{"doi":"10.1093/neuonc/noad244","title":"Efficacy and toxicity of bimodal radiotherapy in WHO grade 2 meningiomas following subtotal resection with carbon ion boost: Prospective phase 2 MARCIE trial","abstract":"BACKGROUND: Novel radiotherapeutic modalities using carbon ions provide an increased relative biological effectiveness (RBE) compared to photons, delivering a higher biological dose while reducing radiation exposure for adjacent organs. This prospective phase 2 trial investigated bimodal radiotherapy using photons with carbon-ion (C12)-boost in patients with WHO grade 2 meningiomas following subtotal resection (Simpson grade 4 or 5). METHODS: A total of 33 patients were enrolled from July 2012 until July 2020. The study treatment comprised a C12-boost (18 Gy [RBE] in 6 fractions) applied to the macroscopic tumor in combination with photon radiotherapy (50 Gy in 25 fractions). The primary endpoint was the 3-year progression-free survival (PFS), and the secondary endpoints included overall survival, safety and treatment toxicities. RESULTS: With a median follow-up of 42 months, the 3-year estimates of PFS, local PFS and overall survival were 80.3%, 86.7%, and 89.8%, respectively. Radiation-induced contrast enhancement (RICE) was encountered in 45%, particularly in patients with periventricularly located meningiomas. Patients exhibiting RICE were mostly either asymptomatic (40%) or presented immediate neurological and radiological improvement (47%) after the administration of corticosteroids or bevacizumab in case of radiation necrosis (3/33). Treatment-associated complications occurred in 1 patient with radiation necrosis who died due to postoperative complications after resection of radiation necrosis. The study was prematurely terminated after recruiting 33 of the planned 40 patients. CONCLUSIONS: Our study demonstrates a bimodal approach utilizing photons with C12-boost may achieve a superior local PFS to conventional photon RT, but must be balanced against the potential risks of toxicities.","journal":"Neuro-Oncology","year":2023,"id":329104,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":21,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9532,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":266743,"name":"Sybren L. N. Maas","orcid":"0000-0002-8745-4405","position":1,"is_corresponding":false},{"id":1051711,"name":"Felix Hinz","orcid":"0009-0004-6394-1999","position":2,"is_corresponding":false},{"id":1051712,"name":"Christian P. Karger","orcid":"0000-0002-7194-8136","position":3,"is_corresponding":false},{"id":663097,"name":"Philipp Sievers","orcid":"0000-0003-3237-6021","position":4,"is_corresponding":false},{"id":1051713,"name":"Tanja Eichkorn","orcid":"0000-0003-0150-1328","position":5,"is_corresponding":false},{"id":1051714,"name":"Eva Meixner","orcid":"0000-0001-7087-9581","position":6,"is_corresponding":false},{"id":1052347,"name":"Philipp Hoegen-Saßmannshausen","orcid":null,"position":7,"is_corresponding":false},{"id":1051715,"name":"Juliane Hörner‐Rieber","orcid":"0000-0003-3911-4438","position":8,"is_corresponding":false},{"id":519180,"name":"Jonathan W. Lischalk","orcid":"0000-0002-3714-7757","position":9,"is_corresponding":false},{"id":1051716,"name":"Katharina Seidensaal","orcid":"0000-0001-5969-6426","position":10,"is_corresponding":false},{"id":1051717,"name":"Denise Bernhardt","orcid":"0000-0001-5231-9097","position":11,"is_corresponding":false},{"id":1052348,"name":"Christine Jungk","orcid":null,"position":12,"is_corresponding":false},{"id":70093,"name":"Andreas Unterberg","orcid":"0000-0003-3742-3288","position":13,"is_corresponding":false},{"id":663102,"name":"Antje Wick","orcid":"0000-0003-0020-6386","position":14,"is_corresponding":false},{"id":247462,"name":"Wolfgang Wick","orcid":"0000-0002-6171-634X","position":15,"is_corresponding":false},{"id":70094,"name":"Andreas von Deimling","orcid":"0000-0002-5863-540X","position":16,"is_corresponding":false},{"id":475118,"name":"Felix Sahm","orcid":"0000-0001-5441-1962","position":17,"is_corresponding":false},{"id":71387,"name":"Stephanie E. 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