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Meta-analysis of adjuvant radiotherapy for intracranial atypical and malignant meningiomas

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Abstract

Introduction

Meningiomas comprise 33% of all CNS tumors. The World Health Organization (WHO) describes meningiomas as benign (BM), atypical (AM), and malignant/anaplastic (MM). High-grade meningiomas such as AMs and MMs are more aggressive, recur more frequently, and portend a worse prognosis than BMs. Currently, the standard treatment for high-grade meningiomas, especially AMs, is ill-defined. In particular, the benefit to survival outcomes of adjuvant radiotherapy post-surgical resection remains unclear. In this study, we investigated the effect of adjuvant radiotherapy (ART) post-surgery on survival outcomes compared to surgery alone for high-grade meningiomas.

Methods

PRISMA guidelines were a foundation for our literature review. We screened the PubMed database for studies reporting overall survival (OS), progression free survival (PFS), and tumor recurrence for intracranial, primary AM and MMs treated with surgery+ART or surgery alone. Fixed and random effect models compared tumor control rate for AM aforementioned groups.

Results

Mean 5-year PFS was 76.9% for AM (surgery+ART) and 55.9% for AM (surgery alone) patients. Mean 5-year OS was 81.3% and 74% for AM (surgery+ART) and AM (surgery alone) groups, respectively. Overall, the mean 5-year PFS for aggregated high-grade meningiomas AM+MM (surgery+ART) was 67.6%. Fixed effect models revealed tumor control rate as 76% for AM (surgery+ART) and 69% for AM (surgery alone) groups. ART induced toxicity incidence ranged from 12.0% to 35.5% for AM and MM patients.

Conclusions

Our analysis suggests that (surgery+ART) may increase PFS, OS, and tumor control rates in high-grade meningiomas. However, further studies involving surgery+ ART should be conducted to fully evaluate the ideal radiosurgical candidate, modality, and dosage.

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Code availability

Statistical analysis was conducted using R Studio v.1.2.5019 (RStudio Inc., Boston, MA).

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Funding

Aditya Kondajji and Thien Nguyen are recipients of the David Geffen Medical Scholarship. Dr. Isaac Yang reports being supported by the UCLA Visionary Ball Fund Grant, Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research UCLA Scholars in Translational Medicine Program Award, Jason Dessel Memorial Seed Grant, UCLA Honberger Endowment Brain Tumor Research Seed Grant, and Stop Cancer (US) Development Award. The sponsors had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA

    Ansley Unterberger BS, Thien Nguyen MD, Courtney Duong BS, Aditya Kondajji BS, Daniel Kulinich MS & Isaac Yang MD

  2. Department of Radiation Oncology, Los Angeles (UCLA), Los Angeles, CA, USA

    Isaac Yang MD

  3. Department of Head and Neck Surgery, Los Angeles (UCLA), Los Angeles, CA, USA

    Isaac Yang MD

  4. Jonsson Comprehensive Cancer Center, Los Angeles (UCLA), Los Angeles, CA, USA

    Isaac Yang MD

  5. Los Angeles Biomedical Research Institute, Los Angeles (UCLA), Los Angeles, CA, USA

    Isaac Yang MD

  6. Harbor-UCLA Medical Center, Los Angeles (UCLA), Los Angeles, CA, USA

    Isaac Yang MD

  7. David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA

    Ansley Unterberger BS, Aditya Kondajji BS, Daniel Kulinich MS & Isaac Yang MD

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Correspondence to Isaac Yang MD.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors. Informed consent: Not required for this study.

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Supplementary information

Supplementary Fig. 1

PRISMA Flow Chart (DOCX 42 kb)

Supplementary Fig. 2

Funnel plot assessing bias of reviewed studies involving AM (surgery+ART) patients. Dashed diagonal lines indicate boundaries of 95% confidence of study variation due to change [10, 14, 17, 19, 20, 21, 23–25, 27] (DOCX 35 kb)

Supplementary Fig. 3

Funnel plot assessing bias of reviewed studies involving AM (surgery alone) patients. Dashed diagonal lines indicate boundaries of 95% confidence of study variation due to change [10, 14, 19, 20, 21, 24, 25, 27] (DOCX 34 kb)

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Unterberger, A., Nguyen, T., Duong, C. et al. Meta-analysis of adjuvant radiotherapy for intracranial atypical and malignant meningiomas. J Neurooncol 152, 205–216 (2021). https://doi.org/10.1007/s11060-020-03674-7

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