{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:42:48Z","timestamp":1791924168270,"version":"4.3.4"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T00:00:00Z","timestamp":1624579200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T00:00:00Z","timestamp":1624579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Medizinische Fakult\u00e4t, Eberhard Karls Universit\u00e4t T\u00fcbingen","award":["Junior Clinician Scientist Application No. 444-0-0"],"award-info":[{"award-number":["Junior Clinician Scientist Application No. 444-0-0"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Radiat Oncol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Atypical meningiomas exhibit a high tendency for tumor recurrence even after multimodal therapy. Information regarding recurrence patterns after additive radiotherapy is scarce but could improve radiotherapy planning and therapy decision. We conducted an analysis of recurrence patterns with regard to target volumes and dose coverage assessing target volume definition and postulated areas of tumor re-growth origin. Prognostic factors contributing to relapse were evaluated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The clinical outcome of patients who had completed additive, somatostatin receptor (SSTR)-PET\/CT-based fractionated intensity-modulated radiotherapy for atypical meningioma between 2007 and 2017 was analyzed. In case of tumor recurrence\/progression, treatment planning was evaluated for coverage of the initial target volumes and the recurrent tumor tissue. We proposed a model evaluating the dose distribution in postulated areas of tumor re-growth origin. The median of proliferation marker MIB-1 was assessed as a prognostic factor for local progression and new distant tumor lesions.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>\n  Data from 31 patients who had received adjuvant (n\u2009=\u200911) or salvage radiotherapy (n\u2009=\u200920) were evaluated. Prescribed dose ranged from 54.0 to 60.0\u00a0Gy. Local control at five years was 67.9%. Analysis of treatment plans of the eight patients experiencing local failure proved sufficient extent of target volumes and coverage of the prescribed dose of at least 50.0\u00a0Gy as determined by mean dose, D98, D2, and equivalent uniform dose (EUD) of all initial target volumes, postulated growth-areas, and areas of recurrent tumor tissue. In all cases, local failure occurred in high-dose volumes. Tumors with a MIB-1 expression above the median (8%) showed a higher tendency for re-growth.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The model showed adequate target volume and relative dose distribution but absolute dose appears lower in recurrent tumors without reaching statistical significance. This might provide a rationale for dose escalation studies. Biological factors such as MIB-1 might aid patients\u2019 stratification for dose escalation.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13014-021-01825-2","type":"journal-article","created":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T12:02:29Z","timestamp":1624622549000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Retrospective analysis of recurrence patterns and clinical outcome of grade II meningiomas following postoperative radiotherapy"],"prefix":"10.1186","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9214-919X","authenticated-orcid":false,"given":"Elgin","family":"Hoffmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Clasen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Frey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob","family":"Ehlers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Behling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Skardelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Bender","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Schittenhelm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Reimold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghazaleh","family":"Tabatabai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Zips","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franziska","family":"Eckert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Paulsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,6,25]]},"reference":[{"issue":"6","key":"1825_CR1","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1007\/s00401-016-1545-1","volume":"131","author":"DN Louis","year":"2016","unstructured":"Louis DN, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016;131(6):803\u201320.","journal-title":"Acta Neuropathol"},{"issue":"2","key":"1825_CR2","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1007\/s11060-014-1507-1","volume":"119","author":"Y Choi","year":"2014","unstructured":"Choi Y, et al. Efficacy of postoperative radiotherapy for high grade meningiomas. J Neurooncol. 2014;119(2):405\u201312.","journal-title":"J Neurooncol"},{"issue":"1","key":"1825_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11060-014-1620-1","volume":"121","author":"MD Jenkinson","year":"2015","unstructured":"Jenkinson MD, et al. Atypical meningoma: current management dilemmas and prospective clinical trials. J Neurooncol. 2015;121(1):1\u20137.","journal-title":"J Neurooncol"},{"issue":"9","key":"1825_CR4","doi-asserted-by":"publisher","first-page":"e383-91","DOI":"10.1016\/S1470-2045(16)30321-7","volume":"17","author":"R Goldbrunner","year":"2016","unstructured":"Goldbrunner R, et al. EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol. 2016;17(9):e383-91.","journal-title":"Lancet Oncol"},{"issue":"2","key":"1825_CR5","doi-asserted-by":"publisher","first-page":"202","DOI":"10.3171\/2010.1.JNS091114","volume":"113","author":"ME Sughrue","year":"2010","unstructured":"Sughrue ME, et al. Outcome and survival following primary and repeat surgery for World Health Organization Grade III meningiomas. J Neurosurg. 2010;113(2):202\u20139.","journal-title":"J Neurosurg"},{"key":"1825_CR6","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.jocn.2015.09.021","volume":"28","author":"MD Jenkinson","year":"2016","unstructured":"Jenkinson MD, et al. Early adjuvant radiotherapy in the treatment of atypical meningioma. J Clin Neurosci. 2016;28:87\u201392.","journal-title":"J Clin Neurosci"},{"issue":"3","key":"1825_CR7","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1007\/s10143-018-0959-8","volume":"42","author":"BJA Pereira","year":"2019","unstructured":"Pereira BJA, et al. Impact of radiotherapy in atypical meningioma recurrence: literature review. Neurosurg Rev. 2019;42(3):631\u20137.","journal-title":"Neurosurg Rev"},{"issue":"1","key":"1825_CR8","doi-asserted-by":"publisher","first-page":"35","DOI":"10.3171\/2016.11.JNS161170","volume":"129","author":"L Rogers","year":"2018","unstructured":"Rogers L, et al. Intermediate-risk meningioma: initial outcomes from NRG Oncology RTOG 0539. J Neurosurg. 2018;129(1):35\u201347.","journal-title":"J Neurosurg"},{"issue":"4","key":"1825_CR9","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1016\/j.ijrobp.2019.11.028","volume":"106","author":"CL Rogers","year":"2020","unstructured":"Rogers CL, et al. High-risk meningioma: initial outcomes from NRG Oncology\/RTOG 0539. Int J Radiat Oncol Biol Phys. 2020;106(4):790\u20139.","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"1","key":"1825_CR10","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1186\/s13014-018-1056-4","volume":"13","author":"B Zollner","year":"2018","unstructured":"Zollner B, et al. Recurrence pattern analysis after [(68)Ga]-DOTATATE-PET\/CT-planned radiotherapy of high-grade meningiomas. Radiat Oncol. 2018;13(1):110.","journal-title":"Radiat Oncol"},{"key":"1825_CR11","doi-asserted-by":"crossref","unstructured":"Rajkrishna B, Patricia RBS, Selvamani B. Patterns of recurrence in patients receiving conformal radiation for intracranial meningioma: a single-institution experience. J Radiother Pract. 2020.","DOI":"10.1017\/S1460396920000539"},{"issue":"11","key":"1825_CR12","doi-asserted-by":"publisher","first-page":"1571","DOI":"10.1080\/0284186X.2017.1372626","volume":"56","author":"S Boeke","year":"2017","unstructured":"Boeke S, et al. Geometric analysis of loco-regional recurrences in relation to pre-treatment hypoxia in patients with head and neck cancer. Acta Oncol. 2017;56(11):1571\u20136.","journal-title":"Acta Oncol"},{"issue":"1","key":"1825_CR13","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1186\/s13014-019-1341-x","volume":"14","author":"K Zwirner","year":"2019","unstructured":"Zwirner K, et al. Integrative assessment of brain and bone invasion in meningioma patients. Radiat Oncol. 2019;14(1):132.","journal-title":"Radiat Oncol"},{"issue":"9","key":"1825_CR14","doi-asserted-by":"publisher","first-page":"970","DOI":"10.1053\/hupa.2001.27119","volume":"32","author":"VJ Amatya","year":"2001","unstructured":"Amatya VJ, et al. Immunohistochemical study of Ki-67 (MIB-1), p53 protein, p21WAF1, and p27KIP1 expression in benign, atypical, and anaplastic meningiomas. Hum Pathol. 2001;32(9):970\u20135.","journal-title":"Hum Pathol"},{"issue":"6B","key":"1825_CR15","first-page":"2717","volume":"15","author":"SM Veronese","year":"1995","unstructured":"Veronese SM, Maisano C, Scibilia J. Comparative prognostic value of Ki-67 and MIB-1 proliferation indices in breast cancer. Anticancer Res. 1995;15(6B):2717\u201322.","journal-title":"Anticancer Res"},{"key":"1825_CR16","doi-asserted-by":"crossref","unstructured":"Alber M, Laub BM, N\u00fcsslin WF.\u00a0Hyperion: an integrated IMRT planning tool. Schlegel W., Bortfeld T, editors 2000.","DOI":"10.1007\/978-3-642-59758-9_17"},{"issue":"12","key":"1825_CR17","doi-asserted-by":"publisher","first-page":"3229","DOI":"10.1088\/0031-9155\/46\/12\/311","volume":"46","author":"M Alber","year":"2001","unstructured":"Alber M, Nusslin F. Optimization of intensity modulated radiotherapy under constraints for static and dynamic MLC delivery. Phys Med Biol. 2001;46(12):3229\u201339.","journal-title":"Phys Med Biol"},{"issue":"4","key":"1825_CR18","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1016\/j.ijrobp.2014.07.027","volume":"90","author":"S Adeberg","year":"2014","unstructured":"Adeberg S, et al. Glioblastoma recurrence patterns after radiation therapy with regard to the subventricular zone. Int J Radiat Oncol Biol Phys. 2014;90(4):886\u201393.","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"1825_CR19","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1186\/1748-717X-8-97","volume":"8","author":"K Ogura","year":"2013","unstructured":"Ogura K, et al. Initial and cumulative recurrence patterns of glioblastoma after temozolomide-based chemoradiotherapy and salvage treatment: a retrospective cohort study in a single institution. Radiat Oncol. 2013;8:97.","journal-title":"Radiat Oncol"},{"key":"1825_CR20","doi-asserted-by":"publisher","first-page":"e1536","DOI":"10.1016\/j.wneu.2018.11.097","volume":"122","author":"BJ Araujo Pereira","year":"2019","unstructured":"Araujo Pereira BJ, et al. Multiple intracranial meningiomas: a case series and review of the literature. World Neurosurg. 2019;122:e1536\u201341.","journal-title":"World Neurosurg"},{"key":"1825_CR21","doi-asserted-by":"crossref","unstructured":"Landberg T. Report 50. J Int Comm Radiat Units Meas. 1993;os26(1).","DOI":"10.1093\/jicru\/os26.1.Report50"},{"key":"1825_CR22","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.radonc.2020.11.014","volume":"156","author":"SE Combs","year":"2020","unstructured":"Combs SE, et al. ESTRO ACROP guideline for target volume delineation of skull base tumors. Radiother Oncol. 2020;156:80\u201394.","journal-title":"Radiother Oncol"},{"key":"1825_CR23","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1186\/1748-717X-4-56","volume":"4","author":"B Gehler","year":"2009","unstructured":"Gehler B, et al. [68Ga]-DOTATOC-PET\/CT for meningioma IMRT treatment planning. Radiat Oncol. 2009;4:56.","journal-title":"Radiat Oncol"},{"issue":"6","key":"1825_CR24","doi-asserted-by":"publisher","first-page":"607","DOI":"10.7785\/tcrt.2012.500267","volume":"11","author":"AW Chan","year":"2012","unstructured":"Chan AW, et al. Dose escalation with proton radiation therapy for high-grade meningiomas. Technol Cancer Res Treat. 2012;11(6):607\u201314.","journal-title":"Technol Cancer Res Treat"},{"issue":"1","key":"1825_CR25","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1186\/s13014-019-1397-7","volume":"14","author":"C Alfredo","year":"2019","unstructured":"Alfredo C, et al. Normofractionated stereotactic radiotherapy versus CyberKnife-based hypofractionation in skull base meningioma: a German and Italian pooled cohort analysis. Radiat Oncol. 2019;14(1):201.","journal-title":"Radiat Oncol"},{"key":"1825_CR26","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s40064-015-0804-2","volume":"4","author":"A Conti","year":"2015","unstructured":"Conti A, et al. CyberKnife multisession stereotactic radiosurgery and hypofractionated stereotactic radiotherapy for perioptic meningiomas: intermediate-term results and radiobiological considerations. Springerplus. 2015;4:37.","journal-title":"Springerplus"},{"issue":"3 Suppl","key":"1825_CR27","first-page":"S20-7","volume":"76","author":"YR Lawrence","year":"2010","unstructured":"Lawrence YR, et al. Radiation dose-volume effects in the brain. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S20-7.","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"2","key":"1825_CR28","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1016\/j.radonc.2018.06.018","volume":"128","author":"DC Weber","year":"2018","unstructured":"Weber DC, et al. Adjuvant postoperative high-dose radiotherapy for atypical and malignant meningioma: a phase-II parallel non-randomized and observation study (EORTC 22042\u201326042). Radiother Oncol. 2018;128(2):260\u20135.","journal-title":"Radiother Oncol"},{"issue":"1","key":"1825_CR29","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/j.ijrobp.2020.08.015","volume":"109","author":"G Lee","year":"2021","unstructured":"Lee G, et al. Adjuvant radiation therapy versus surveillance after surgical resection of atypical meningiomas. Int J Radiat Oncol Biol Phys. 2021;109(1):252\u201366.","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"2","key":"1825_CR30","doi-asserted-by":"publisher","first-page":"443","DOI":"10.3171\/2017.9.JNS171609","volume":"130","author":"WC Chen","year":"2018","unstructured":"Chen WC, et al. Histopathological features predictive of local control of atypical meningioma after surgery and adjuvant radiotherapy. J Neurosurg. 2018;130(2):443\u201350.","journal-title":"J Neurosurg"},{"issue":"12","key":"1825_CR31","doi-asserted-by":"publisher","first-page":"1420","DOI":"10.1016\/S0046-8177(98)90010-7","volume":"29","author":"CM Abramovich","year":"1998","unstructured":"Abramovich CM, Prayson RA. MIB-1 labeling indices in benign, aggressive, and malignant meningiomas: a study of 90 tumors. Hum Pathol. 1998;29(12):1420\u20137.","journal-title":"Hum Pathol"},{"issue":"9","key":"1825_CR32","doi-asserted-by":"publisher","first-page":"970","DOI":"10.1053\/hupa.2001.27119","volume":"32","author":"VJ Amatya","year":"2001","unstructured":"Amatya VJ, et al. Immunohistochemical study of Ki-67 (MIB-1), p53 protein, p21WAF1, and p27KIP1 expression in benign, atypical, and anaplastic meningiomas. Hum Pathol. 2001;32(9):970\u20135.","journal-title":"Hum Pathol"},{"issue":"5","key":"1825_CR33","doi-asserted-by":"publisher","first-page":"e97108","DOI":"10.1371\/journal.pone.0097108","volume":"9","author":"S Yamaguchi","year":"2014","unstructured":"Yamaguchi S, et al. Prognostic factors for survival in patients with high-grade meningioma and recurrence-risk stratification for application of radiotherapy. PLoS One. 2014;9(5):e97108.","journal-title":"PLoS One"}],"container-title":["Radiation Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13014-021-01825-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13014-021-01825-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13014-021-01825-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T10:10:14Z","timestamp":1635243014000},"score":1,"resource":{"primary":{"URL":"https:\/\/ro-journal.biomedcentral.com\/articles\/10.1186\/s13014-021-01825-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,25]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1825"],"URL":"https:\/\/doi.org\/10.1186\/s13014-021-01825-2","relation":{},"ISSN":["1748-717X"],"issn-type":[{"value":"1748-717X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,25]]},"assertion":[{"value":"23 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 June 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the local ethics committee Tuebingen, Germany (417\/2017B02) and follows the principles of the Declaration of Helsinki.  For this type of retrospective study formal consent is not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"GT reports personal fees (advisory board, speaker`s fees) from AbbVie, Bayer, Bristol-Myers-Squibb, Medac, Novocure, travel grants from Bristol-Myers-Squibb, educational and travel grants from Novocure, research grants from Roche Diagnostics, research and travel grants from Medac. The other authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"116"}}