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Postoperative radiotherapy for meningiomas - a decision-making analysis
Galina Farina Fischer1, Detlef Brügge2, Nicolaus Andratschke3
1Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland. galina.fischer@posteo.ch.
BMC Cancer
|May 5, 2022
Summary
Postoperative radiotherapy for meningiomas is not standardized, with expert recommendations varying by tumor grade and resection status. Consensus exists for high-grade tumors, but significant heterogeneity remains for lower grades, highlighting a need for clearer guidelines.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Oncology
Background:
- Meningioma management presents challenges, particularly regarding the standardized use of postoperative radiotherapy.
- Treatment strategies for meningiomas vary significantly among experts due to limited evidence.
Purpose of the Study:
- To analyze decision-making processes for postoperative radiotherapy in meningiomas among Swiss radiation oncology experts.
- To identify consensus and discrepancies in clinical practice regarding adjuvant irradiation for meningiomas.
Main Methods:
- Radiation oncology experts from ten Swiss centers provided treatment algorithms for meningiomas.
- Algorithms were converted into decision trees using objective consensus methodology to analyze clinical routines.
Main Results:
- Key decision factors for postoperative radiotherapy include histological grade, resection status, recurrence, tumor location, and tumor size.
- All experts recommended radiotherapy for WHO grade III meningiomas and incompletely resected WHO grade II tumors.
- Recommendations for adjuvant irradiation in WHO grade I and II meningiomas, especially recurrent or incompletely resected cases, showed significant heterogeneity.
Conclusions:
- Treatment strategies for meningiomas vary considerably due to limited evidence, even within Switzerland.
- Clear consensus supports postoperative radiotherapy for WHO grade III meningiomas and opposes it for hemispheric grade I meningiomas outside critical locations.
- The prevalence of meningiomas, particularly in older populations, contrasts with the variability in clinical recommendations.
