Boron Neutron Capture Therapy for Malignant Meningiomas
The management of malignant meningioma (MM) is very difficult. In a large series of patients with this tumor, the MM recurrence rate was reported to be 78–84 % within 5 years, and the median survival of patients 6.89 years. Late mortality due to recurrenc
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Shinji Kawabata and Shin-Ichi Miyatake
Contents 22.1 Introduction ................................................................................................................... 399 22.2 Patients and Methods.................................................................................................... 400 22.3 Results ............................................................................................................................ 400 22.3.1 Parameters of BNCT in Each Patient ................................................................ 400 22.3.2 Representative Cases......................................................................................... 401 22.4 Discussion ....................................................................................................................... 403 References ................................................................................................................................. 405
22.1
Introduction
The management of malignant meningioma (MM) is very difficult. In a large series of patients with this tumor, the MM recurrence rate was reported to be 78–84 % within 5 years [4, 12], and the median survival of patients 6.89 years. Late mortality due to recurrence was to be 69 % after the initial surgery [12]. Although some treatments for recurrent MM have been reported, a standard treatment has not yet been developed. We propose here a novel radiation modality, boron neutron capture therapy (BNCT), for the treatment of MMs. The rationale for BNCT for MMs was that a relatively high accumulation of boronophenylalanine (BPA) was observed in MM in the preliminary study by positron emission tomography (PET) [16]. The first case of MM treated by BNCT showed a drastic shrinkage of the mass immediately after BNCT with prolonged survival [16]. Therefore, we applied this novel treatment for a series of MM patients, and their radiographic improvements were reported elsewhere [9]. S. Kawabata • S.-I. Miyatake (*) Department of Neurosurgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan e-mail: [email protected] W.A.G. Sauerwein et al. (eds.), Neutron Capture Therapy, DOI 10.1007/978-3-642-31334-9_22, © Springer-Verlag Berlin Heidelberg 2012
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S. Kawabata and S.-I. Miyatake
In this chapter, we describe our clinical experiences with treating MM by BNCT and the patients’ typical responses, clinical courses, and problems after the treatment.
22.2
Patients and Methods
Fourteen cases of MM were treated by 22 rounds of BNCT from 2005 to 2008. Repetitive BNCTs were applied in several cases intentionally. These 14 cases were histologically diagnosed with anaplastic meningioma in 9 cases, papillary meningioma in 2, rhabdoid meningioma in 1, sarcoma in 1, and atypical meningioma in 1. All cases except one were recurrent cases that had been treated with repetitive surgery and conventional X-ray radiotherapy (XRT) with and without stereotactic radiosurgery (SRS). The patients received 18F-BPA-PET to a
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