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Clinical Trial
. 2023 Jan 5;25(1):137-145.
doi: 10.1093/neuonc/noac137.

Low-risk meningioma: Initial outcomes from NRG Oncology/RTOG 0539

C Leland Rogers  1 , Stephanie L Pugh  2 , Michael A Vogelbaum  3 , Arie Perry  4 , Lynn S Ashby  5 , Jignesh M Modi  6 , Anthony M Alleman  7 , Igor J Barani  8 , Steve Braunstein  9 , Joseph A Bovi  10 , John F de Groot  11 , Anthony C Whitton  12 , Scott M Lindhorst  13 , Nimisha Deb  14 , Dennis C Shrieve  15 , Hui-Kuo Shu  16 , Beatrice Bloom  17 , Mitchell Machtay  18 , Mark V Mishra  19 , Clifford G Robinson  20 , Minhee Won  2 , Minesh P Mehta  21
Affiliations
Clinical Trial

Low-risk meningioma: Initial outcomes from NRG Oncology/RTOG 0539

C Leland Rogers et al. Neuro Oncol. .

Abstract

Background: Three- and five-year progression-free survival (PFS) for low-risk meningioma managed with surgery and observation reportedly exceeds 90%. Herewith we summarize outcomes for low-risk meningioma patients enrolled on NRG/RTOG 0539.

Methods: This phase II trial allocated patients to one of three groups per World Health Organization grade, recurrence status, and resection extent. Low-risk patients had either gross total (GTR) or subtotal resection (STR) for a newly diagnosed grade 1 meningioma and were observed after surgery. The primary endpoint was 3-year PFS. Adverse events (AEs) were scored using Common Terminology Criteria for Adverse Events (CTCAE) version 3.

Results: Among 60 evaluable patients, the median follow-up was 9.1 years. The 3-, 5-, and 10-year rates were 91.4% (95% CI, 84.2 to 98.6), 89.4% (95% CI, 81.3 to 97.5), 85.0% (95% CI, 75.3 to 94.7) for PFS and 98.3% (95% CI, 94.9 to 100), 98.3%, (95% CI, 94.9 to 100), 93.8% (95% CI, 87.0 to 100) for overall survival (OS), respectively. With centrally confirmed GTR, 3/5/10y PFS and OS rates were 94.3/94.3/87.6% and 97.1/97.1/90.4%. With STR, 3/5/10y PFS rates were 83.1/72.7/72.7% and 10y OS 100%. Five patients reported one grade 3, four grade 2, and five grade 1 AEs. There were no grade 4 or 5 AEs.

Conclusions: These results prospectively validate high PFS and OS for low-risk meningioma managed surgically but raise questions regarding optimal management following STR, a subcohort that could potentially benefit from adjuvant therapy.

Keywords: WHO grade 1 (benign); cooperative group trial; meningioma; observation; surgery.

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Figures

Fig. 1
Fig. 1
NRG Oncology/ RTOG-0539 CONSORT diagram.
Fig. 2
Fig. 2
(A) PFS for the entire low-risk cohort. The listed percentages are the Kaplan-Meier PFS estimates at 1, 3, 5, and 10 years, respectively. (B) PFS by resection status. The listed percentages are the Kaplan-Meier PFS estimates at 1, 3, 5, and 10 years, respectively. (C) Time to progression (local failure). The listed percentages are the cumulative incidence estimates at 1, 3, and 5 years, respectively. D: OS. The listed percentages are the Kaplan-Meier OS estimates at 1, 5, and 10 years, respectively. GTR, gross total resection; PFS, progression-free survival; STR, subtotal resection; OS, overall survival.
See this image and copyright information in PMC

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