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Systematic review and meta-analysis of proton therapy for intracranial meningioma reports pooled outcomesProton therapy for brain tumors shows strong control with fewer side effects

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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.

Imagine a tumor growing near your brain's most vital areas. Surgeons cannot remove it all without risking serious damage. You need radiation, but you worry about harming healthy tissue. A newer type of radiation may offer a better path.

This treatment is called proton therapy. It uses a different type of energy than standard radiation. It aims to protect the healthy brain around the tumor. A new review looks at how well it works for meningiomas, the most common primary brain tumor.

Meningiomas are tumors that form in the layers covering the brain and spinal cord. Many are slow growing. But when they press on the brain or nerves, they can cause headaches, vision problems, or weakness. Surgery is often the first step. Sometimes, though, the tumor is too close to critical structures. This makes a complete removal risky.

In these cases, doctors often use radiation to stop the tumor from growing. Standard radiation uses X rays, which are called photons. These beams pass through the body and can affect healthy tissue along their path. This can lead to side effects, especially in the brain.

But here is the twist. Proton therapy works differently. It uses protons, which are tiny particles. Unlike photons, protons can be aimed to stop at a precise depth. They release most of their energy right at the tumor site. This means less radiation goes beyond the tumor to healthy brain tissue.

Think of it like a water sprinkler. Standard radiation is like a sprinkler that sprays water everywhere, even where you do not want it. Proton therapy is like a sprinkler that can be turned off exactly at the edge of the lawn. This precision is key when a tumor sits next to the brainstem or optic nerves.

The review looked at 19 studies covering 1,431 patients. Most patients had low grade tumors, which tend to grow slowly. About a quarter had more aggressive grades. The proton doses used varied, but most fell between 13 and 70 Gray.

The researchers pooled the data to see overall trends. They looked at how well the tumors were controlled and what side effects occurred. This method helps give a clearer picture than any single study alone.

This does not mean proton therapy is available for everyone right now.

The results showed a strong safety profile. The pooled rate of complications was about 16 percent. This means that for every 100 patients, roughly 16 had some side effect. These effects can range from mild to serious, depending on the case. The finding suggests the treatment is generally well tolerated.

Tumor control was also promising. The five year overall survival rate was 91 percent. This means that after five years, 91 out of 100 patients were still alive. Local control, which means the tumor did not grow, averaged 71 percent. This is a solid result for tumors that are often difficult to treat completely with surgery.

An expert perspective from the field notes that proton therapy is a valuable tool. It fits well for patients with tumors in complex locations. It also helps when a patient has already had radiation and needs more treatment. The review supports its use in select cases.

What does this mean for you or a loved one? If you have a meningioma near a critical brain area, ask your doctor about proton therapy. It is not a first line option for everyone. But it is a real choice for some patients. Discuss the benefits and risks with your care team.

It is important to be honest about the limitations. This review combines many different studies. Some studies were small. The follow up time was not always long. We still need more data on very long term effects and the best doses to use.

Looking ahead, more research is underway. Scientists are running larger trials to compare proton therapy directly with standard radiation. They want to find out which patients benefit most. As this work continues, we will learn more about how to use this tool safely and effectively.

Study Details

Study typeMeta analysis
Sample sizen = 1,431
EvidenceLevel 1
Follow-up60.0 mo
PublishedMay 2026
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.
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