Risk group-adapted adjuvant radiotherapy for WHO grade I and II skull base meningioma
Salvage treatment including surgery and radiotherapy (RT) for recurrent or progressive meningioma is not an easy task, especially for the skull base location. And yet, criteria for adjuvant radiotherapy after initial surgery are not clearly defined for WHO grade I/II meningioma. We determined prognostic factors for recurrence and evaluated the benefit of risk group-adapted adjuvant RT for WHO grade I/II meningioma in the skull base.
We reviewed 272 patients who underwent surgery and were pathologically confirmed with WHO grade I or II skull base meningioma between January 2000 and July 2017. Subgroup analyses were performed for WHO grade I (259 patients) and WHO grade II (13 patients) meningiomas to evaluate the benefit of RT in each subgroup.
Patients with WHO grade II meningiomas tended to present more neurologic symptoms and to receive RT more frequently. In prognostic factor analysis, tumor size (p = 0.039), surgical extent (p < 0.001), and RT (p = 0.005) were associated with recurrence-free survival (RFS). In subgroup analysis of WHO grade I, RFS was significantly better in RT group after matching other variables. The risk stratification was performed using three risk factors (petroclival location, tumor size, Simpson grade) in WHO grade I patients, and significantly different RFS was observed according to the risk group in non-RT patients.
Tumor size, Simpson grade, and adjuvant RT were prognostic factors. The risk group-adapted approach can facilitate the selection of patients who may benefit from adjuvant RT for WHO grade I/II skull base meningiomas.
KeywordsMeningioma WHO grade I/II Skull base neoplasm Adjuvant radiotherapy Surgical extent Risk factors
Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education, Republic of Korea, Grant/Award Number: (2017R1D1A1B03035047); Korean Health Industry Development Institute funded by the Ministry of Health and Welfare, Republic of Korea, Grant/Award Number: (HI15C0638).
Compliance with ethical standards
Conflict of interest
The authors report no conflict of interest concerning the materials or methods in this study or the findings specified in this paper.
- Adeberg S et al (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 CrossRefGoogle Scholar
- Aghi MK et al (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) CrossRefGoogle Scholar
- Combs SE et al (2013) Skull base meningiomas: Long-term results and patient self-reported outcome in 507 patients treated with fractionated stereotactic radiotherapy (FSRT) or intensity modulated radiotherapy (IMRT) radiotherapy and oncology. J Eur Soc Therapeutic Radiol Oncol 106:186–191. https://doi.org/10.1016/j.radonc.2012.07.008 CrossRefGoogle Scholar
- Milker-Zabel S, Zabel A, Schulz-Ertner D, Schlegel W, Wannenmacher M, Debus J (2005) Fractionated stereotactic radiotherapy in patients with benign or atypical intracranial meningioma: long-term experience and prognostic factors. Int J Radiat Oncol Biol Phys 61:809–816. https://doi.org/10.1016/j.ijrobp.2004.07.669 CrossRefGoogle Scholar
- Milker-Zabel S, Zabel-du Bois A, Huber P, Schlegel W, Debus J (2007) Intensity-modulated radiotherapy for complex-shaped meningioma of the skull base: long-term experience of a single institution. Int J Radiat Oncol Biol Phys 68:858–863. https://doi.org/10.1016/j.ijrobp.2006.12.073 CrossRefGoogle Scholar
- Perry A, Scheithauer BW, Stafford SL, Lohse CM, Wollan PC (1999) “Malignancy” in meningiomas: a clinicopathologic study of 116 patients with grading implications. Cancer 85:2046–2056Google Scholar
- Thoemmes F (2012) Propensity score matching in SPSS arXiv preprint arXiv:12016385Google Scholar
- Van Havenbergh T, Carvalho G, Tatagiba M, Plets C, Samii M (2003) Natural history of petroclival meningiomas. Neurosurgery 52:55–62 (discussion 62–54) Google Scholar