Outcomes following upfront radiation versus monitoring in atypical meningiomas: 16-year experience at a tertiary medical center.

TitleOutcomes following upfront radiation versus monitoring in atypical meningiomas: 16-year experience at a tertiary medical center.
Publication TypeJournal Article
Year of Publication2021
AuthorsPan PC, Pisapia DJ, Ramakrishna R, Schwartz TH, Pannullo SC, Knisely JPS, Chiang GC, Ivanidze J, Stieg PE, Liechty B, Brandmaier A, Fine HA, Magge RS
JournalNeurooncol Adv
Volume3
Issue1
Paginationvdab094
Date Published2021 Jan-Dec
ISSN2632-2498
Abstract

Background: The role of postoperative upfront radiotherapy (RT) in the management of gross totally resected atypical meningiomas remains unclear. This single-center retrospective review of newly diagnosed histologically confirmed cases of World Health Organization (WHO) Grade II atypical meningioma at Weill Cornell Medicine from 2004 to 2020 aims to compare overall survival (OS) and progression-free survival (PFS) of postoperative upfront RT versus observation, stratified by resection status (gross total resection [GTR] vs subtotal resection [STR]).

Methods: Ninety cases of atypical meningioma were reviewed (56% women; median age 61 years; median follow-up 41 months).

Results: In patients with GTR, hazard ratio (HR) of PFS was 0.09 for postoperative upfront RT versus observation alone (95% confidence interval [CI] 0.01-0.68; = .02), though HR for OS was not significant (HR 0.46; 95% CI 0.05-4.45; = .5). With RT, PFS was 100% at 12 and 36 months (compared to 84% and 63%, respectively, with observation); OS at 36 months (OS36) was 100% (compared to 94% with observation). In patients with STR, though PFS at 36 months was higher for RT arm versus observation (84% vs 74%), OS36 was 100% in both arms. HR was not significant (HR 0.76; 95% CI 0.16-3.5; = .73).

Conclusions: This retrospective study suggests postoperative upfront RT following GTR of atypical meningioma is associated with improved PFS compared to observation. Further studies are required to draw conclusions about OS.

DOI10.1093/noajnl/vdab094
Alternate JournalNeurooncol Adv
PubMed ID34345823
PubMed Central IDPMC8325755
Related Faculty: 
Benjamin L. Liechty, M.D. David Pisapia, M.D.

Pathology & Laboratory Medicine 1300 York Avenue New York, NY 10065 Phone: (212) 746-6464
Surgical Pathology: (212) 746-2700