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The role of single-fraction stereotactic radiosurgery for atypical meningiomas (WHO grade II): treatment results based on a 25-year experience

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Abstract

Purpose

To clarify the role of stereotactic radiosurgery (SRS) for atypical meningiomas (AM).

Methods

A retrospective analysis of 68 patients with AM having SRS from 1995 until 2019.

Results

Nineteen patients (28%) had undergone prior external beam radiation therapy (EBRT) (median dose, 54 Gy). The median follow-up period was 52 months. Eighteen (26%), 17 (25%), and 33 (49%) patients received SRS as an upfront adjuvant (≤ 6 months), early salvage (7–18 months), or late salvage treatment (> 18 months), respectively. The 3-, 5-, and 10-year progression-free survivals (PFSs) were 52%, 35%, and 25%, respectively. The 3-, 5-, and 10-year disease-specific survivals were 85%, 78%, and 61%, respectively. Adverse radiation events (AREs) were observed in 12 patients (18%), with increased or new seizures being the most frequent complication (n = 7). Prior EBRT was associated with reduced PFS (HR 5.92, P < 0.01), reduced DSS (HR 5.84, P < 0.01), and an increased risk of ARE (HR 3.31, P = 0.04). Timing of SRS was correlated with reduced PFS for patients having early salvage treatment compared to upfront adjuvant (HR 3.17, P = 0.01) or late salvage treatment (HR 4.39, P < 0.01).

Conclusion

PFS for patients with residual/recurrent AM remains poor despite SRS. Prior EBRT was associated with worse tumor control, higher tumor-related mortality, and an increased risk of ARE. Further study on the timing of SRS is needed to determine if upfront adjunctive SRS improves tumor control compared to salvage SRS.

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Data availability

The data used in the present study will be available upon reasonable request to the corresponding author.

Code availability

Not applicable.

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Funding

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Author information

Authors and Affiliations

  1. Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA

    Hirotaka Hasegawa, Kunal Vakharia, Michael J. Link, Ian F. Parney, Terry C. Burns & Bruce E. Pollock

  2. Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA

    Scott L. Stafford, Paul D. Brown, Elizabeth S. Yan, Anita Mahajan, Nadia N. Laack & Bruce E. Pollock

  3. Department of Neurosurgery, The University of Tokyo, Bunkyo, Tokyo, Japan

    Hirotaka Hasegawa

Authors
  1. Hirotaka Hasegawa
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  2. Kunal Vakharia
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Contributions

HH: conceptualization, data acquisition, analysis, interpretation, drafting manuscript, final approval of the version to be published. KV: data acquisition, final approval of the version to be published. MJL, SLS, PDB, IFP, TCB, ESY, AM, NNL: critically revising manuscript, final approval of the version to be published. BEP: conceptualization, data analysis, interpretation, critically revising manuscript, final approval of the version to be published.

Corresponding author

Correspondence to Bruce E. Pollock.

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The authors have nothing to declare.

Ethical approval

The study was approved by Institutional Review board (IRB #21-000215).

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Informed consent was waived given the retrospective non-invasive nature of the study.

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Hasegawa, H., Vakharia, K., Link, M.J. et al. The role of single-fraction stereotactic radiosurgery for atypical meningiomas (WHO grade II): treatment results based on a 25-year experience. J Neurooncol 155, 335–342 (2021). https://doi.org/10.1007/s11060-021-03882-9

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