Early or late radiotherapy following gross or subtotal resection for atypical meningiomas: Clinical outcomes and local control |
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| Affiliation: | 1. Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, United States;2. Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States;3. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States;4. Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, United States;1. Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA;2. Department of Neurosurgery, College of Medicine, Korea University, Seoul, Korea;1. Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany;2. BG Universitätsklinikum Bergmannsheil Bochum, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany;3. Institut für Medizinische Biometrie, Informatik und Epidemiologie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany;4. Helios-Klinikum Meiningen, Bergstr. 3, 98617 Meiningen, Germany;1. Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA;2. Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA;1. Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea;2. Computer Science and Engineering, Chungnam National University, Daejeon, South Korea;1. Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA;2. Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA;3. Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA;4. Department of Neurosurgery, Louisiana State University Health Center, Shreveport, Louisiana, USA;5. Department of Pediatric Neurosurgery, Children''s Hospital Colorado, Aurora, Colorado, USA;1. Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA;2. Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California, USA;3. Department of Epidemiology, University of California, Los Angeles, Los Angeles, California, USA;4. Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California, USA;5. Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA |
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| Abstract: | We report a single institution series of surgery followed by either early adjuvant or late radiotherapy for atypical meningiomas (AM). AM patients, by WHO 2007 definition, underwent subtotal resection (STR) or gross total resection (GTR). Sixty-three of a total 115 patients then received fractionated or stereotactic radiation treatment, early adjuvant radiotherapy (≤4 months after surgery) or late radiotherapy (at the time of recurrence). Kaplan Meier method was used for survival analysis with competing risk analysis used to assess local failure. Overall survival (OS) at 1, 2, and 5 years for all patients was 87%, 85%, 66%, respectively. Progression free survival (PFS) at 1, 2, and 5 years for all patients was 65%, 30%, and 18%, respectively. OS at 1, 2, and 5 years was 75%, 72%, 55% for surgery alone, and 97%, 95%, 75% for surgery + radiotherapy (log-rank p-value = 0.0026). PFS at 1, 2, and 5 years for patients undergoing surgery without early adjuvant radiotherapy was 64%, 49%, and 27% versus 81%, 73%, and 59% for surgery + early adjuvant radiotherapy (log-rank p-value = 0.0026). The cumulative incidence of local failure at 1, 2, and 5 years for patients undergoing surgery without early External Beam Radiation Therapy (EBRT) was 18.7%, 35.0%, and 52.9%, respectively, versus 4.2%, 13.3%, and 20.0% for surgery and early EBRT (p-value = 0.02). Adjuvant radiotherapy improves OS in patients with AM. Early adjuvant radiotherapy improves PFS, likely due to the improvement in local control seen with early adjuvant EBRT. |
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| Keywords: | Radiotherapy Atypical meningioma Early Late |
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