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

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Recent 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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Using 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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>From 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 &gt; 69 years (p &lt; 0.001), male sex (p = 0.03), and tumor size 5 to &lt; 6 cm (p &lt; 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 &lt; 3 cm, p = 0.01; 3 to &lt; 4 cm, p &lt; 0.001; 4 to &lt; 5 cm, p &lt; 0.001; 5 to &lt; 6 cm, p &lt; 0.001; and ≥ 6 cm, p &lt; 0.001; reference = 1 to &lt; 2 cm), as well as borderline (p &lt; 0.001) and malignant (p &lt; 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).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The 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.</jats:p></jats:sec>

Current knowledge on spinal meningiomas: a systematic review protocol

“…These findings are consistent with the results of a quality-of-life questionnaire our group conducted on 84 spinal meningioma patients at an average of 8.7 years after surgery 33. The need for alternative or adjuvant therapies is emphasised in the literature, especially for recurring tumours refractory to conventional therapies and higher-grade tumours (WHO II–III) or for patients who are poor surgical candidates 28 34. In these cases, other treatment modalities, including targeted, hormonal, micro-RNA or different forms of radiation therapy, may have to be explored.…”

“…The available literature covers many aspects of spinal meningiomas, such as incidence,2 8 46 age2 4 and gender distribution,2 4 7 8 treatments and their outcomes,4 47 48 but many studies are limited by small sample3 48–56 sizes and short follow-up times 3 50 52 57. Regarding the effect of preoperative neurological impairment, tumour grade and size on postoperative outcomes3 30 50 52–59 and adjuvant therapies,28 34 the available data are conflicting. These issues will be addressed by the systematic review’s design, as integrating data from diverse origins will allow for a more representative synthesis that reflects the population of patients with spinal meningiomas more accurately 60.…”

A giant nondural-based lumbosacral clear cell meningioma mimicking schwannoma: A case report and review of the literature

“…Adjuvant radiotherapy in Grade II meningioma is usually not recommended when GTR is achieved. [ 28 29 ] However, in the case of subtotal excision, multiple lesions, or concurrent/previous cranial meningioma, it is usually recommended by most of the authors. [ 29 30 31 32 ] However, adjuvant radiotherapy after GTR has been suggested by a few authors.…”

“…[28,29] However, in the case of subtotal excision, multiple lesions, or concurrent/previous cranial meningioma, it is usually recommended by most of the authors. [29][30][31][32] However, adjuvant radiotherapy after GTR has been suggested by a few authors. [33] Tao et al in their study reported that radiotherapy should not be performed immediately after the first operation for spinal CCMs, because the recurrence rate is lower than that for intracranial CCMs.…”

“…[33] Tao et al in their study reported that radiotherapy should not be performed immediately after the first operation for spinal CCMs, because the recurrence rate is lower than that for intracranial CCMs. [28] Most of the literature reported no significant benefit of adjuvant radiotherapy in overall survival over GTR alone, [29][30][31][32] but significant improvements in progression-free survival have been reported. [34] We have achieved GTR in our patient; hence, adjuvant radiotherapy was not given.…”