Adjuvant radiation for WHO grade II and III intracranial meningiomas: insights on survival and practice patterns from a
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CLINICAL STUDY
Adjuvant radiation for WHO grade II and III intracranial meningiomas: insights on survival and practice patterns from a National Cancer Registry Desmond A. Brown1 · Anshit Goyal1,2 · Panagiotis Kerezoudis1 · Mohammed Ali Alvi1,2 · Benjamin T. Himes1 · Mohamad Bydon1,2 · Jamie J. Van Gompel1 · Kaisorn L. Chaichana3 · Alfredo Quiñones‑Hinojosa3 · Terry C. Burns1 · Elizabeth Yan4 · Ian F. Parney1 Received: 25 May 2020 / Accepted: 23 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction WHO grades II (atypical) and III (malignant) meningiomas are associated with significant morbidity and mortality. The role of adjuvant radiotherapy (RT) in management remains controversial. The goal of this study was to evaluate the impact of adjuvant RT on 5-year survival in patients with atypical and malignant meningiomas. We secondarily aimed to assess contemporary practice patterns and the impact of sociodemographic factors on outcome. Methods We queried the National Cancer Database for patients ≥ 18 years of age with cranial atypical or malignant meningiomas from 2010 through 2015 who underwent surgical resection with or without adjuvant radiotherapy. Subjects with unknown WHO grade or radiation status and those not receiving any surgical procedure were excluded from analysis. Results The study includes 7486 patients, 6788 with atypical and 698 with malignant meningiomas. Overall 5-year survival was 76.9% (95% CI 75.5–78.3%) and 43.3% (95% CI 38.8–48.2%) among patients with WHO grades II and III meningiomas, respectively. Adjuvant RT correlated with improved survival in a multivariable model in patients with grade II tumors (HR 0.78; p = 0.029) regardless of the extent of resection. Age (HR 2.33; p 6 weeks and > 90 days following surgery in an attempt to exclude patients receiving RT for likely recurrences as opposed to primary disease treatment. All p-values were 2-sided and statistical significance was accepted as p
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