Journal article
Treatment of WHO Grade 2 Meningiomas With Stereotactic Radiosurgery: Identification of an Optimal Group for SRS Using RPA
International journal of radiation oncology, biology, physics, v 110(3), pp 804-814
01 Jul 2021
PMID: 33548341
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
This study assesses a large multi-institutional database to present the outcomes of World Health Organization grade 2 meningiomas treated with stereotactic radiosurgery (SRS). We also compare the 3-year progression-free survival (PFS) to that reported in the Radiation Therapy Oncology Group 0539 phase 2 cooperative group meningioma trial.
From an international, multicenter group, data were collected for grade 2 meningioma patients treated with SRS for demonstrable tumor from 1994 to 2019. Statistical methods used included the Kaplan-Meier method, Cox proportional hazards analysis, and recursive partitioning analysis.
Two hundred thirty-three patients treated at 12 institutions were included. Patients presented at a median age of 60 years (range, 13-90), and many had at least 2 prior resections (30%) or radiation therapy (22%). Forty-eight percent of patients had prior gross total resection. At SRS, the median treatment volume was 6.1 cm
(0.1-97.6). A median 15 Gy (10-30) was delivered to a median percent isodose of 50 (30-80), most commonly in 1 fraction (95%). A model was developed using recursive partitioning analysis, with one point attributed to age >50 years, treatment volume >11.5 cm
, and prior radiation therapy or multiple surgeries. The good-prognostic group (score, 0-1) had improved PFS (P < .005) and time to local failure (P < .005) relative to the poor-prognostic group (score, 2-3). Age >50 years (hazard ratio = 1.85 [95% confidence interval, 1.09-3.14]) and multiple prior surgeries (hazard ratio = 1.80 [1.09-2.99]) also portended reduced PFS in patients without prior radiation therapy. Two hundred eighteen of 233 patients in this study qualified for the high-risk group of Radiation Therapy Oncology Group 0539, and they demonstrated similar outcomes (3-year PFS: 53.9% vs 58.8%). The good-prognostic group of SRS patients demonstrated slightly improved outcomes (3-year PFS: 63.1% vs 58.8%).
SRS should be considered in carefully selected patients with atypical meningiomas. We suggest the use of our good-prognostic group to optimize patient selection, and we strongly encourage the initiation of a clinical trial to prospectively validate these outcomes.
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Details
- Title
- Treatment of WHO Grade 2 Meningiomas With Stereotactic Radiosurgery: Identification of an Optimal Group for SRS Using RPA
- Creators
- Roman O Kowalchuk - Mayo ClinicMatthew J Shepard - University of Virginia Health SystemKimball Sheehan - University of Virginia Health SystemDarrah Sheehan - University of Virginia Health SystemAndrew Faramand - University of Pittsburgh Medical CenterAjay Niranjan - University of Pittsburgh Medical CenterHideyuki Kano - University of Pittsburgh Medical CenterJason Gurewitz - NYU Langone HealthKenneth Bernstein - NYU Langone HealthRoman Liscak - Na Homolce HospitalKhumar Guseynova - Na Homolce HospitalInga S Grills - Beaumont HealthJacob S Parzen - Beaumont HealthChristopher P Cifarelli - West Virginia UniversityAzeem A Rehman - West Virginia UniversityAhmet Atik - Cleveland ClinicJoshua Bakhsheshian - University of Southern CaliforniaGabriel Zada - University of Southern CaliforniaEric Chang - University of Southern CaliforniaSteven Giannotta - University of Southern CaliforniaHerwin Speckter - Centro Gamma Knife Dominicano, CEDIMAT, Plaza de la Salud, Santo Domingo, Dominican RepublicHsiu-Mei WuDouglas Kondziolka - NYU Langone HealthDavid Mathieu - Université de SherbrookeCheng-Chia Lee - Taipei Veterans General HospitalRonald E Warnick - Mayfield Brain & SpineL Dade Lunsford - University of Pittsburgh Medical CenterDaniel M Trifiletti - Jacksonville CollegeJason P Sheehan - University of Virginia Health System
- Publication Details
- International journal of radiation oncology, biology, physics, v 110(3), pp 804-814
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology
- Web of Science ID
- WOS:000657308400029
- Scopus ID
- 2-s2.0-85102082919
- Other Identifier
- 991022154807004721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Oncology
- Radiology, Nuclear Medicine & Medical Imaging