Outcomes of salvage radiation for recurrent world health organization grade II meningiomas: a retrospective cohort study

Abstract

Purpose

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.

Methods

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’).

Results

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).

Conclusion

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.

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Data availability

De-identified raw data available upon request.

Code availability

Available upon request.

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Correspondence to Varun R. Kshettry.

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Gene H. Barnett (consultant, Monteris Medical, Inc.), John Suh (consultant for NovoCure and Philips), Varun R. Kshettry (consultant, Integra).

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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

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Keywords

  • Intensity modulated radiotherapy
  • Progression-free survival
  • Atypical meningiomas
  • Salvage radiation
  • Stereotactic radiosurgery