Adjuvant Radiotherapy Versus Surveillance for Grade 2 Intracranial Meningiomas: A Multi-Institutional Propensity Score-Matched Study

Hwa Kyung Byun; Won Ick Chang; Joo Ho Lee; Chul-Kee Park; In Ah Kim; Chae-Yong Kim; Jaeho Cho; Eui Hyun Kim; Jong Hee Chang; Seok-Gu Kang; Ju Hyung Moon; Sang Hyung Lee; Jason Joon Bock Lee; Il Han Kim; Chang-Ok Suh; Chan Woo Wee; Hong In Yoon

doi:10.3389/fonc.2022.877244

Adjuvant Radiotherapy Versus Surveillance for Grade 2 Intracranial Meningiomas: A Multi-Institutional Propensity Score-Matched Study

Front Oncol. 2022 Jul 1:12:877244. doi: 10.3389/fonc.2022.877244. eCollection 2022.

Authors

Hwa Kyung Byun¹, Won Ick Chang², Joo Ho Lee², Chul-Kee Park³, In Ah Kim⁴, Chae-Yong Kim⁵, Jaeho Cho¹, Eui Hyun Kim⁶, Jong Hee Chang⁶, Seok-Gu Kang⁶, Ju Hyung Moon⁶, Sang Hyung Lee⁷, Jason Joon Bock Lee⁸, Il Han Kim², Chang-Ok Suh^{1

9}, Chan Woo Wee^{10

11}, Hong In Yoon¹

Affiliations

¹ Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.
² Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
³ Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
⁴ Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
⁵ Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
⁶ Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
⁷ Department of Neurosurgery, Seoul Metropolitan Government - Seoul National University (SMG-SNU) Boramae Medical Center, Seoul, South Korea.
⁸ Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
⁹ Department of Radiation Oncology, Bundang CHA Medical Center, CHA University, Seongnam, South Korea.
¹⁰ Department of Radiation Oncology, Seoul Metropolitan Government - Seoul National University (SMG-SNU) Boramae Medical Center, Seoul, South Korea.
¹¹ Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea.

Abstract

Purpose: We aimed to compare the outcomes of adjuvant radiotherapy (ART) and surveillance in patients with grade 2 meningiomas (MNG2) who underwent surgical resection.

Materials and methods: Data from four hospitals, in which patients aged ≥18 years underwent Simpson grade 1-4 surgical resection for newly diagnosed MNG2 between 1998 and 2018, were examined in this multicenter retrospective cohort study. Patients receiving ART with conventional fractionation were compared with those undergoing surveillance. Progression-free survival (PFS), progression/recurrence (P/R) were evaluated.

Results: This study included 518 patients, 158 of whom received ART. The median follow-up duration was 64.9 months. In the total cohort, ART was independently associated with significantly improved PFS (HR, 0.35; 95% CI, 0.23-0.55; P<0.001) and P/R (HR, 0.30; 95% CI, 0.18-0.48; P<0.001). In the propensity score-matched cohort (n=143 in each group), the 5-year PFS rates were 80.8% and 57.7% (P=0.004), and the 5-year P/R rates were 16.5% and 40.0% (P=0.002) in the ART and surveillance groups, respectively. After gross total resection, the 5-year PFS (85.0% vs. 64.7%; P=0.020) and P/R rates (15.2% vs. 32.0%; P=0.035) were significantly better in the ART group than in the surveillance group. A model for P/R was developed using recursive partitioning analysis with surgical extent, tumor size, and Ki-67 index. ART reduced the risk of P/R in the low- (P=0.069), intermediate- (P=0.044), and high-risk groups (P<0.001). Local control was also significantly enhanced by ART among all the risk groups (all P<0.05).

Conclusions: ART significantly improved PFS and P/R in patients with MNG2, irrespective of the surgical extent, and can be recommended after gross total resection. A prognostic model may guide decision-making for the use of ART.

Keywords: adjuvant radiotherapy; intracranial meningioma; propensity score matching; surgical resection; surveillance.