KEAP1-mutant atypical meningioma: illustrative case

Area of Science:

• Oncology
• Radiation Oncology
• Neurosurgery

Background:

• Limited evidence exists for radiotherapy in brain cancers, despite its use in systemic therapy selection.
• Kelch-like ECH-associated protein 1 (KEAP1) mutations are linked to radioresistance in various cancers.
• The impact of KEAP1 mutations on meningioma radioresponse remains uninvestigated.

Purpose of the Study:

• To report the first case of a KEAP1-mutant meningioma.
• To describe the clinical course and response to multimodal radiotherapy, including intensity-modulated radiation therapy (IMRT) and stereotactic radiosurgery (SRS).
• To explore the implications of KEAP1 mutations on radiotherapy outcomes and potential management strategies.

Main Methods:

• A 40-year-old female with KEAP1-mutant atypical meningioma underwent resection and IMRT.
• Recurrence led to reoperation and adjuvant SRS.
• Treatment response and adverse events, including radiation necrosis, were monitored.

Main Results:

• The patient experienced recurrence at 15 months post-IMRT.
• Post-SRS, an excellent treatment response was observed at 7 months with symptom improvement.
• Radiation necrosis developed 2 months post-SRS, requiring bevacizumab for resolution.

Conclusions:

• This is the first report of a KEAP1-mutant meningioma and its management.
• Multimodal radiotherapy (IMRT followed by SRS) achieved an excellent response.
• The development of radiation necrosis suggests that radiological modification may be beneficial for patients with KEAP1 mutations.