Repeated stereotactic radiosurgery for high grade meningioma

Area of Science:

• Neurosurgery
• Radiation Oncology
• Oncology

Background:

• Atypical and anaplastic meningiomas (WHO Grades II and III) pose significant therapeutic challenges due to their aggressive nature and high recurrence rates.
• Limited data exists on the efficacy and safety of repeated stereotactic radiosurgery (SRS) for these high-grade tumors.

Purpose of the Study:

• To evaluate the effectiveness and safety of repeated stereotactic radiosurgery (SRS) in managing patients with recurrent or residual high-grade meningioma.
• To identify factors predictive of tumor growth and adverse events following SRS.

Main Methods:

• Retrospective analysis of 112 patients with high-grade recurrent or residual meningioma treated with SRS between 2002 and 2022.
• Data collection included clinicodemographic profiles, treatment parameters, and imaging phenotypes, with a median follow-up of 41.7 months.

Main Results:

• Tumor control was achieved in 29.5% of cases at median follow-up. Progression-free survival rates at 1, 3, and 5 years were 79.5%, 43.8%, and 30.4%, respectively.
• Repeated SRS showed higher progression-free survival rates (97.6%, 69%, 45.2% at 1, 3, 5 years).
• Male sex, older age, anaplastic phenotype, subtotal resection, and larger tumor volume predicted tumor growth. Adverse radiation effects occurred in 33.8% of patients undergoing repeated SRS, mostly asymptomatic.

Conclusions:

• Stereotactic radiosurgery (SRS) is a viable and safe treatment for recurrent/residual high-grade meningioma, even with repeated courses.
• Anaplastic phenotype, subtotal resection, and larger tumor volume are associated with increased tumor growth risk, indicating a need for vigilant post-treatment surveillance.