Role of external beam radiotherapy in the treatment of relapsing meningioma

Abstract

The role of radiotherapy in the treatment of relapsing meningiomas is not well established. Data of patients treated with radiotherapy for a relapsing meningioma were retrospectively analyzed. Overall survival (OS) was the primary endpoint of the analysis. Local control and acute and late toxicity rates have been also reported. From April 1986 to February 2011, 37 patients with a diagnosis of recurrent meningioma were treated. Median age was 64 years (range 36-79). A total of 18, 10, 5 and 4 patients were affected by relapsing benign, atypical, malignant meningiomas and meningiosarcomas, respectively (WHO classification). Median dose was 60 Gy (range 46-66 Gy). The median follow-up was 42 months (range 3-300 months). OS at 1, 3, 5 and 8 years was 81, 55.6, 43.9 and 25.8%, respectively (median OS 45 months). A strong statistical trend was observed toward better OS rates in patients treated with radiotherapy at first recurrence compared to those treated at the second (or more) recurrence (OS 50.5 vs. 30.8%, p=0.055). A statistical impact of the histology (WHO I vs. II, III and IV) on 5-year OS was also observed (OS 60 vs. 30%, 0 and 0%, p=0.010). Radiotherapy has been well tolerated, with no G2-4 neurological toxicity (RTOG toxicity score). Conventional radiation therapy has an important role in multidisciplinary approach in the treatment of recurrence of meningiomas. The histological type and the timing of the radiotherapy are prognostic factors in terms of survival.

Surgical management of giant sphenoid wing meningiomas encasing major cerebral arteries

“…2,7,13,20 However, recent studies assessing volume rather than diameter of residual tumor have demonstrated a significant recurrence in a short time span following radiation therapy. 21 We must insist on the importance of aiming to remove as much of the tumor as possible when complete resection is not possible.…”

The Role of Adjuvant Radiotherapy After Gross Total Resection of Atypical Meningiomas

“…Therefore, we deemed that including these patients in our study would result in additional limitations to our meta-analysis. Furthermore, patients with Simpson Grade IV and V excisions were excluded because in such patients recurrence rates were shown to be higher and survival rates lower in previous studies (3,9,13,35). All data gathered from experiments on human subjects were conducted in accordance with the Declaration of Helsinki.…”

Fractionated radiotherapy and radiosurgery of intracranial meningiomas

“…Recurrent meningiomas after the first surgery exhibit a more aggressive course than newly diagnosed meningiomas [53]. As several studies show improved salvage control rates with surgery plus RT, or radiation alone versus surgery alone [44,54], the National Comprehensive Cancer Network (NCCN) has advised that recurrent a meningioma should be resected if possible, and an adjuvant RT should be delivered [53].…”

“…As several studies show improved salvage control rates with surgery plus RT, or radiation alone versus surgery alone [44,54], the National Comprehensive Cancer Network (NCCN) has advised that recurrent a meningioma should be resected if possible, and an adjuvant RT should be delivered [53]. Non-surgical patients should receive RT alone, chemotherapy being reserved for meningioma progressing after RT [55].…”