The Role of Radiotherapy Following Gross Total Resection of Atypical Meningiomas

J. Bryan Iorgulescu1, Ricardo Komotar, MD1, Dhanya Anand1, Daniel Raper1, Eric Holland, MD, PhD1

1New York, NY United States

Keywords: meningioma, recurrent disease, radiotherapy, resection, brain tumor

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     Atypical (WHO Grade II) meningiomas (AM) comprise a heterogeneous group of tumors, with a spectrum of histopathologies and clinical outcomes.
     The role of postoperative radiotherapy (RT) for patients with AM who have undergone gross total resection (GTR) remains unclear - a role we sought to clarify by reviewing our experience over the past 2 decades.
     Fifty-two patients underwent GTR for AM. After a mean follow-up of 51.9 months, overall survival was 81% and 17% of patients had recurred.
     We retrospectively analyzed all patients at our institution who underwent GTR with final histology demonstrating atypical meningioma from 1992-2011. Information regarding patients, tumor characteristics, and postoperative adjuvant therapy was evaluated from medical records. Time to recurrence and overall survival were analyzed using univariate, multivariate, and Kaplan-Meier survival analyses.
     There was no recurrence in 13/14 (93%) patients who received postoperative RT, compared to 26/38 (68%) patients without postoperative RT (p = .08), demonstrating a strong trend toward improved local control with postoperative RT. No other factors were significantly associated with recurrence in univariate or multivariate analyses.
     This is a retrospective study.
     This retrospective series supports the observation that postoperative radiotherapy likely results in lower recurrence rates of gross totally resected atypical meningiomas.
     Although a multi-center prospective trial will ultimately be needed to fully define the role of radiotherapy in managing gross totally resected AM, our results contribute to a growing number of series that support routine postoperative RT as an adjuvant treatment for these lesions.


Project Roles:

J. Iorgulescu (), R. Komotar (), D. Anand (), D. Raper (), E. Holland ()