Revisiting Adjuvant Radiotherapy following Gross total Resection of WHO Grade II Meningioma.

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Revisiting Adjuvant Radiotherapy following Gross total Resection of WHO Grade II Meningioma.

World Neurosurg. 2017 Apr 24;:

Authors: Graffeo CS, Leeper HE, Perry A, Uhm JH, Lachance DJ, Brown PD, Ma DJ, Van Gompel JJ, Giannini C, Johnson DR, Raghunathan A

Abstract
BACKGROUND: Atypical meningioma is a WHO grade II tumor, with intermediate prognosis and risk-of-recurrence. Optimal management following gross total resection (GTR) is controversial, with observation versus adjuvant radiotherapy (RT) contentiously debated.
METHODS: Pathologic review was performed of all atypical meningiomas diagnosed at our institution from 1988-2011. Retrospective chart review documented patient demographics, extent of surgical resection, documented radiation therapy, PFS, and OS. Supplemental systematic literature review was completed surveying English language articles published since 1979 comparing observation and RT after GTR of atypical meningioma.
RESULTS: Sixty-nine patients met inclusion criteria. Sixty-one underwent observation and 8 received RT. Overall, 15 observation and 3 RT patients experienced tumor recurrence (5-year PFS 79% vs. 88%; p=0.67); 19 observation and 2 RT patients died (5-year OS 89% vs. 83%; p=0.68). Systematic review identified 9 preceding studies reporting extractable data comparing observation and RT outcomes after GTR. Recurrence was 18% and 19% after observation and RT (p=0.9); total survival was 84% and 93% (p=0.2). At 5 years, PFS was 81% after observation and 88% after RT (p=0.2), while survival was 87% after observation and 96% after RT (p=0.4).
CONCLUSION: Observation alone after GTR of atypical meningioma was not associated with increased risk of tumor recurrence or mortality. Although some preceding authors advocate for RT based on empiric experience, systematic review also suggests that observation may provide equivalent PFS and OS to RT. Taken together, these findings indicate that observation after GTR may be a safe alternative to RT.

PMID: 28450233 [PubMed - as supplied by publisher]

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