Early or late radiotherapy following gross or subtotal resection for atypical meningiomas: Clinical outcomes and local control

Abstract

We report a single institution series of surgery followed by either early adjuvant or late radiotherapy for atypical meningiomas (AM). AM patients, by WHO 2007 definition, underwent subtotal resection (STR) or gross total resection (GTR). Sixty-three of a total 115 patients then received fractionated or stereotactic radiation treatment, early adjuvant radiotherapy (≤4 months after surgery) or late radiotherapy (at the time of recurrence). Kaplan Meier method was used for survival analysis with competing risk analysis used to assess local failure. Overall survival (OS) at 1, 2, and 5 years for all patients was 87%, 85%, 66%, respectively. Progression free survival (PFS) at 1, 2, and 5 years for all patients was 65%, 30%, and 18%, respectively. OS at 1, 2, and 5 years was 75%, 72%, 55% for surgery alone, and 97%, 95%, 75% for surgery + radiotherapy (log-rank p-value = 0.0026). PFS at 1, 2, and 5 years for patients undergoing surgery without early adjuvant radiotherapy was 64%, 49%, and 27% versus 81%, 73%, and 59% for surgery + early adjuvant radiotherapy (log-rank p-value = 0.0026). The cumulative incidence of local failure at 1, 2, and 5 years for patients undergoing surgery without early External Beam Radiation Therapy (EBRT) was 18.7%, 35.0%, and 52.9%, respectively, versus 4.2%, 13.3%, and 20.0% for surgery and early EBRT (p-value = 0.02). Adjuvant radiotherapy improves OS in patients with AM. Early adjuvant radiotherapy improves PFS, likely due to the improvement in local control seen with early adjuvant EBRT.

Effectiveness of Postoperative Radiotherapy on Atypical Meningioma Patients: A Population-Based Study

“…Nevertheless, in accordance with previous studies (11, 15), our study showed a significant survival benefit from PORT for patients undergoing STR, indicating that PORT should be performed for atypical meningioma patients undergoing STR. Although PORT has been routinely recommended for atypical meningioma patients undergoing STR (3, 5), it is surprising that the utilization rate of PORT was only 42.6% in these patients and even lower in the elder patients.…”

“…Most of the patients who die within 1 month after surgery do not have the opportunity to receive postoperative radiotherapy. Including these patients in analyses will lead to an abrupt drop at the beginning of the Kaplan–Meier survival curve of patients not receiving PORT, which can be seen in several previous studies (4, 11, 17). This may result in a false positive result in the comparison of OS between patients receiving and not receiving PORT.…”

Combination of IFITM1 knockdown and radiotherapy inhibits the growth of oral cancer

“…Beyond this study, much research in radiotherapy has been documented in various fields. Takemura et al used the age‐adjusted Charlson comorbidity index to predict the prognosis of laryngopharyngeal cancer patients treated with radiation therapy; Wang et al performed a clinical analysis of recurrence patterns in patients with nasopharyngeal carcinoma treated with intensity‐modulated radiotherapy; and Dohm et al studied the effect of early or late radiotherapy following gross or subtotal resection for atypical meningiomas.…”

Adjuvant radiotherapy versus observation following gross total resection for atypical meningioma: a systematic review and meta-analysis

“…The attrition bias was high in 11 studies with missing data because of restriction in follow-up duration or loss to follow-up for analyzing the outcome [ 3 , 10 , 30 , 35 , 36 , 39 – 43 , 45 ]. The risk of reporting bias was high in five studies that did not report the recurrence number or the percentage of each cohort [ 26 , 34 , 37 , 40 , 41 ].…”