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Impact of postoperative radiotherapy on recurrence of primary intracranial atypical meningiomas

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Abstract

Background

Atypical meningiomas (WHO grade II) have high recurrence rate. However, data on the effect of radiotherapy (RT) is still conflicting. The aim of this study was to evaluate the influence of postoperative RT on the recurrence of primary atypical intracranial meningiomas.

Methods

The medical records of all patients who underwent surgery (2007–2017 in 4 neurosurgical departments) for a histologically diagnosed primary atypical meningioma were reviewed to assess progression-free survival (PFS) and prognostic factors.

Results

This analysis included 258 patients with a median age of 60 years (54.7% female). The predominant tumor locations were convexity and falx (60.9%) followed by the skull base (37.2%). Simpson grade I–II resection was achieved in 194 (75.2%) patients, Simpson grade III–IV in 53 patients (20.5%). Tumor progressed in 54 cases (20.9%). Postoperative RT was performed in 46 cases (17.8%). RT was more often applied after incomplete resection (37.7% vs. 13.4% Simpson III–IV vs. I–II). A multivariate analysis showed a significantly shorter PFS associated with Simpson III–IV [HR 1.19, (95% CI) 1.09–1.29, p < 0.001] and age > 65 years [HR 2.89, (95% CI) 1.56–5.33, p = 0.001]. A subgroup analysis with a minimal follow-up of 36 months revealed that Simpson III–IV [HR 3.01, 95% CI 1.31–6.931.03–1.24, p = 0.009] and age > 65 years [HR 2.48, 95% CI 1.20–5.13, p = 0.014] reduced PFS. The impact of postoperative RT on PFS remained statistically insignificant, even in a propensity-score matched survival analysis [n = 46; p = 0.438; OR 0.710 (0.299–1.687)].

Conclusions

In the present study, postoperative RT did not improve PFS. The most important prognostic factors remain the extent of resection and age.

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Acknowledgements

This work has been presented as a plenary talk at the meeting of the European Association of Neurosurgical Societies (EANS) in Brussels/ Belgium on 23rd October 2018.

Funding

This research was not supported by any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Naureen Keric and Darius Kalasauskas have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, University Medical Center Mainz, Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    Naureen Keric, Darius Kalasauskas, Ali Ayyad & Florian Ringel

  2. Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria

    Christian F. Freyschlag & Claudius Thomé

  3. Department of Neurosurgery, Technical University Munich, Munich, Germany

    Jens Gempt, Nicole Lange & Bernhard Meyer

  4. Department of Neurosurgery, Charité University Berlin, Berlin, Germany

    Martin Misch & Peter Vajkoczy

  5. Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany

    Alicia Poplawski

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Correspondence to Naureen Keric.

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The ethics committee of Rhineland-Palatinate, Germany reviewed and approved this study [837.476.17 (11310)].

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Keric, N., Kalasauskas, D., Freyschlag, C.F. et al. Impact of postoperative radiotherapy on recurrence of primary intracranial atypical meningiomas. J Neurooncol 146, 347–355 (2020). https://doi.org/10.1007/s11060-019-03382-x

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