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. 2022 May 4;22(1):492.
doi: 10.1186/s12885-022-09607-z.

Postoperative radiotherapy for meningiomas - a decision-making analysis

Galina Farina Fischer  1 , Detlef Brügge  2 , Nicolaus Andratschke  3 , Brigitta Gertrud Baumert  4 , Davide Giovanni Bosetti  5 , Francesca Caparrotti  6 , Evelyn Herrmann  7   8 , Alexandros Papachristofilou  9 , Susanne Rogers  10 , Lucia Schwyzer  11 , Daniel Rudolf Zwahlen  12 , Thomas Hundsberger #  13   14 , Paul Martin Putora #  2   7
Affiliations

Postoperative radiotherapy for meningiomas - a decision-making analysis

Galina Farina Fischer et al. BMC Cancer. .

Abstract

Background: The management of meningiomas is challenging, and the role of postoperative radiotherapy is not standardized.

Methods: Radiation oncology experts in Swiss centres were asked to participate in this decision-making analysis on the use of postoperative radiotherapy (RT) for meningiomas. Experts from ten Swiss centres agreed to participate and provided their treatment algorithms. Their input was converted into decision trees based on the objective consensus methodology. The decision trees were used as a basis to identify consensus and discrepancies in clinical routine.

Results: Several criteria used for decision-making in postoperative RT in meningiomas were identified: histological grading, resection status, recurrence, location of the tumour, zugzwang (therapeutic need to treat and/or severity of symptoms), size, and cell division rate. Postoperative RT is recommended by all experts for WHO grade III tumours as well as for incompletely resected WHO grade II tumours. While most centres do not recommend adjuvant irradiation for WHO grade I meningiomas, some offer this treatment in recurrent situations or routinely for symptomatic tumours in critical locations. The recommendations for postoperative RT for recurrent or incompletely resected WHO grade I and II meningiomas were surprisingly heterogeneous.

Conclusions: Due to limited evidence on the utility of postoperative RT for meningiomas, treatment strategies vary considerably among clinical experts depending on the clinical setting, even in a small country like Switzerland. Clear majorities were identified for postoperative RT in WHO grade III meningiomas and against RT for hemispheric grade I meningiomas outside critical locations. The limited data and variations in clinical recommendations are in contrast with the high prevalence of meningiomas, especially in elderly individuals.

Keywords: Adjuvant; Decision-making; Meningioma; Postoperative; Radiotherapy; SRS.

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Conflict of interest statement

G. F. Fischer: The author declares that she has no competing interests.

D. Brügge: The author declares that he has no competing interests.

N. Andratschke: Personal fees from Debiopharm, personal fees from AstraZeneca, grants, personal fees and nonfinancial support from ViewRay, and grants from Brainlab outside the submitted work.

B.G. Baumert: Personal fees and nonfinancial support from Roche outside the submitted work.

D. G. Bosetti: The author declares that he has no competing interests.

F. Caparrotti: The author declares that she has no competing interests.

E. Herrmann: The author declares that she has no competing interests.

A. Papachristofilou: Grants to the institution by Calypso, Bayer, Amgen, Astellas, AstraZeneca, Boehringer Ingelheim, Merck, and Sanofi not related to this work.

S. Rogers: The author declares that she has no competing interests.

L. Schwyzer: The author declares that she has no competing interests.

D. Zwahlen: The author declares that he has no competing interests.

T. Hundsberger: The author declares that he has no competing interests.

P. M. Putora: Grants to the institution by AstraZeneca, Celgene, Roche and Takeda not related to this work.

Figures

Fig. 1
Fig. 1
Two sample decision trees illustrating the input from one centre each on postoperative RT
Fig. 2
Fig. 2
a-d Fractionation schemes for WHO grade III settings
Fig. 3
Fig. 3
Clinical settings with full consensus of applying postoperative RT
Fig. 4
Fig. 4
Example of different fractionation schemes for the same clinical scenario
Fig. 5
Fig. 5
Percentages of centres omitting postoperative irradiation for incompletely resected WHO grade I tumours
See this image and copyright information in PMC

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