The optimal modality of radiation—intensity-modulated radiation therapy (IMRT) or stereotactic radiosurgery (SRS)—in patients with recurrent WHO grade II meningiomas is not well-established. The purpose of this study was to compare progression-free survival (PFS) in patients undergoing salvage IMRT vs SRS. We compared PFS in those with and without history of prior radiation.
Forty-two patients with 71 tumor recurrences treated with IMRT or SRS were retrospectively reviewed. Thirty-two salvage treatments were performed on recurrent tumors never treated with prior radiation (‘radiation-naïve’ cohort), whereas 39 salvage treatments were performed on recurrent tumors previously treated with radiation (‘re-treatment cohort’).
In the ‘radiation-naïve’ cohort, 3-year PFS for IMRT and SRS was 68.8% and 60.7%, respectively (p = 0.61). The median tumor volume for patients treated with IMRT was significantly larger than for patients treated with SRS (5.7 vs 2.2 cm3; p = 0.04). The 3-year PFS for salvage IMRT or SRS in the ‘re-treatment’ cohort was 45.4% vs 65.8% in the ‘radiation-naïve’ cohort (p = 0.008). When analyzing the outcome of multiple re-treatments, median PFS was 47 months for 1st or 2nd salvage radiation (IMRT or SRS) compared to 16 months for the 3rd or greater salvage radiation treatment (p = 0.003).
For salvage radiation of recurrent grade II tumors that are ‘radiation-naïve’, comparable 3-year PFS rates were found between IMRT and SRS, despite the IMRT group having significantly larger tumors. Salvage radiation overall was less successful in the ‘re-treatment’ cohort compared with the ‘radiation-naïve’ cohort. Additionally, the effectiveness of radiation significantly declines with successive salvage radiation treatments.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
De-identified raw data available upon request.
Available upon request.
Davis FG, Kupelian V, Freels S et al (2001) Prevalence estimates for primary brain tumors in the United States by behavior and major histology groups. Neuro Oncol 3:152–158. https://doi.org/10.1093/neuonc/3.3.152
Modha A, Gutin PH (2005) Diagnosis and treatment of atypical and anaplastic meningiomas: a review. Neurosurgery 57:538–549. https://doi.org/10.1227/01.NEU.0000170980.47582.A5
Rogers L, Gilbert M, Vogelbaum MA (2010) Intracranial meningiomas of atypical (WHO grade II) histology. J Neurooncol 99:393–405. https://doi.org/10.1007/s11060-010-0343-1
Kshettry VR, Ostrom QT, Kruchko C et al (2015) Descriptive epidemiology of World Health Organization grades II and III intracranial meningiomas in the United States. Neuro Oncol 17:1166–1173. https://doi.org/10.1093/neuonc/nov069
Rogers L, Barani I, Chamberlain M et al (2015) Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review. J Neurosurg 122:4–23. https://doi.org/10.3171/2014.7.JNS131644
Claus EB, Bondy ML, Schildkraut JM et al (2005) Epidemiology of intracranial meningioma. Neurosurgery 57:1088–1094. https://doi.org/10.1227/01.NEU.0000188281.91351.B9
Pearson BE, Markert JM, Fisher WS et al (2008) Hitting a moving target: Evolution of a treatment paradigm for atypical meningiomas amid changing diagnostic criteria. Neurosurg Focus 24:1–8. https://doi.org/10.3171/FOC/2008/24/5/E3
Willis J, Smith C, Ironside JW et al (2005) The accuracy of meningioma grading: a 10-year retrospective audit. Neuropathol Appl Neurobiol 31:141–149. https://doi.org/10.1111/j.1365-2990.2004.00621.x
Aghi MK, Carter BS, Cosgrove GR 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
Hammouche S, Clark S, Wong AHL et al (2014) Long-term survival analysis of atypical meningiomas: survival rates, prognostic factors, operative and radiotherapy treatment. Acta Neurochir (Wien) 156:1475–1481. https://doi.org/10.1007/s00701-014-2156-z
Wang YC, Chuang CC, Wei KC et al (2016) Long term surgical outcome and prognostic factors of atypical and malignant meningiomas. Sci Rep 6:1–8. https://doi.org/10.1038/srep35743
Bagshaw HP, Burt LM, Jensen RL et al (2017) Adjuvant radiotherapy for atypical meningiomas. J Neurosurg 126:1822–1828. https://doi.org/10.3171/2016.5.JNS152809
Mair R, Morris K, Scott I et al (2011) Radiotherapy for atypical meningiomas: clinical article. J Neurosurg 115:811–819. https://doi.org/10.3171/2011.5.JNS11112
Hardesty DA, Wolf AB, Brachman DG et al (2013) The impact of adjuvant stereotactic radiosurgery on atypical meningioma recurrence following aggressive microsurgical resection. J Neurosurg 119:475–481. https://doi.org/10.3171/2012.12.JNS12414
Sun SQ, Kim AH, Cai C et al (2014) Management of atypical cranial meningiomas, Part 1. Neurosurgery 75:347–355. https://doi.org/10.1227/neu.0000000000000461
Jo K, Park HJ, Nam DH et al (2010) Treatment of atypical meningioma. J Clin Neurosci 17:1362–1366. https://doi.org/10.1016/j.jocn.2010.03.036
Chen WC, Hara J, Magill ST et al (2018) Salvage therapy outcomes for atypical meningioma. J Neurooncol 138:425–433. https://doi.org/10.1007/s11060-018-2813-9
Shrieve DC, Hazard L, Boucher K, Jensen RL (2004) Dose fractionation in stereotactic radiotherapy for parasellar meningiomas: radiobiological considerations of efficacy and optic nerve tolerance. J Neurosurg 101(Suppl):390–395
Choi CYH, Soltys SG, Gibbs IC et al (2010) Cyberknife stereotactic radiosurgery for treatment of atypical (Who Grade II) cranial meningiomas. Neurosurgery 67:1180–1188. https://doi.org/10.1227/NEU.0b013e3181f2f427
Pollock BE, Stafford SL, Link MJ et al (2012) Stereotactic radiosurgery of World Health Organization grade II and III intracranial meningiomas: treatment results on the basis of a 22-year experience. Cancer 118:1048–1054. https://doi.org/10.1002/cncr.26362
Hakim R, Alexander E, Loeffler JS et al (1998) Results of linear accelerator-based radiosurgery for intracranial meningiomas. Neurosurgery 42:446–454. https://doi.org/10.1097/00006123-199803000-00002
Stafford SL, Pollock BE, Foote RL, et al (2001) Meningioma radiosurgery: complications among 190 consecutive patients. Neurosurgery 49
Milosevic MF, Frost PJ, Laperriere NJ et al (1996) Radiotherapy for atypical or malignant intracranial meningioma. Int J Radiat Oncol Biol Phys 34:817–822. https://doi.org/10.1016/0360-3016(95)02166-3
Kano H, Takahashi JA, Katsuki T et al (2007) Stereotactic radiosurgery for atypical and anaplastic meningiomas. J Neurooncol 84:41–47. https://doi.org/10.1007/s11060-007-9338-y
Rogers L, Zhang P, Vogelbaum MA et al (2018) Intermediate-risk meningioma: Initial outcomes from NRG Oncology RTOG 0539. J Neurosurg 129:35–47. https://doi.org/10.3171/2016.11.JNS161170
Sun SQ, Cai C, Murphy RKJ et al (2016) Radiation therapy for residual or recurrent atypical meningioma: The effects of modality, timing, and tumor pathology on long-term outcomes. Neurosurgery 79:23–32. https://doi.org/10.1227/NEU.0000000000001160
Pasquier D, Bijmolt S, Veninga T et al (2008) Atypical and malignant meningioma: outcome and prognostic factors in 119 irradiated patients. a multicenter, retrospective study of the rare cancer network. Int J Radiat Oncol Biol Phys 71:1388–1393. https://doi.org/10.1016/j.ijrobp.2007.12.020
Hug EB, DeVries A, Thornton AF et al (2000) Management of atypical and malignant meningiomas: role of high-dose, 3D-conformal radiation therapy. J Neurooncol 48:151–160. https://doi.org/10.1023/A:1006434124794
Aboukais R, Zairi F, Lejeune JP et al (2015) Grade 2 meningioma and radiosurgery. J Neurosurg 122:1157–1162. https://doi.org/10.3171/2014.9.JNS14233
Harris AE, Lee JYK, Omalu B et al (2003) The effect of radiosurgery during management of aggressive meningiomas. Surg Neurol 60:298–305. https://doi.org/10.1016/S0090-3019(03)00320-3
Goldsmith BJ, Wara WM, Wilson CB, Larson DA (1994) Postoperative irradiation for subtotally resected meningiomas. a retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 80:195–201. https://doi.org/10.3171/jns.1994.80.2.0195
Rogers CL, Won M, Vogelbaum MA et al (2020) High-risk meningioma: initial outcomes from NRG oncology/RTOG 0539. Int J Radiat Oncol Biol Phys 106:790–799. https://doi.org/10.1016/j.ijrobp.2019.11.028
Press RH, Prabhu RS, Appin CL et al (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
Attia A, Chan MD, Mott RT et al (2012) Patterns of failure after treatment of atypical meningioma with gamma knife radiosurgery. J Neurooncol 108:179–185. https://doi.org/10.1007/s11060-012-0828-1
Sethi RA, Rush SC, Liu S et al (2015) Dose-response relationships for meningioma radiosurgery. Am J Clin Oncol Cancer Clin Trials 38:600–604. https://doi.org/10.1097/COC.0000000000000008
McDonald MW, Plankenhorn DA, McMullen KP et al (2015) Proton therapy for atypical meningiomas. J Neurooncol 123:123–128. https://doi.org/10.1007/s11060-015-1770-9
Lu VM, Goyal A, Lee A et al (2019) The prognostic significance of TERT promoter mutations in meningioma: a systematic review and meta-analysis. J Neurooncol 142:1–10. https://doi.org/10.1007/s11060-018-03067-x
Sievers P, Hielscher T, Schrimpf D et al (2020) CDKN2A/B homozygous deletion is associated with early recurrence in meningiomas. Acta Neuropathol 140:409–413. https://doi.org/10.1007/s00401-020-02188-w
Sahm F, Schrimpf D, Stichel D et al (2017) DNA methylation-based classification and grading system for meningioma: a multicentre, retrospective analysis. Lancet Oncol 18:682–694. https://doi.org/10.1016/S1470-2045(17)30155-9
Olar A, Wani KM, Wilson CD et al (2017) Global epigenetic profiling identifies methylation subgroups associated with recurrence-free survival in meningioma. Acta Neuropathol 133:431–444. https://doi.org/10.1007/s00401-017-1678-x
Conflict of interest
Gene H. Barnett (consultant, Monteris Medical, Inc.), John Suh (consultant for NovoCure and Philips), Varun R. Kshettry (consultant, Integra).
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Momin, A.A., Shao, J., Soni, P. et al. Outcomes of salvage radiation for recurrent world health organization grade II meningiomas: a retrospective cohort study. J Neurooncol (2021). https://doi.org/10.1007/s11060-021-03711-z
- Intensity modulated radiotherapy
- Progression-free survival
- Atypical meningiomas
- Salvage radiation
- Stereotactic radiosurgery