas, unlike their benign counterparts, are highly aggressive, locally destructive, and likely to recur after treatment. These diseases are difficult to definitively treat with traditional radiotherapy without injuring adjacent brain parenchyma. The physical properties of ion radiotherapy allows for treatment plans that avoid damaging critical neural structures. The objectives of this systematic review were to evaluate the use and efficacy of ion radiotherapy in the treatment of atypical and anaplastic meningiomas.METHODS: We performed a systematic review of the literature by querying the PubMed and Ovid databases to identify and examine literature addressing the efficacy of ion radiotherapy in maintaining long-term local tumor control for patients with atypical or anaplastic meningiomas. The outcome of interest was rate of local tumor control at 5 years after ion radiotherapy.RESULTS: Across the included studies, proton therapy delivered a mean local control rate of 59.62% after 5 years. Carbon ion radiotherapy studies showed local control rates of 95% and 63% at 2 years for grade II and III meningiomas, respectively. In contrast, carbon ion radiotherapy studies that failed to differentiate between atypical and anaplastic meningiomas produced a local control rate of 33% at 2 years.CONCLUSIONS: Proton and carbon ion radiotherapy maintain comparable rates of local control to conventional photon therapy and allow for more targeted treatment plans that may limit excess radiation damage. Although additional prospective trials are needed, ion therapy represents a burgeoning field in the treatment of atypical and anaplastic meningiomas.},
	keywords = {meningioma; atypical meningioma; anaplastic meningioma; Proton beam therapy; carbon ion therapy; Ion radiotherapy},
	year = {2019},
	eissn = {1878-8769},
	pages = {282-291}
}

@article{MTMT:30981189,
	title = {Base of the skull meningioma: Efficacy, clinical tolerance and radiological evaluation after radiotherapy},
	url = {https://m2.mtmt.hu/api/publication/30981189},
	author = {Brahimi, Y. and Antoni, D. and Srour, R. and Proust, F. and Cebula, H. and Labani, A. and Noel, G.},
	doi = {10.1016/j.canrad.2017.09.010},
	journal-iso = {CANCER RADIOTHER},
	journal = {CANCER RADIOTHERAPIE},
	volume = {22},
	unique-id = {30981189},
	issn = {1278-3218},
	abstract = {Skull base meningioma leads to functional disturbances, which can significantly alter the quality of life. The optimal management of these lesions, whose goals are neurological preservation and tumour local control, is not yet clearly established. It is widely recognized that the goal of a radical excision should be abandoned despite the advances in the field of microsurgery of skull base lesions. Although less morbid, partial tumour excision would be associated with increased risk of local tumour recurrence. Although discussed both exclusive and adjuvant have proven to be highly successful in terms of clinical improvement and local control. Various radiation techniques have demonstrated their efficacy in the management of this pathology. However, high rates of clinical improvement are in contrast with low rates of radiological improvement. The notion of clinical and radiological dissociation appeared. However, in most of these studies, the analysis of the radiological response could be subject of legitimate criticism. This work proposes to review the local control, the efficacy and the clinical tolerance and the radiological response of the various radiation techniques for the meningioma of the base of the skull and to demonstrate the interest of quantitative volumetric analyses in the follow-up of meningioma after radiotherapy. (C) 2018 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.},
	keywords = {skull base; meningioma; Intensity-modulated radiation therapy; stereotactic radiation; Volumetric analyses},
	year = {2018},
	eissn = {1769-6658},
	pages = {264-286}
}

@article{MTMT:30981188,
	title = {Clinical outcome after high-precision radiotherapy for skull base meningiomas: Pooled data from three large German centers for radiation oncology},
	url = {https://m2.mtmt.hu/api/publication/30981188},
	author = {Combs, Stephanie E. and Farzin, Mostafa and Boehmer, Julia and Oehlke, Oliver and Molls, Michael and Debus, Jurgen and Grosu, Anca-Ligia},
	doi = {10.1016/j.radonc.2018.03.006},
	journal-iso = {RADIOTHER ONCOL},
	journal = {RADIOTHERAPY AND ONCOLOGY},
	volume = {127},
	unique-id = {30981188},
	issn = {0167-8140},
	abstract = {Purpose: To evaluate outcome in patients with base of skull meningiomas treated with modern high precision radiation therapy (RT) techniques.Patients and methods: 927 patients from three centers were treated with either radiosurgery or fractionated high-precision RT for meningiomas. Treatment planning was based on CT and MRI following institutional guidelines. For radiosurgery, a median dose of 13 Gy was applied, for fractionated treatments, a median dose of 54 Gy in 1.8 Gy single fractions was prescribed. Follow-up included a clinical examination as well as contrast-enhanced imaging. All patients were followed up prospectively after radiotherapy in the three departments within a strict follow-up regimen. The median follow-up time was 81 months (range 1-348 months).Results: Median local control was 79 months (range 1-348 months). Local control (LC) was 98% at 1 year, 94% at 3 years, 92% at 5 years and 86% at 10 years. There was no difference between radiosurgery and fractionated RT. We analyzed the influence of higher doses on LC and could show that dose did not impact LC. Moreover, there was no difference between 54 Gy and 57.6 Gy in the fractionated group. Side effects were below 5% in both groups without any severe treatment-related complications.Discussion: Based on the pooled data analysis this manuscript provides a large series of meningiomas of the skull base treated with modern high precision RT demonstrating excellent local control and low rates of side effects. Such data support the recommendation of RT for skull base meningiomas in the interdisciplinary tumor board discussions. The strong role of RT must influence treatment recommendations keeping in mind the individual risk-benefit profile of treatment alternatives. (C) 2018 Elsevier B.V. All rights reserved.},
	keywords = {outcome; meningioma; IMRT; FSRT},
	year = {2018},
	eissn = {1879-0887},
	pages = {274-279}
}

@article{MTMT:30981187,
	title = {Radiologic Response and Disease Control of Recurrent Intracranial Meningiomas Treated With Reirradiation},
	url = {https://m2.mtmt.hu/api/publication/30981187},
	author = {Lin, Alexander J. and Hui, Caressa and Dahiya, Sonika and Lu, Hsiang-Chih and Kim, Albert H. and Campian, Jian L. and Tsien, Christina and Zipfel, Gregory J. and Rich, Keith M. and Chicoine, Michael and Huang, Jiayi},
	doi = {10.1016/j.ijrobp.2018.05.011},
	journal-iso = {INT J RADIAT ONCOL},
	journal = {INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS},
	volume = {102},
	unique-id = {30981187},
	issn = {0360-3016},
	abstract = {Purpose: To evaluate the clinical outcomes of reirradiation of recurrent meningiomas and factors related to patient selection and treatment modality.Methods and Materials: Recurrent meningioma patients who failed prior stereotactic radiosurgery (SRS) or fractionated external beam radiation therapy (EBRT) received reirradiation using either SRS or EBRT. Complete response (CR), partial response (PR), and progression after reirradiation were evaluated using the MacDonald criteria. Local control (LC), progression-free survival (PFS), and overall survival (OS) after reirradiation were analyzed using the Kaplan-Meier method. Logistic and Cox regression analyses were performed to identify factors associated with reirradiation modality and PFS, respectively.Results: Forty-three patients (14 grade 1/unknown, 29 grade 2/3) were reirradiated with SRS (67%) or EBRT (33%). Median time from initial SRS/EBRT to reirradiation was 60 months (range, 7.5-202); median tumor volume at the time of reirradiation was 4.8 cm(3) (range, 0.14-64). After a median radiologic follow-up of 19.4 months, the response rate (CR + PR) was 8% for grade 1 and 20% for grade 2/3 meningiomas. After 2 years, LC was 78%, PFS was 63%, and OS was 80%. Larger tumor volume and prior SRS were associated with reirradiation using EBRT. Reirradiated grade 2/3 meningiomas had significantly worse PFS than grade 1 (2-year PFS: 50% vs 92%, respectively; P =.02) but not LC (P =.11) or OS (P =.39). On multivariable analysis, worse PFS was significantly associated with grade 2/3 histology (hazard ratio, 3.92; 95% confidence interval, 1.33-11.6) as well as worse Karnofsky Performance Scale score but not reirradiation dose, volume, and modality. Grades 3 to 4 radiation necrosis developed in 4 patients (10%).Conclusions: Reirradiation of recurrent meningiomas appears to be feasible with promising clinical outcomes and an acceptable toxicity profile. (C) 2018 Elsevier Inc. All rights reserved.},
	year = {2018},
	eissn = {1879-355X},
	pages = {194-203},
	orcid-numbers = {Dahiya, Sonika/0000-0002-5585-0964; Huang, Jiayi/0000-0002-5153-506X}
}

@article{MTMT:30981192,
	title = {Does Proton Therapy Have a Future in CNS Tumors?},
	url = {https://m2.mtmt.hu/api/publication/30981192},
	author = {Combs, Stephanie E.},
	doi = {10.1007/s11940-017-0447-4},
	journal-iso = {CURR TREAT OPTION NE},
	journal = {CURRENT TREATMENT OPTIONS IN NEUROLOGY},
	volume = {19},
	unique-id = {30981192},
	issn = {1092-8480},
	abstract = {Proton therapy is characterized by certain physical properties leading to a reduction in integral dose. As proton therapy becomes more widely available, the ongoing discussion on the real indications for proton therapy becomes more important. In the present article, data on proton therapy for tumors of the central nervous system (CNS) is summarized and discussed in view of modern photon treatments. Still today, no randomized controlled trials are available confirming any clinical benefit of protons in CNS tumors. For certain skull base lesions, such as chordomas and chondrosarcomas, dose escalation is possible with protons thus patients should be referred to a proton center if readily available. For vestibular schwannoma, at present, proton data are inferior to advanced photons. For glioma patients, early data is present for low-grade gliomas, presenting comparable results to photons; dose escalation studies for high-grade gliomas have led to significant side effects, thus strategies of dose-escalation need to rethought. For skull base meningiomas, data from stereotactic series and IMRT present excellent local control with minimal side effects, thus any improvement with protons might only be marginal. The largest benefit is considered in pediatric CNS tumors, due to the intricate radiation sensitivity of children's normal tissue, as well as the potential of long-term survivorship. Long-term data is still lacking, and even recent analyses do not all lead to a clear reduction in side effects with improvement of outcome; furthermore, clinical data seem to be comparable. However, based on the preclinical evidence, proton therapy should be evaluated in every pediatric patient. Protons most likely have a benefit in terms of reduction of long-term side effects, such as neurocognitive sequelae or secondary malignancies; moreover, dose escalation can be performed in radio-resistant histologies. Clinical data with long-term follow-up is still warranted to prove any superiority to advanced photons in CNS tumors. If available, protons should be evaluated for chordoma or chondrosarcoma of the skull base and pediatric tumors. However, many factors are important for excellent oncology care, and no time delay or inferior oncological care should be accepted for the sake of protons only.},
	keywords = {RADIOTHERAPY; Protons; Brain tumors; Skull base tumors; particle therapy},
	year = {2017},
	eissn = {1534-3138}
}

@article{MTMT:30981191,
	title = {The role of radiotherapy in the management of high-grade meningiomas},
	url = {https://m2.mtmt.hu/api/publication/30981191},
	author = {Hwang, Katie L. and Hwang, William L. and Bussiere, Marc R. and Shih, Helen A.},
	doi = {10.21037/cco.2017.06.09},
	journal-iso = {CHINESE CLIN ONCOL},
	journal = {CHINESE CLINICAL ONCOLOGY},
	volume = {6},
	unique-id = {30981191},
	issn = {1009-0460},
	abstract = {Meningiomas account for approximately one-third of primary central nervous system tumors with a subset that are aggressive and carry significant morbidity and mortality. Treatment of these high-grade meningiomas, classified by the World Health Organization as grade II (atypical) and grade III (anaplastic) meningiomas, typically includes the combination of surgery and radiotherapy. However, current data guiding the timing, dosage, and modality of radiation treatment (RT) has been limited to case series and retrospective studies. Nevertheless, most studies support that radiation therapy reduces recurrence risk and improves overall survival (OS) for patients with high-grade meningiomas. In this review, we examine the evidence for radiation therapy in the management of patients with atypical and anaplastic meningiomas and discuss current ongoing prospective trials that will further elucidate the optimal role of radiotherapy in the treatment of these aggressive tumors.},
	keywords = {RADIATION; proton therapy; atypical meningioma; anaplastic meningioma; stereotactic radiosurgery (SRS)},
	year = {2017}
}

@article{MTMT:30981190,
	title = {ACCELERATED PROTONS IN THE TREATMENT OF CNS TUMORS IN CHILDREN: A REVIEW OF THE LITERATURE},
	url = {https://m2.mtmt.hu/api/publication/30981190},
	author = {Щербенко, О.И. and Shcherbenko, O.I.},
	journal-iso = {Practical Oncology},
	journal = {Practical Oncology},
	volume = {18},
	unique-id = {30981190},
	issn = {1726-9814},
	abstract = {Для большинства детей, больных опухолями мозга, лучевая терапия является одним из основных компонентов лечебного комплекса. Основной проблемой при ее использовании является предупреждение отдаленных последствий у потенциально излечимых больных. Благодаря особенностям распределения энергии в тканях, применение ускоренных протонов для лучевой терапии позволяет обеспечить максимальное снижение радиационной нагрузки на критические структуры и уменьшить выраженность отдаленных последствий лечения по сравнению с наблюдаемыми после облучения фотонами при равнозначном непосредственном эффекте. В связи с этим протонное облучение предпочтительно для больных с потенциально излечимыми опухолями, для которых фотонное облучение связано с большим риском реализации поздних радиационных повреждений. Стоимость протонного облучения выше, но это компенсируется снижением затрат на лечение отдаленных последствий, чаще наблюдаемых после фотонной лучевой терапии.For the majority of pediatric patients with brain tumors radiation therapy is one major component in a medical complex. The main problem with its use is the prevention of remote consequences for potentially curable patients. The use of radiation therapy with accelerated protons, due to the peculiarities of the distribution of energy in the tissues, allows for maximum reduction of the radiation load on critical structure and to reduce the severity of late effects compared with that observed after irradiation by photons with the equivalent immediate effect. In this regard, proton irradiation is preferable for patients with potentially curable brain tumors, for which the photon radiation is associated with risk of development of late complications. The higher cost of proton irradiation refunded by reduction in the cost of treating the consequences observed after photon radiation therapy.},
	keywords = {COMPLICATIONS; CHILDREN; Radiation therapy; Cost of treatment; CNS tumors; дети; осложнения; лучевая терапия; опухоли ЦНС; ускоренные протоны; фотонное излучение; стоимость лечения; Accelerated protons; Photon radiation},
	year = {2017},
	pages = {298-306}
}