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Review
. 2023 Dec 18;11(2):115-124.
doi: 10.1093/nop/npad077. eCollection 2024 Apr.

Radiotherapy intensification for atypical and malignant meningiomas: A systematic review

Simona Gaito  1   2   3 , Love Goyal  3 , Romelie Rieu  4   5 , Anna France  1 , Neil G Burnet  3 , Claire Barker  3 , Shermaine Pan  3 , Rovel J Colaco  3 , Giuseppe Minniti  6   7 , Federico Roncaroli  8 , Ed Smith  1   2   3 , Marianne Aznar  2 , Gillian Whitfield  2   3
Affiliations
Review

Radiotherapy intensification for atypical and malignant meningiomas: A systematic review

Simona Gaito et al. Neurooncol Pract. .

Abstract

Background: The outcomes of nonbenign (WHO Grades 2 and 3 [G2, G3]) meningiomas are suboptimal and radiotherapy (RT) dose intensification strategies have been investigated. The purpose of this review is to report on clinical practice and outcomes with particular attention to RT doses and techniques.

Methods: The PICO criteria (Population, Intervention, Comparison, and Outcomes) were used to frame the research question, directed at outlining the clinical outcomes in patients with G2-3 meningiomas treated with RT. The same search strategy was run in Embase and MEDLINE and, after deduplication, returned 1 807 records. These were manually screened for relevance and 25 were included.

Results: Tumor outcomes and toxicities are not uniformly reported in the selected studies since different endpoints and time points have been used by different authors. Many risk factors for worse outcomes are described, the most common being suboptimal RT. This includes no or delayed RT, low doses, and older techniques. A positive association between RT dose and progression-free survival (PFS) has been highlighted by analyzing the studies in this review (10/25) that report the same endpoint (5y-PFS).

Conclusions: This literature review has shown that standard practice RT leads to suboptimal tumor control rates in G2-3 meningiomas, with a significant proportion of disease recurring after a relatively short follow-up. Randomized controlled trials are needed in this setting to define the optimal RT approach. Given the increasing data to suggest a benefit of higher RT doses for high-risk meningiomas, novel RT technologies with highly conformal dose distributions are preferential to achieve optimal target coverage and organs at risk sparing.

Keywords: malignant meningiomas; proton therapy; radiotherapy intensification.

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Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
A preferred reporting items for systematic reviews and meta-analysis (PRISMA) flowchart used for selecting the relevant articles for this systematic review.
Figure 2.
Figure 2.
The most reported clinical- and treatment-related variables (grouped in bigger categories) described as associated with outcomes in atypical and malignant meningiomas in the studies presented in this literature review. RT treatment includes: Rt dose, technique and no/delayed RT.
Figure 3.
Figure 3.
Regression of Meningioma 5-y PFS versus Dose (weighted by sample size). The circles refer to the pure G2 series, the squares to the mixed G2–G3 series. The size of the dots is proportional to the cohort size of each study. Of note, only the studies reporting the same endpoint (5-y PFS) have been included in this analysis.
See this image and copyright information in PMC

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