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Meta-analysis of adjuvant radiotherapy for intracranial atypical and malignant meningiomas
Ansley Unterberger1,2, Thien Nguyen1, Courtney Duong1
1Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA.
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.
Insights
Adjuvant radiotherapy (ART) after surgery may improve survival and tumor control for high-grade meningiomas. Further research is needed to optimize ART protocols for these aggressive brain tumors.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Oncology
Background:
- Meningiomas are common CNS tumors, with high-grade types (atypical and malignant) exhibiting aggressive behavior and poor prognosis.
- Standard treatment for high-grade meningiomas is not well-defined, particularly the role of adjuvant radiotherapy (ART) post-surgery.
- The impact of ART on survival outcomes for high-grade meningiomas remains unclear.
Purpose of the Study:
- To investigate the effect of adjuvant radiotherapy (ART) post-surgery on survival outcomes for high-grade meningiomas.
- To compare outcomes of surgery plus ART versus surgery alone for atypical (AM) and malignant (MM) meningiomas.
Main Methods:
- A literature review was conducted following PRISMA guidelines, screening PubMed for relevant studies.
- Studies reporting overall survival (OS), progression-free survival (PFS), and tumor recurrence were included.
- Fixed and random effect models were used to compare tumor control rates between treatment groups.
Main Results:
- Mean 5-year PFS was 76.9% for AM with surgery+ART versus 55.9% for AM with surgery alone.
- Mean 5-year OS was 81.3% for AM with surgery+ART versus 74% for AM with surgery alone.
- ART-induced toxicity ranged from 12.0% to 35.5% in AM and MM patients.
Conclusions:
- Surgery plus ART may enhance PFS, OS, and tumor control rates in high-grade meningiomas.
- Further research is required to determine optimal candidates, modalities, and dosages for ART in these patients.
