Outcomes Following Upfront Radiation Versus Monitoring in Atypical Meningiomas: 16-year Experience at a Tertiary Medical Center

Overview

Journal Neurooncol Adv

Publisher Oxford University Press

Date 2021 Aug 4

PMID 34345823

Citations 4

Authors

Peter C Pan

David J Pisapia

Rohan Ramakrishna

Theodore H Schwartz

Susan C Pannullo

Jonathan P S Knisely

Gloria C Chiang

Jana Ivanidze

Philip E Stieg

Benjamin Liechty

Andrew Brandmaier

Howard A Fine

Rajiv S Magge

Affiliations

Soon will be listed here.

Abstract

Background: The role of postoperative upfront radiotherapy (RT) in the management of gross totally resected atypical meningiomas remains unclear. This single-center retrospective review of newly diagnosed histologically confirmed cases of World Health Organization (WHO) Grade II atypical meningioma at Weill Cornell Medicine from 2004 to 2020 aims to compare overall survival (OS) and progression-free survival (PFS) of postoperative upfront RT versus observation, stratified by resection status (gross total resection [GTR] vs subtotal resection [STR]).

Methods: Ninety cases of atypical meningioma were reviewed (56% women; median age 61 years; median follow-up 41 months).

Results: In patients with GTR, hazard ratio (HR) of PFS was 0.09 for postoperative upfront RT versus observation alone (95% confidence interval [CI] 0.01-0.68; = .02), though HR for OS was not significant (HR 0.46; 95% CI 0.05-4.45; = .5). With RT, PFS was 100% at 12 and 36 months (compared to 84% and 63%, respectively, with observation); OS at 36 months (OS36) was 100% (compared to 94% with observation). In patients with STR, though PFS at 36 months was higher for RT arm versus observation (84% vs 74%), OS36 was 100% in both arms. HR was not significant (HR 0.76; 95% CI 0.16-3.5; = .73).

Conclusions: This retrospective study suggests postoperative upfront RT following GTR of atypical meningioma is associated with improved PFS compared to observation. Further studies are required to draw conclusions about OS.

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