Adjuvant Radiosurgery versus Serial Surveillance following Subtotal Resection of Atypical Meningioma: A Systematic Analysis.

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Adjuvant Radiosurgery versus Serial Surveillance following Subtotal Resection of Atypical Meningioma: A Systematic Analysis.

World Neurosurg. 2016 Nov 14;:

Authors: Lagman C, Bhatt NS, Lee SJ, Bui TT, Chung LK, Voth BL, Barnette NE, Pouratian N, Lee P, Selch M, Kaprealian T, Chin R, McArthur DL, Mukherjee D, Patil CG, Yang I

Abstract
OBJECTIVES: Atypical meningioma (AM) is an aggressive subtype of meningioma that is associated with high recurrence rates following surgical resection. Recent studies have compared outcomes of various treatment strategies, but advantages of adjuvant radiosurgery (ARS) over serial surveillance (SS) following subtotal resection (STR) remain unclear. To further elucidate this issue, the authors systematically analyze the current literature on AM and compare outcomes of ARS versus SS after STR.
METHODS: Embase, PubMed, and Cochrane databases were queried using relevant search terms. Retrospective case series that described patients with AM treated with ARS and SS after STR were included. Tests of proportions were performed to detect significant variations in recurrence rate, 5-year progression-free (PFS), and 5-year overall survival (OS) between the treatment strategies (ARS versus SS) and among individual studies.
RESULTS: A total of 619 patients (263 ARS and 356 SS) were identified. Mean recurrence rates, 5-year PFS, and 5-year OS were 53.5%, 50.3%, and 74.9% for ARS versus 89.8%, 19.1%, and 89.8% for SS, respectively. Recurrence rates between treatment strategies and ARS studies differed (p < .001). 5-year PFS between treatment strategies, ARS, and SS studies differed (p < .001, p = .007 and p < .001, respectively).
CONCLUSION: The evidence demonstrates significant differences in recurrence rates and 5-year PFS between ARS and SS, suggesting a potential benefit of ARS. As we further our understanding of the clinical outcomes of various treatment strategies for AM, we also move closer to integrating modalities, such as radiosurgery, into management guidelines.

PMID: 27856384 [PubMed - as supplied by publisher]

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