TY - JOUR
T1 - Radiation therapy for residual or recurrent atypical meningioma
T2 - The effects of modality, timing, and tumor pathology on long-term outcomes
AU - Sun, Sam Q.
AU - Cai, Chunyu
AU - Murphy, Rory K.J.
AU - Dewees, Todd
AU - Dacey, Ralph G.
AU - Grubb, Robert L.
AU - Rich, Keith M.
AU - Zipfel, Gregory J.
AU - Dowling, Joshua L.
AU - Leuthardt, Eric C.
AU - Simpson, Joseph R.
AU - Robinson, Clifford G.
AU - Chicoine, Michael R.
AU - Perrin, Richard J.
AU - Huang, Jiayi
AU - Kim, Albert H.
N1 - Publisher Copyright:
© 2015 by the Congress of Neurological Surgeons.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - BACKGROUND: Optimal use of stereotactic radiosurgery (SRS) vs external beam radiation therapy (EBRT) for treatment of residual/recurrent atypical meningioma is unclear. OBJECTIVE: To analyze features associated with progression after radiation therapy. METHODS: Fifty radiation-naive patients who received SRS or EBRT for residual and/or recurrent atypical meningioma were examined for predictors of progression using Cox regression and Kaplan-Meier analyses. RESULTS: Thirty-two patients (64%) received adjuvant radiation after subtotal resection, 12 patients (24%) received salvage radiation after progression following subtotal resection, and 6 patients (12%) received salvage radiation after recurrence following gross total resection. Twenty-one patients (42%) received SRS (median 18 Gy), and 7 (33%) had tumor progression. Twenty-nine patients (58%) received EBRT (median 54 Gy), and 13 (45%) had tumor progression. Whereas tumor volume (P .53), SRS vs EBRT (P .45), and adjuvant vs salvage (P .34) were not associated with progression after radiation therapy, spontaneous necrosis (hazard ratio [HR] 82.3, P <.001), embolization necrosis (HR 15.6, P .03), and brain invasion (HR 3.8, P .008) predicted progression in univariate and multivariate analyses. Tumors treated with SRS/EBRT had 2- and 5-year actuarial locoregional control rates of 91%/88% and 71%/69%, respectively. Tumors with spontaneous necrosis, embolization necrosis, and no necrosis had 2- and 5-year locoregional control rates of 76%, 92%, and 100% and 36%, 73%, and 100%, respectively (P <.001). CONCLUSION: This study suggests that necrosis may be a negative predictor of radiation response regardless of radiation timing or modality.
AB - BACKGROUND: Optimal use of stereotactic radiosurgery (SRS) vs external beam radiation therapy (EBRT) for treatment of residual/recurrent atypical meningioma is unclear. OBJECTIVE: To analyze features associated with progression after radiation therapy. METHODS: Fifty radiation-naive patients who received SRS or EBRT for residual and/or recurrent atypical meningioma were examined for predictors of progression using Cox regression and Kaplan-Meier analyses. RESULTS: Thirty-two patients (64%) received adjuvant radiation after subtotal resection, 12 patients (24%) received salvage radiation after progression following subtotal resection, and 6 patients (12%) received salvage radiation after recurrence following gross total resection. Twenty-one patients (42%) received SRS (median 18 Gy), and 7 (33%) had tumor progression. Twenty-nine patients (58%) received EBRT (median 54 Gy), and 13 (45%) had tumor progression. Whereas tumor volume (P .53), SRS vs EBRT (P .45), and adjuvant vs salvage (P .34) were not associated with progression after radiation therapy, spontaneous necrosis (hazard ratio [HR] 82.3, P <.001), embolization necrosis (HR 15.6, P .03), and brain invasion (HR 3.8, P .008) predicted progression in univariate and multivariate analyses. Tumors treated with SRS/EBRT had 2- and 5-year actuarial locoregional control rates of 91%/88% and 71%/69%, respectively. Tumors with spontaneous necrosis, embolization necrosis, and no necrosis had 2- and 5-year locoregional control rates of 76%, 92%, and 100% and 36%, 73%, and 100%, respectively (P <.001). CONCLUSION: This study suggests that necrosis may be a negative predictor of radiation response regardless of radiation timing or modality.
KW - Atypical meningioma
KW - Radiation therapy
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U2 - 10.1227/NEU.0000000000001160
DO - 10.1227/NEU.0000000000001160
M3 - Article
C2 - 26645969
AN - SCOPUS:84949595520
SN - 0148-396X
VL - 79
SP - 23
EP - 32
JO - Neurosurgery
JF - Neurosurgery
IS - 1
ER -