Effectiveness of Postoperative Radiotherapy on Atypical Meningioma Patients: A Population-Based Study

Abstract

Purpose: It is controversial whether atypical meningioma patients undergoing gross-total resection (GTR) can benefit from postoperative radiotherapy (PORT). This study aimed to investigate the effectiveness of PORT on atypical meningioma patients.Methods: Patients diagnosed with atypical meningioma from 2008 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan–Meier survival curves were generated, and the log-rank test was used to compare the differences among groups. Univariable and multivariable COX regressions were conducted for survival analyses.Results: A total of 1,014 patients were enrolled. The 5-years survival rate of the overall patients was 79.0%. PORT was performed in 315 (31.1%) patients. The utilization rates of PORT in patients undergoing GTR and undergoing subtotal resection (STR) were 26.7% and 42.2%, respectively. For patients undergoing STR, log-rank test showed that overall survival (OS) time was significantly longer in patients receiving PORT than those not (p = 0.026). For patients undergoing GTR, OS time did not show significant association with PORT (p = 0.339). In addition, patients undergoing STR with PORT had no significantly different OS time compared with those undergoing GTR with PORT (p = 0.398). Multivariable Cox regression analysis showed that receipt of PORT (p = 0.187) was not an independent predictor of OS after adjustment.Conclusion: PORT may not prolong the OS in atypical meningioma patients undergoing GTR. However, patients undergoing STR may benefit from PORT and achieve similar OS to those undergoing GTR.

Effectiveness of Postoperative Adjuvant Radiotherapy in Atypical Meningioma Patients After Gross Total Resection: A Meta-Analysis Study

“…It was showed that patients without PORT after STR had worse PFS ( 16 ). Recently, Chenyang Wang et al ( 30 ) found that PORT could significantly improve OS in AM patients who underwent STR ( 30 ), which was consistent with our previous finding ( 27 ). Currently, PORT has been routinely recommended for AM patients who underwent STR ( 6 , 31 ).…”

“…A recent study based on the National Cancer Database found that PORT and GTR were both associated with improved survival for AM patients ( 26 ). Whereas our recent study based on the Surveillance, Epidemiology, and End Results database found that PORT might not prolong the overall survival (OS) in AM patients undergoing GTR ( 27 ).…”

Adjuvant radiotherapy versus observation following gross total resection for atypical meningioma: a systematic review and meta-analysis

“…In the current meta-analysis, there was no statistical difference in pooled OS for any period between adjuvant RT and observation cohorts, in line with results of included individual studies [ 39 , 40 ]. Zeng et al have reported that the OS of AM patients who undergo GTR only is similar to that of patients who receive adjuvant RT after GTR or STR regardless of the extent of resection [ 40 ]. The extent of resection for AM can be an overwhelmingly significant factor to improve the OS, enough to conceal the effect of adjuvant RT.…”

“…The attrition bias was high in 11 studies with missing data because of restriction in follow-up duration or loss to follow-up for analyzing the outcome [ 3 , 10 , 30 , 35 , 36 , 39 – 43 , 45 ]. The risk of reporting bias was high in five studies that did not report the recurrence number or the percentage of each cohort [ 26 , 34 , 37 , 40 , 41 ].…”

High risk of recurrence for grade II meningioma: a 10-year multicenter analysis of prognosis factors

“…RT was significantly associated with shorter recurrencefree survival time (P<0.0001) but without impact on OS (P=0.88) (24). In previous study with a large sample size, adjuvant radiotherapy was not a prognostic factor for survival in the overall population (P=0.187), but for patients with subtotal resection, adjuvant radiotherapy significantly improved OS (P=0.026) (25). Wang et al showed a lower recurrence rate for patients treated with subtotal resection followed by adjuvant radiotherapy (P=0.023) (26).…”