Outcome After Protontherapy for Progression or Recurrence of Surgically Treated Meningioma

Abstract

Background To assess the outcome after meningioma surgery and protontherapy (PT). Methods We processed the French Système National des Données de Santé database to retrieve appropriate cases of meningiomas operated and irradiated between 2008 and 2017. Survival methods were implemented. Results One hundred ninety-three patients who received PT after meningioma surgery over a 10-year period were identified. Of the 193 patients, 75.6% were female. Median age at surgery was 50 years (interquartile range [IQR] 41–62). The median number of PT fractions was 31 (IQR 30–39) given over a median duration of 52 days (IQR 44–69). Fourteen patients (7.3%) also received photon radiotherapy and six patients (3.1%) stereotactic radiosurgery. Median follow-up was 4.4 years (IQR 3.86–4.71). Five-year progression-free survival (PFS) rate was 69% (95% confidence interval [CI] 62.1–76.6). For benign, atypical, and malignant meningioma, 5-year PFS rates were 71.5% (95% CI 64.4–79.4), 55.6% (95% CI 32.5–95), and 35.6% (95% CI 12.8–98.9), respectively ( p <0.01). In the adjusted regression, tumour location (hazard ratio [HR]=0.1, 95% CI 0.05–0.22, p <0.001), aggressive meningioma (HR=2.26, 95% CI 1.1–4.66, p =0.027), and the need of cerebrospinal fluid (CSF) insertion for hydrocephalus (HR=3.51, 95% CI 1.32–9.31, p =0.012) remained significantly associated to the PFS. All grades considered, 5-year overall survival (OS) rates was 89.7% (95% CI 84.6–95.1). For benign, atypical, and malignant meningioma, 5-year OS rates were 93% (95% CI 88.7–97.4), 76.4% (95% CI 51.4–100), and 44.4% (95% CI 16.7–100), respectively ( p <0.01). In the multivariable regression, an older age above 70 years (HR=5.95, 95% CI 2.09–16.89, p <0.001) associated to a high level of comorbidities (HR=5.31, 95% CI 1.43–19.78, p =0.013) and a malignant meningioma (HR=5.68, 95% CI 1.54–20.94, p =0.009) remained significantly associated to a reduced OS. Conclusion Five-year PFS and OS after meningioma surgery and PT is favourable but impaired for older patients with high level of morbidities, tumour of the convexity, malignant histopathology and for those requiring CSF shunting. Further inclusion and prolonged follow-up is required to assess other predictors such as sex, tumour volume, or given dose.

Meningioma in the elderly

“…WHO3 meningiomas are locally aggressive with poor PFS and overall survival, 13 , 61 , 118 particularly in the elderly. 5 , 84 , 85 Adjuvant RT is typically recommended, 7 and appears to have a significant survival benefit in most patients.…”

“…The prognosis of higher grade meningiomas is substantially worse, and 5-year overall survival rates may be as low as 76% and 44% for WHO2 and 3, respectively, even after resection and RT. 61 , 86 In one study of elderly patients with WHO3 meningioma, overall survival at 5 years was just 35%, with median survival of 38 months. 84 Data from the Central Brain Tumor Registry in the USA suggests a median survival of 40 months in patients aged 65–69 with malignant meningioma, which falls to just 25 months in patients aged 80–84 and 15 months in patients aged older than 85.…”

Management of Recurrent Meningiomas: State of the Art and Perspectives

“…N = 41 articles met the inclusion criteria and N = 16 articles failed to assess management of meningioma recurrence. Finally, N = 24 articles were included in our review [ 22 , 29 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 55 , 56 , 57 ] ( Flowchart 1 ). The articles were distributed as follows: studies on chemotherapy (N = 14); RT, PT, and SRS (N = 6); BNCT (N = 2); and surgery (N = 3).…”

“…Champeaux-Depond et al [ 49 ] reviewed cases of patients who underwent proton-therapy following meningioma recurrence or progression after initial surgery: the authors included data from N = 193 patients, with a median FU of 4.4 years (IQR 4.85–4.71). The five-year PFS were 71.5% (95% CI 64.4–79.4), 55.6% (95% CI 32.5–95), and 35.6% (95% CI 12.8–98.9) for WHO grade 1, 2, and 3 meningiomas, respectively.…”

“…The five-year PFS were 71.5% (95% CI 64.4–79.4), 55.6% (95% CI 32.5–95), and 35.6% (95% CI 12.8–98.9) for WHO grade 1, 2, and 3 meningiomas, respectively. The 5-years OS rates were 93% (95% CI 88.7–97.4), 76.4% (95% CI 51.4–100), and 44.4% (95% CI 16.7–100) for WHO grade 1, 2, and 3 meningiomas, respectively [ 49 ].…”