Overall survival benefit associated with adjuvant radiotherapy in WHO grade II meningioma

Wang, Chenyang; Kaprealian, Tania; Suh, John H.; Kubicky, Charlotte Dai; Ciporen, Jeremy N.; Chen, Yiyi; Jaboin, Jerry J.

doi:10.1093/neuonc/nox007

Cited by 78 publications

(44 citation statements)

References 34 publications

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“…14,21,23 Moreover, radiotherapy/radiosurgery after resection has been reported for large or atypical/anaplastic tumors. 13,16,26 Adjuvant radiotherapy has also been used among patients with spinal meningioma who had a concurrent or previous cranial meningioma. 19 Results from the present study are consistent with the previous literature, showing increased odds of radiation use with tumors that are larger and with borderline or malignant behavior.…”

Section: Discussionmentioning

confidence: 99%

Trends in the utilization of radiotherapy for spinal meningiomas: insights from the 2004–2015 National Cancer Database

Yolcu¹,

Goyal²,

Alvi³

et al. 2019

Neurosurgical Focus

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OBJECTIVERecent studies have reported on the utility of radiosurgery for local control and symptom relief in spinal meningioma. The authors sought to evaluate national utilization trends in radiotherapy (including radiosurgery), investigate possible factors associated with its use in patients with spinal meningioma, and its impact on survival for atypical tumors.METHODSUsing the ICD-O-3 topographical codes C70.1, C72.0, and C72.1 and histological codes 9530–9535 and 9537–9539, the authors queried the National Cancer Database for patients in whom spinal meningioma had been diagnosed between 2004 and 2015. Patients who had undergone radiation in addition to surgery and those who had received radiation as the only treatment were analyzed for factors associated with each treatment.RESULTSFrom among 10,458 patients with spinal meningioma in the database, the authors found a total of 268 patients who had received any type of radiation. The patients were divided into two main groups for the analysis of radiation alone (137 [51.1%]) and radiation plus surgery (131 [48.9%]). An age > 69 years (p < 0.001), male sex (p = 0.03), and tumor size 5 to < 6 cm (p < 0.001) were found to be associated with significantly higher odds of receiving radiation alone, whereas a Charlson-Deyo Comorbidity Index ≥ 2 (p = 0.01) was associated with significantly lower odds of receiving radiation alone. Moreover, a larger tumor size (2 to < 3 cm, p = 0.01; 3 to < 4 cm, p < 0.001; 4 to < 5 cm, p < 0.001; 5 to < 6 cm, p < 0.001; and ≥ 6 cm, p < 0.001; reference = 1 to < 2 cm), as well as borderline (p < 0.001) and malignant (p < 0.001) tumors were found to be associated with increased odds of undergoing radiation in addition to surgery. Receiving adjuvant radiation conferred a significant reduction in overall mortality among patients with borderline or malignant spinal meningiomas (HR 2.12, 95% CI 1.02–4.1, p = 0.02).CONCLUSIONSThe current analysis of cases from a national cancer database revealed a small increase in the use of radiation for the management of spinal meningioma without a significant increase in overall survival. Larger tumor size and borderline or malignant behavior were found to be associated with increased radiation use. Data in the present analysis failed to show an overall survival benefit in utilizing adjuvant radiation for atypical tumors.

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Section: Discussionmentioning

confidence: 99%

Trends in the utilization of radiotherapy for spinal meningiomas: insights from the 2004–2015 National Cancer Database

Yolcu¹,

Goyal²,

Alvi³

et al. 2019

Neurosurgical Focus

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“…In the recent decade, the efficacy of adjuvant radiotherapy has been demonstrated for high-grade meningiomas [15][16][17]. Hilary et al demonstrated that adjuvant radiotherapy for meningiomas resected with Simpson grade I-III improved local control rates [16].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Clinical Outcome of First Recurrence Skull Base Meningiomas

Kuranari

Tamura

Tsuda

et al. 2019

JCM

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Skull base meningiomas (SBMs) are considered to be less aggressive and have a slower growth rate than non-SBMs. However, SBMs often develop local recurrences after surgical resection. Gross total removal is difficult because SBMs are deep-seated tumors and involve critical neurovascular structures. The treatment strategy for recurrent SBMs remains controversial. The present study aimed to evaluate the long-term clinical course and prognostic factors associated with shorter progression-free survival (PFS) of recurrent SBMs. This retrospective study included 85 recurrent SBMs from 65 patients who underwent surgery from January 2005 to September 2018. Overall survival (OS) and PFS were evaluated, and the associations among shorter PFS and age, sex, tumor size, lesions, World Health Organization (WHO) grading, removal rate, and time since prior surgery were analyzed. The median follow-up period for PFS was 68 months. The 2-, 5-, and 10-year PFS rates were 68.0%, 52.8%, and 22.7%, respectively. WHO grade II or III, multiple lesions, and tumor size were significantly associated with shorter PFS (p < 0.0001, p = 0.030, and p = 0.173, respectively). Although, radiotherapy did not improve PFS and OS for overall patients, PFS of the patients with subtotal and partial removal for WHO grade II SBMs was significantly improved by the radiotherapy. Multivariate analysis identified WHO grade II or III and multiple lesions as independent prognostic factors for shorter PFS (p < 0.0001 and p = 0.040, respectively). It is essential to estimate the risks associated with shorter PFS for patients with recurrent SBMs to aid in the development of appropriate postoperative strategies.

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“…95 A large retrospective study found that adjuvant radiotherapy following surgery of atypical meningiomas was associated with improved overall survival (OS) only in patients who underwent subtotal resection but not gross total resection. 96 The benefits of radiation should be weighed against the potential risks, with a 3.4 to 16.7% rate of treatment-related toxicity including cerebral necrosis, neurocognitive impairment, hypopituitarism, and radiation-induced tumors. 95 Two large phase II trials evaluating the efficacy and optimum dose of radiotherapy have recently finished accrual.…”

Section: Surgery and Radiationmentioning

confidence: 99%

Meningiomas: Overview and New Directions in Therapy

Wang

Osswald

2018

Semin Neurol

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The majority of meningiomas, the most common primary brain tumor, are considered to be benign, and characteristic magnetic resonance imaging features allow a preliminary diagnosis. Meningiomas can be classified in the World Health Organization system as grade I, II, or III, depending on various histological features. In many cases, observation is the preferred management option, although this means the absence of a histological diagnosis. If necessary, standard therapy consists of surgery with or without adjuvant radiation, depending on the tumor grade and the degree of resection. To date, systemic therapies are not included in the standard of care. The level of evidence for treatment recommendations is low, and effective treatment regimens, especially for surgery-refractory and radiation-refractory meningiomas, are still very limited. Recent studies have broadened our knowledge of the genetics and pathogenesis of meningiomas and will lead to new therapeutic options. This review summarizes the epidemiology, pathogenesis and genetics, classification, and diagnosis of meningiomas, as well as management principles, including promising new avenues of therapy.

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Overall survival benefit associated with adjuvant radiotherapy in WHO grade II meningioma

Abstract: Despite the lack of consensus on whether adjuvant RT reduces recurrence after surgical resection of AM, our study observed significantly improved OS with adjuvant RT compared with no adjuvant RT after STR.

Cited by 78 publications

References 34 publications

Trends in the utilization of radiotherapy for spinal meningiomas: insights from the 2004–2015 National Cancer Database

Trends in the utilization of radiotherapy for spinal meningiomas: insights from the 2004–2015 National Cancer Database

Long-Term Clinical Outcome of First Recurrence Skull Base Meningiomas

Meningiomas: Overview and New Directions in Therapy

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