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. 2014 Nov;16(11):1547-53.
doi: 10.1093/neuonc/nou098. Epub 2014 Jun 2.

Adjuvant radiation therapy, local recurrence, and the need for salvage therapy in atypical meningioma

Ayal A Aizer  1 , Nils D Arvold  1 , Paul Catalano  1 , Elizabeth B Claus  1 , Alexandra J Golby  1 , Mark D Johnson  1 , Ossama Al-Mefty  1 , Patrick Y Wen  1 , David A Reardon  1 , Eudocia Q Lee  1 , Lakshmi Nayak  1 , Mikael L Rinne  1 , Rameen Beroukhim  1 , Stephanie E Weiss  1 , Shakti H Ramkissoon  1 , Malak Abedalthagafi  1 , Sandro Santagata  1 , Ian F Dunn  1 , Brian M Alexander  1
Affiliations

Adjuvant radiation therapy, local recurrence, and the need for salvage therapy in atypical meningioma

Ayal A Aizer et al. Neuro Oncol. 2014 Nov.

Abstract

Background: The impact of adjuvant radiation in patients with atypical meningioma remains poorly defined. We sought to determine the impact of adjuvant radiation therapy in this population.

Methods: We identified 91 patients with World Health Organization grade II (atypical) meningioma managed at Dana-Farber/Brigham and Women's Cancer Center between 1997 and 2011. A propensity score model incorporating age at diagnosis, gender, Karnofsky performance status, tumor location, tumor size, reason for diagnosis, and era of treatment was constructed using logistic regression for the outcome of receipt versus nonreceipt of radiation therapy. Propensity scores were then used as continuous covariates in a Cox proportional hazards model to determine the adjusted impact of adjuvant radiation therapy on both local recurrence and the combined endpoint of use of salvage therapy and death due to progressive meningioma.

Results: The median follow-up in patients without recurrent disease was 4.9 years. After adjustment for pertinent confounding variables, radiation therapy was associated with decreased local recurrence in those undergoing gross total resection (hazard ratio, 0.25; 95% CI, 0.07-0.96; P = .04). No differences in overall survival were seen in patients who did and did not receive radiation therapy.

Conclusion: Patients who have had a gross total resection of an atypical meningioma should be considered for adjuvant radiation therapy given the improvement in local control. Multicenter, prospective trials are required to definitively evaluate the potential impact of radiation therapy on survival in patients with atypical meningioma.

Keywords: atypical meningioma; radiation; recurrence; salvage.

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Figures

Fig. 1.
Fig. 1.
Local recurrence in patients undergoing GTR, as stratified by receipt versus nonreceipt of radiation.
Fig. 2.
Fig. 2.
Salvage therapy/death due to progressive meningioma in patients undergoing GTR, as stratified by receipt versus nonreceipt of radiation.
Fig. 3.
Fig. 3.
Patient outcome, as stratified by receipt versus nonreceipt of radiotherapy (RT), in patients undergoing radiographic GTR.
See this image and copyright information in PMC

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