Reirradiation of recurrent meningioma

Abstract

Management of meningioma includes observation, resection, and radiation therapy (RT). For patients with recurrent disease, similar options exist. However, the control rate following a second course of RT for recurrent disease is unknown. We reviewed an institutional database of patients with meningioma treated with stereotactic radiosurgery or fractionated stereotactic RT who underwent a second course for recurrent disease. Cox regression model was used for analysis. Variables tested included tumor volume, RT type, tumor grade, age at diagnosis, time to progression, and interval between RT. Eleven of 19 patients (58%) experienced disease progression. Median time to second progression was 10 months. Freedom from progression at one year was lower in patients with grade II or III tumors compared to those with grade 1 or unknown histology (17% compared to 92%, p=0.0054). Cox regression showed that a grade II-III tumor affects progression-free survival (PFS), with a hazard ratio of 5.37 (p=0.011). Median time to progression (MTP) for patients with grade II-III tumors was eight months. MTP was not reached for patients with grade 1/unknown tumors. Reirradiation for recurrent meningioma yields modest tumor control rates but for patients with grade II or III tumors, outcomes are poor.

Figure 1

Timeline depicting the disease course of all 19 patients included in the study, divided into those with “high-grade” (World Health Organization grade II/III) and “low-grade” lesions. Progression, death, and loss to follow-up are indicated where appropriate.

Figure 2

Kaplan–Meier curve of progression free survival (PFS) for the entire patient cohort showing an estimate for the one-year PFS of 66%.

Figure 3

Kaplan–Meier curve of progression free survival (PFS) separated by tumor grade showing that estimates for median PFS were eight months for patients with high-grade tumors and 57 months for other patients.