Systematic review and meta-analysis of proton therapy for intracranial meningioma reports pooled outcomes

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Neurosurgical review Published May 9, 2026 Medically reviewed May 12, 2026 Study authors: Wijaya Jeremiah Hillkiah, Elashry Abdelrahman Ramadan, Javaid Sarmad, Khaled Mohga, Jibu Bismon, Nar… PubMed ↗ DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider proton therapy for select meningioma patients, but interpret pooled outcomes cautiously due to high heterogeneity.

This systematic review and meta-analysis evaluated proton therapy for adult patients with intracranial meningioma, including 1,431 patients across included studies. The pooled complication rate was 16% (95% CI 5-27; p < 0.001; I² = 98.5%), indicating substantial heterogeneity. Five-year overall survival was 91% (95% CI 88-94; p < 0.001; I² = 49.3%), and radiologic local control was 71% (95% CI 50-86; I² = 88.2%). The authors note that the high heterogeneity across studies limits the precision of these estimates. The comparator was not reported, and the primary outcome was not specified. Safety assessment showed acceptable toxicity with a pooled complication rate of 16%, though serious adverse events and discontinuations were not reported. Limitations acknowledged include the need for further prospective studies to optimize dosing and assess long-term outcomes. The practice relevance is that proton therapy may be a valuable option for select patients, especially those with low-grade or anatomically complex meningiomas, but clinicians should interpret the pooled estimates cautiously given the high heterogeneity and lack of comparative data.

Study Details

Study typeMeta analysis

Sample sizen = 1,431

EvidenceLevel 1

Follow-up60.0 mo

PublishedMay 2026

PMID42104122

View Original Abstract ↓

Meningiomas are the most common primary intracranial tumors, often treated surgically. However, complete resection is frequently limited by proximity to critical structures, necessitating adjuvant or definitive radiotherapy. Proton therapy offers dosimetric advantages over photon-based radiotherapy, particularly in sparing adjacent normal tissues. This study aims to systematically evaluate the effectiveness and safety of proton therapy for intracranial meningiomas across tumor grades and clinical scenarios. A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines using PubMed, EMBASE, Scopus, Web of Science, and Cochrane from inception to November 10, 2025. Studies were eligible if they reported clinical outcomes of proton therapy in ≥ 10 adult meningioma patients. Data extraction and risk-of-bias assessment were performed independently by two reviewers. Pooled complication rates and survival outcomes were calculated using random-effects models. Nineteen studies involving 1,431 patients were included. WHO Grade I tumors comprised 70.6% of cases; Grades II/III made up 25.2% and 4.2%, respectively. The most common proton dose regimens ranged from 13 to 70.2 Gy (RBE). The pooled complication rate was 16% (95% CI 5-27; p < 0.001; I² = 98.5%). Nine studies reported a statistically significant 5-year overall-survival proportion of 91% (95% CI 88-94; p < 0.001; I² = 49.3%). Radiologic local control averaged 71% (95% CI 50-86; I² = 88.2%). Proton therapy provides effective tumor control with acceptable toxicity, especially for low-grade or anatomically complex meningiomas. It is a valuable option for select patients, though further prospective studies are needed to optimize dosing and assess long-term outcomes.