Meta-analysis of adjuvant radiotherapy for intracranial atypical and malignant meningiomas

doi:10.1007/s11060-020-03674-7

Review

. 2021 Apr;152(2):205-216.

doi: 10.1007/s11060-020-03674-7. Epub 2021 Feb 26.

Meta-analysis of adjuvant radiotherapy for intracranial atypical and malignant meningiomas

Ansley Unterberger^{1

2}, Thien Nguyen¹, Courtney Duong¹, Aditya Kondajji^{1

2}, Daniel Kulinich^{1

2}, Isaac Yang^{3

4

5

6

7

8

9}

Affiliations

¹ Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA.
² David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA.
³ Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁴ Department of Radiation Oncology, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁵ Department of Head and Neck Surgery, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁶ Jonsson Comprehensive Cancer Center, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁷ Los Angeles Biomedical Research Institute, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁸ Harbor-UCLA Medical Center, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁹ David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.

PMID: 33635510
DOI: 10.1007/s11060-020-03674-7

Review

Meta-analysis of adjuvant radiotherapy for intracranial atypical and malignant meningiomas

Ansley Unterberger et al. J Neurooncol. 2021 Apr.

. 2021 Apr;152(2):205-216.

doi: 10.1007/s11060-020-03674-7. Epub 2021 Feb 26.

Authors

Ansley Unterberger^{1

2}, Thien Nguyen¹, Courtney Duong¹, Aditya Kondajji^{1

2}, Daniel Kulinich^{1

2}, Isaac Yang^{3

4

5

6

7

8

9}

Affiliations

¹ Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA.
² David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA.
³ Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁴ Department of Radiation Oncology, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁵ Department of Head and Neck Surgery, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁶ Jonsson Comprehensive Cancer Center, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁷ Los Angeles Biomedical Research Institute, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁸ Harbor-UCLA Medical Center, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁹ David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.

PMID: 33635510
DOI: 10.1007/s11060-020-03674-7

Abstract

Introduction: Meningiomas comprise 33% of all CNS tumors. The World Health Organization (WHO) describes meningiomas as benign (BM), atypical (AM), and malignant/anaplastic (MM). High-grade meningiomas such as AMs and MMs are more aggressive, recur more frequently, and portend a worse prognosis than BMs. Currently, the standard treatment for high-grade meningiomas, especially AMs, is ill-defined. In particular, the benefit to survival outcomes of adjuvant radiotherapy post-surgical resection remains unclear. In this study, we investigated the effect of adjuvant radiotherapy (ART) post-surgery on survival outcomes compared to surgery alone for high-grade meningiomas.

Methods: PRISMA guidelines were a foundation for our literature review. We screened the PubMed database for studies reporting overall survival (OS), progression free survival (PFS), and tumor recurrence for intracranial, primary AM and MMs treated with surgery+ART or surgery alone. Fixed and random effect models compared tumor control rate for AM aforementioned groups.

Results: Mean 5-year PFS was 76.9% for AM (surgery+ART) and 55.9% for AM (surgery alone) patients. Mean 5-year OS was 81.3% and 74% for AM (surgery+ART) and AM (surgery alone) groups, respectively. Overall, the mean 5-year PFS for aggregated high-grade meningiomas AM+MM (surgery+ART) was 67.6%. Fixed effect models revealed tumor control rate as 76% for AM (surgery+ART) and 69% for AM (surgery alone) groups. ART induced toxicity incidence ranged from 12.0% to 35.5% for AM and MM patients.

Conclusions: Our analysis suggests that (surgery+ART) may increase PFS, OS, and tumor control rates in high-grade meningiomas. However, further studies involving surgery+ ART should be conducted to fully evaluate the ideal radiosurgical candidate, modality, and dosage.

Keywords: Adjuvant; Atypical meningioma; High-grade meningioma; Malignant meningioma; Radiation therapy; Radiosurgery.

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References

1. Davis FG, Kupelian V, Freels S, McCarthy B, Surawicz T (2001) Prevalence estimates for primary brain tumors in the United States by behavior and major histology groups. Neuro-Oncology 3:152–158. https://doi.org/10.1093/neuonc/3.3.152 - DOI - PubMed - PMC
1. Ostrom QT, Gittleman H, Farah P, Ondracek A, Chen Y, Wolinsky Y, Stroup NE, Kruchko C, Barnholtz-Sloan JS (2013) CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2006–2010. Neuro-Oncology 15(Suppl 2):ii1–i56. https://doi.org/10.1093/neuonc/not151 - DOI - PubMed - PMC
1. Dolecek TA, Dressler EV, Thakkar JP, Liu M, Al-Qaisi A, Villano JL (2015) Epidemiology of meningiomas post-Public Law 107–206: the benign brain tumor cancer registries amendment act. Cancer 121:2400–2410. https://doi.org/10.1002/cncr.29379 - DOI - PubMed - PMC
1. Buerki RA, Horbinski CM, Kruser T, Horowitz PM, James CD, Lukas RV (2018) An overview of meningiomas. Future Oncol 14:2161–2177. https://doi.org/10.2217/fon-2018-0006 - DOI - PubMed - PMC
1. Kaur G, Sayegh ET, Larson A, Bloch O, Madden M, Sun MZ, Barani IJ, James CD, Parsa AT (2014) Adjuvant radiotherapy for atypical and malignant meningiomas: a systematic review. Neuro-Oncology 16:628–636. https://doi.org/10.1093/neuonc/nou025 - DOI - PubMed - PMC

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[1] Davis FG, Kupelian V, Freels S, McCarthy B, Surawicz T (2001) Prevalence estimates for primary brain tumors in the United States by behavior and major histology groups. Neuro-Oncology 3:152–158. https://doi.org/10.1093/neuonc/3.3.152 - DOI - PubMed - PMC

[2] Davis FG, Kupelian V, Freels S, McCarthy B, Surawicz T (2001) Prevalence estimates for primary brain tumors in the United States by behavior and major histology groups. Neuro-Oncology 3:152–158. https://doi.org/10.1093/neuonc/3.3.152 - DOI - PubMed - PMC

[3] Ostrom QT, Gittleman H, Farah P, Ondracek A, Chen Y, Wolinsky Y, Stroup NE, Kruchko C, Barnholtz-Sloan JS (2013) CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2006–2010. Neuro-Oncology 15(Suppl 2):ii1–i56. https://doi.org/10.1093/neuonc/not151 - DOI - PubMed - PMC

[4] Ostrom QT, Gittleman H, Farah P, Ondracek A, Chen Y, Wolinsky Y, Stroup NE, Kruchko C, Barnholtz-Sloan JS (2013) CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2006–2010. Neuro-Oncology 15(Suppl 2):ii1–i56. https://doi.org/10.1093/neuonc/not151 - DOI - PubMed - PMC

[5] Dolecek TA, Dressler EV, Thakkar JP, Liu M, Al-Qaisi A, Villano JL (2015) Epidemiology of meningiomas post-Public Law 107–206: the benign brain tumor cancer registries amendment act. Cancer 121:2400–2410. https://doi.org/10.1002/cncr.29379 - DOI - PubMed - PMC

[6] Dolecek TA, Dressler EV, Thakkar JP, Liu M, Al-Qaisi A, Villano JL (2015) Epidemiology of meningiomas post-Public Law 107–206: the benign brain tumor cancer registries amendment act. Cancer 121:2400–2410. https://doi.org/10.1002/cncr.29379 - DOI - PubMed - PMC

[7] Buerki RA, Horbinski CM, Kruser T, Horowitz PM, James CD, Lukas RV (2018) An overview of meningiomas. Future Oncol 14:2161–2177. https://doi.org/10.2217/fon-2018-0006 - DOI - PubMed - PMC

[8] Buerki RA, Horbinski CM, Kruser T, Horowitz PM, James CD, Lukas RV (2018) An overview of meningiomas. Future Oncol 14:2161–2177. https://doi.org/10.2217/fon-2018-0006 - DOI - PubMed - PMC

[9] Kaur G, Sayegh ET, Larson A, Bloch O, Madden M, Sun MZ, Barani IJ, James CD, Parsa AT (2014) Adjuvant radiotherapy for atypical and malignant meningiomas: a systematic review. Neuro-Oncology 16:628–636. https://doi.org/10.1093/neuonc/nou025 - DOI - PubMed - PMC

[10] Kaur G, Sayegh ET, Larson A, Bloch O, Madden M, Sun MZ, Barani IJ, James CD, Parsa AT (2014) Adjuvant radiotherapy for atypical and malignant meningiomas: a systematic review. Neuro-Oncology 16:628–636. https://doi.org/10.1093/neuonc/nou025 - DOI - PubMed - PMC

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Meta-analysis of adjuvant radiotherapy for intracranial atypical and malignant meningiomas

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Meta-analysis of adjuvant radiotherapy for intracranial atypical and malignant meningiomas

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