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Analysis of patterns of failure and appraisal of postoperative radiation field for grade II–III meningioma

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Abstract

Purpose

To analyze patterns of failure according to treatment modalities and evaluate the adequacy of an institution’s current volume of postoperative radiotherapy (PORT) for World Health Organization (WHO) grade II or III meningiomas.

Patients and methods

Data of 98 patients treated by either surgery and PORT (PORT group, n = 53) or surgery alone (surgery group, n = 45) between March 2000 and December 2013 were reviewed. Clinical target volume of PORT was delineated as a 1.5–2-cm expansion from the tumor bed. Local failure (LF) was defined as recurrence within a 2-cm margin from the tumor bed. Failures other than LF were defined as out-field failure (OFF). Median total dose of PORT was 59.4 (range 45.0–69.0) Gy.

Results

The PORT group had larger proportions of grade III meningiomas (18/53, 34.0%) than the surgery group (8/46, 15.6%) (p = 0.037). After a median 73.4-month follow-up, 29 patients experienced LF and 5 developed OFF. The actuarial 5-year local control (LC) rates were 86.7% and 59.3% in the PORT and surgery groups, respectively (p = 0.002). PORT was a significant factor of LC in the univariate (p = 0.003, hazard ratio [HR] 3.449, 95% confidence interval [CI] 1.516–7.846) and multivariate analyses (p < 0.001, HR 5.486, 95% CI 2.178–13.820).

Conclusions

Despite the larger proportion of grade III meningiomas in the PORT group, PORT reduced LF in patients with WHO grade II or III meningiomas compared with the surgery group. The current PORT field seems reasonable because LF was the dominant pattern of failure in patients treated by surgery alone.

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References

  1. Wiemels J, Wrensch M, Claus EB (2010) Epidemiology and etiology of meningioma. J Neurooncol 99:307–314. https://doi.org/10.1007/s11060-010-0386-3

    Article  PubMed  PubMed Central  Google Scholar 

  2. Mawrin C, Perry A (2010) Pathological classification and molecular genetics of meningiomas. J Neurooncol 99:379–391. https://doi.org/10.1007/s11060-010-0342-2

    Article  CAS  PubMed  Google Scholar 

  3. Saraf S, McCarthy BJ, Villano JL (2011) Update on meningiomas. Oncologist 16:1604–1613. https://doi.org/10.1634/theoncologist.2011-0193

    Article  PubMed  PubMed Central  Google Scholar 

  4. Whittle IR, Smith C, Navoo P, Collie D (2004) Meningiomas. Lancet 363:1535–1543. https://doi.org/10.1016/S0140-6736(04)16153-9

    Article  PubMed  Google Scholar 

  5. Walcott BP, Nahed BV, Brastianos PK, Loeffler JS (2013) Radiation treatment for WHO grade II and III meningiomas. Front Oncol 3:227. https://doi.org/10.3389/fonc.2013.00227

    Article  PubMed  PubMed Central  Google Scholar 

  6. Klinger DR, Flores BC, Lewis JJ, Hatanpaa K, Choe K, Mickey B, Barnett S (2015) Atypical meningiomas: recurrence, reoperation, and radiotherapy. World Neurosurg 84:839–845. https://doi.org/10.1016/j.wneu.2015.04.033

    Article  PubMed  Google Scholar 

  7. Aghi MK, Carter BS, Cosgrove GR, Ojemann RG, Amin-Hanjani S, Martuza RL, Curry WT Jr, Barker FG 2nd (2009) Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation. Neurosurgery 64:56–60. https://doi.org/10.1227/01.NEU.0000330399.55586.63 (discussion 60)

    Article  PubMed  Google Scholar 

  8. Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW (2008) Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. J Neurol Neurosurg Psychiatry 79:574–580. https://doi.org/10.1136/jnnp.2007.121582

    Article  PubMed  Google Scholar 

  9. Park HJ, Kang HC, Kim IH, Park SH, Kim DG, Park CK, Paek SH, Jung HW (2013) The role of adjuvant radiotherapy in atypical meningioma. J Neurooncol 115:241–247. https://doi.org/10.1007/s11060-013-1219-y

    Article  CAS  PubMed  Google Scholar 

  10. Rogers L, Zhang P, Vogelbaum MA, Perry A, Ashby LS, Modi JM, Alleman AM, Galvin J, Brachman D, Jenrette JM, De Groot J, Bovi JA, Werner-Wasik M, Knisely JPS, Mehta MP (2017) Intermediate-risk meningioma: initial outcomes from NRG Oncology RTOG 0539. J Neurosurg 129(1):35–47. https://doi.org/10.3171/2016.11.JNS161170

    Article  PubMed  PubMed Central  Google Scholar 

  11. Press RH, Prabhu RS, Appin CL, Brat DJ, Shu HK, Hadjipanayis C, Olson JJ, Oyesiku NM, Curran WJ, Crocker I (2014) Outcomes and patterns of failure for grade 2 meningioma treated with reduced-margin intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 88:1004–1010. https://doi.org/10.1016/j.ijrobp.2013.12.037

    Article  PubMed  Google Scholar 

  12. Leland Rogers M, FACRO, FASTRO (2017) NRG-BN003: phase III trial of observation versus irradiation for a gross totally resected grade II meningioma. https://www.nrgoncology.org/Clinical-Trials/Protocol-Table. Accessed 14 June 2017

  13. Adeberg S, Hartmann C, Welzel T, Rieken S, Habermehl D, von Deimling A, Debus J, Combs SE (2012) Long-term outcome after radiotherapy in patients with atypical and malignant meningiomas—clinical results in 85 patients treated in a single institution leading to optimized guidelines for early radiation therapy. Int J Radiat Oncol Biol Phys 83:859–864. https://doi.org/10.1016/j.ijrobp.2011.08.010

    Article  PubMed  Google Scholar 

  14. Dziuk TW, Woo S, Butler EB, Thornby J, Grossman R, Dennis WS, Lu H, Carpenter LS, Chiu JK (1998) Malignant meningioma: an indication for initial aggressive surgery and adjuvant radiotherapy. J Neurooncol 37:177–188

    Article  CAS  PubMed  Google Scholar 

  15. Wang YC, Chuang CC, Wei KC, Chang CN, Lee ST, Wu CT, Hsu YH, Lin TK, Hsu PW, Huang YC, Tseng CK, Wang CC, Chen YL, Chen PY (2016) Long term surgical outcome and prognostic factors of atypical and malignant meningiomas. Sci Rep 6:35743. https://doi.org/10.1038/srep35743

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Bagshaw HP, Burt LM, Jensen RL, Suneja G, Palmer CA, Couldwell WT, Shrieve DC (2017) Adjuvant radiotherapy for atypical meningiomas. J Neurosurg 126:1822–1828. https://doi.org/10.3171/2016.5.JNS152809

    Article  PubMed  Google Scholar 

  17. Mair R, Morris K, Scott I, Carroll TA (2011) Radiotherapy for atypical meningiomas. J Neurosurg 115:811–819. https://doi.org/10.3171/2011.5.JNS11112

    Article  PubMed  Google Scholar 

  18. Weber DC, Ares C, Villa S, Peerdeman SM, Renard L, Baumert BG, Lucas A, Veninga T, Pica A, Jefferies S, Ricardi U, Miralbell R, Stelmes JJ, Liu Y, Collette L, Collette S (2018) Adjuvant postoperative high-dose radiotherapy for atypical and malignant meningioma: A phase-II parallel non-randomized and observation study (EORTC 22042–26042). Radiother Oncol 128:260–265. https://doi.org/10.1016/j.radonc.2018.06.018

    Article  PubMed  Google Scholar 

  19. Jenkinson MD, Javadpour M, Haylock BJ, Young B, Gillard H, Vinten J, Bulbeck H, Das K, Farrell M, Looby S, Hickey H, Preusser M, Mallucci CL, Hughes D, Gamble C, Weber DC (2015) The ROAM/EORTC-1308 trial: radiation versus observation following surgical resection of atypical meningioma: study protocol for a randomised controlled trial. Trials 16:519. https://doi.org/10.1186/s13063-015-1040-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Wang C, Kaprealian TB, Suh JH, Kubicky CD, Ciporen JN, Chen Y, Jaboin JJ (2017) Overall survival benefit associated with adjuvant radiotherapy in WHO grade II meningioma. Neuro Oncol 19:1263–1270. https://doi.org/10.1093/neuonc/nox007

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Durand A, Labrousse F, Jouvet A, Bauchet L, Kalamarides M, Menei P, Deruty R, Moreau JJ, Fevre-Montange M, Guyotat J (2009) WHO grade II and III meningiomas: a study of prognostic factors. J Neurooncol 95:367–375. https://doi.org/10.1007/s11060-009-9934-0

    Article  PubMed  Google Scholar 

  22. Stafford SL, Perry A, Suman VJ, Meyer FB, Scheithauer BW, Lohse CM, Shaw EG (1998) Primarily resected meningiomas: outcome and prognostic factors in 581 Mayo Clinic patients, 1978 through 1988. Mayo Clin Proc 73:936–942. https://doi.org/10.4065/73.10.936

    Article  CAS  PubMed  Google Scholar 

  23. Meadows AT, Friedman DL, Neglia JP, Mertens AC, Donaldson SS, Stovall M, Hammond S, Yasui Y, Inskip PD (2009) Second neoplasms in survivors of childhood cancer: findings from the Childhood Cancer Survivor Study cohort. J Clin Oncol 27:2356–2362. https://doi.org/10.1200/JCO.2008.21.1920

    Article  PubMed  PubMed Central  Google Scholar 

  24. Minniti G, Traish D, Ashley S, Gonsalves A, Brada M (2005) Risk of second brain tumor after conservative surgery and radiotherapy for pituitary adenoma: update after an additional 10 years. J Clin Endocrinol Metab 90:800–804. https://doi.org/10.1210/jc.2004-1152

    Article  CAS  PubMed  Google Scholar 

  25. Yu JS, Yong WH, Wilson D, Black KL (2000) Glioblastoma induction after radiosurgery for meningioma. Lancet 356:1576–1577. https://doi.org/10.1016/S0140-6736(00)03134-2

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea

    Jason Joon Bock Lee, Hong In Yoon, Jaeho Cho & Chang-Ok Suh

  2. Department of Radiation Oncology, Inha University Hospital, Inha University College of Medicine, Incheon, Republic of Korea

    Jeongshim Lee

  3. Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Se Hoon Kim

  4. Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seoul, 03722, Republic of Korea

    Kyu Sung Lee & Jong Hee Chang

  5. Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea

    Chang-Ok Suh

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  1. Jason Joon Bock Lee
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Lee, J.J.B., Lee, J., Yoon, H.I. et al. Analysis of patterns of failure and appraisal of postoperative radiation field for grade II–III meningioma. J Neurooncol 144, 333–341 (2019). https://doi.org/10.1007/s11060-019-03232-w

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