Helical Tomotherapy Based Image-Guided Intensity-Modulated Radiation Therapy for Complex, Irregular, Residual, Recurrent, Progressive Benign/ Low-Grade MeningiomasTejpal Gupta*, Tabassum Wadasadawala, Reena Phurailatpam, Siji Nojin Paul and Rakesh Jalali
Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC) & Tata Memorial Hospital (TMH), Tata Memorial Centre, Kharghar, Navi Mumbai, India
- Corresponding Author:
- Dr. Tejpal Gupta
Associate Professor, Radiation Oncology
ACTREC, Tata Memorial Centre, Kharghar
Navi Mumbai:410210, India
E-mail: [email protected]
Received Date: June 11, 2012; Accepted Date: June 21, 2012; Published Date: June 25, 2012
Citation: Gupta T, Wadasadawala T, Phurailatpam R, Paul SN, Jalali R (2012) Helical Tomotherapy Based Image-Guided Intensity-Modulated Radiation Therapy for Complex, Irregular, Residual, Recurrent, Progressive Benign/Low-Grade Meningiomas. J Nucl Med Radiat Ther S3:004. doi:10.4172/2155-9619.S3-004
Copyright: © 2012 Gupta T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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