Patient-Facility Distance and Adjuvant Radiotherapy for WHO Grade 2-3 Meningioma

Adjuvant radiotherapy (RT) is commonly used after surgery for WHO grade 2 and 3 meningioma, but the role of patient-facility distance in RT receipt and dose/fractionation choice is not well defined. We examined whether travel distance was associated with receipt and type of adjuvant RT.

We used the National Cancer Database to identify adults diagnosed between 2010 and 2020 with surgically treated WHO grade 2 or 3 meningioma and a CROWFLY distance ≤250 miles. Patients were categorized into 3 groups according to WHO grade and extent of resection: grade 2 with gross total resection, grade 2 with subtotal resection/biopsy, and grade 3 with any resection. Outcomes were receipt of adjuvant RT, SRS/HF-SRS versus fractionated EBRT among classifiable RT recipients, and overall survival.

Among 14,218 patients, 4063 (28.6%) received adjuvant RT. In multivariate models, the odds of RT receipt decreased with increasing distance, becoming statistically significant at 25 to <50 miles and remaining lower in more distant bins. Among 2767 classifiable RT recipients, greater distance was associated with higher odds of SRS/HF-SRS rather than fractionated EBRT. Distance was not associated with overall survival. Selected fine-bin estimates included OR=1.47 at 25 to <50 miles, OR=2.40 at 75 to <100 miles, and OR=3.08 at 150 to 250 miles.

Greater patient-facility distance was associated with lower receipt of adjuvant RT and greater use of shorter stereotactic regimens among treated patients. These findings support geography as a predictor of both whether and how patients with higher-grade meningioma receive postoperative radiotherapy.