Adjuvant treatment of meningioma with stereotactic radiation surgery and hypofractionated stereotactic radiation surgery: Patterns of care and survival in a large, hospital database

Abstract

ObjectivesStereotactic radiation surgery (SRS) and hypofractionated stereotactic radiation surgery (HF-SRS) have become an alternative to external beam radiation therapy (EBRT) in the adjuvant treatment of meningiomas. The purpose of this study was to identify national treatment patterns and survival outcomes for meningiomas on the basis of radiation treatment modality in the adjuvant setting.Methods and materialsThe National Cancer Database was queried for patients with meningioma diagnosed between 2010 and 2012. World Health Organization grade I disease with subtotal resection and all cases of grade II disease regardless of the extent of the resection were included. Logistic regression was used to determine factors that were associated with receipt of SRS/HF-SRS compared with EBRT. Cox regression was used to determine covariables associated with differences in overall survival (OS).ResultsA total of 802 patients met the inclusion criteria of which 173 patients received SRS/HF-SRS (22%) and 629 patients (78%) received EBRT. The 3-year OS rate was 97.3% for the SRS/HF-SRS group and 93.4% for the EBRT group (P = .018). On subgroup analysis by grade, for grade I the 3-year OS rate was 98.3% for the SRS/HF-SRS group versus 96.7% for the EBRT group (P = .117). For grade II disease, the 3-year OS rate was 94.4% in the SRS/HF-SRS group versus 92.4% in the EBRT group (P = .199). On multivariable analysis, World Health Organization grade II histology (odds ratio [OR]: 0.34; 95% confidence interval [CI], 0.21-0.56; P < .001) and gross total resection (OR: 0.29; 95% CI, 0.15-0.57; P < .001) were associated with a decreased likelihood of receiving SRS/HF-SRS but private insurance (OR: 8.89; 95% CI, 1.15-68.47; P = .036) and Medicare (OR: 10.03; 95% CI, 1.28-78.69; P = .028) were associated with an increased likelihood of receiving SRS/HF-SRS. Year of diagnosis was not associated with receipt of SRS/HF-SRS. The multivariable Cox regression demonstrated a trend toward improved OS for treatment with SRS/HF-SRS (hazard ratio: 0.24; 95% CI, 0.06-1.03; P = .055).ConclusionsSRS and HF-SRS are associated with similar survival as EBRT; however, SRS/HF-SRS is used infrequently and usage has not increased over time.

Hypofractionated Stereotactic Radiotherapy for the Treatment of Benign Intracranial Meningiomas: Long-Term Safety and Efficacy

“…Notable reports include Han et al who compared hSRT with both SRS and cRT for the upfront treatment of ICMs and found no significant difference in the clinical response, late toxicities, or PFS [ 18 ]. In addition, Albert et al demonstrated a trend toward improved 3-year OS in post-operative patients receiving SRS or hSRT compared with cRT [ 19 ].…”

Overview of Radiosurgery for Intracranial Meningiomas

“…A total of 802 patients were included, of which 173 patients received SRS/SRT (22%) and 629 patients (78%) received external beam radiation therapy (EBRT). The 3-year overall survive rate of 2 treatments were similar (97.3% in SRS/SRT group and 93.4% in EBRT group) [9]. This chapter is intended to have an overview of radiosurgery as treatment of intracranial meningiomas.…”

“…Hypofractationated therapy by CyberKnife in meningioma treatment was reviewed by French group. Meniai-Merzouki et al collected 126 patients with 136 meningiomas undergone treatment between December 2008 and June 2016 with median prescription dose of 25 Gy (12-40) in a 5 median fractions (3)(4)(5)(6)(7)(8)(9)(10). They showed that the subgroup with more fractions (25-40 Gy in 5-10 fractions) had significant higher progression free survival that the subgroup with less fractions (21)(22)(23) Gy in 3 fractions), and only 2% of patients experienced radionecrosis at 24 months [25].…”

Differentially Expressed MicroRNAs in Radioresistant and Radiosensitive Atypical Meningioma: A Clinical Study in Chinese Patients

“…According to the World Health Organization (WHO) criteria, meningioma is currently classified as grade I, II or atypical, and III or anaplastic (2), representing 80, 5-34, and 1-3% (3) of all meningiomas, respectively. Although most meningiomas are benign, the non-benign meningiomas are associated with poor prognosis, including aggressive behavior, and early tumor recurrence or progression (4). As such, for highgrade meningioma, adjuvant radiotherapy (ART) is an important method to control tumor recurrence after surgical resection.…”

“…However, due to the controversial results obtained between different studies, whether the ART is beneficial for the treatment of atypical meningioma (AM) patients, especially for those who underwent gross total resection (GTR, Simpson I-II), remains unclear (4)(5)(6)(7)(8)(9)(10)(11). Presently, for AM patients, the decision to perform ART after GTR is often based on the experience of the clinician.…”