Fractionated radiotherapy for surgically resected intracranial meningiomas: A multicentre retrospective cohort study

Justin Z Wang; Farshad Nassiri; Alexander P Landry; Vikas Patil; Alexander Rebchuk; Zamir A Merali; Chloe Gui; Grace Lee; Lauren Rogers; Jessica Sinha; Zeel Patel; Jeffrey A Zuccato; Mathew R Voisin; David Munoz; Julian Spears; Michael D Cusimano; Sunit Das; Serge Makarenko; Stephen Yip; Andrew Gao; Normand Laperriere; Derek S Tsang; Gelareh Zadeh

doi:10.1016/j.radonc.2023.109861

Fractionated radiotherapy for surgically resected intracranial meningiomas: A multicentre retrospective cohort study

Radiother Oncol. 2023 Nov:188:109861. doi: 10.1016/j.radonc.2023.109861. Epub 2023 Aug 22.

Authors

Justin Z Wang¹, Farshad Nassiri¹, Alexander P Landry¹, Vikas Patil¹, Alexander Rebchuk², Zamir A Merali³, Chloe Gui³, Grace Lee⁴, Lauren Rogers⁵, Jessica Sinha⁶, Zeel Patel⁶, Jeffrey A Zuccato¹, Mathew R Voisin¹, David Munoz⁷, Julian Spears⁸, Michael D Cusimano⁸, Sunit Das⁹, Serge Makarenko², Stephen Yip¹⁰, Andrew Gao¹¹, Normand Laperriere¹², Derek S Tsang¹², Gelareh Zadeh¹³

Affiliations

¹ MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
² Division of Neurosurgery, Vancouver General Hospital, Vancouver, BC, Canada.
³ Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
⁴ MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, ON, Canada; Temerty Faculty of Medicine, The University of Toronto, Toronto, ON, Canada.
⁵ MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, ON, Canada; Faculty of Arts & Science, Queen's University, Kingston, ON, Canada.
⁶ MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, ON, Canada.
⁷ Department of Pathology, St. Michael's Hospital, Toronto, ON, Canada.
⁸ Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada.
⁹ Keenan Chair in Surgery, Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada.
¹⁰ Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada.
¹¹ Laboratory Medicine Program, University Health Network, Toronto, ON, Canada.
¹² Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
¹³ MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada. Electronic address: gelareh.zadeh@uhn.ca.

PMID: 37619659
DOI: 10.1016/j.radonc.2023.109861

Abstract

Background: Aside from surgical resection, the only standard of care treatment modality for meningiomas is radiotherapy (RT). Despite this, few studies have focused on identifying clinical covariates associated with failure of fractionated RT following surgical resection (fRT), and the timing of fRT following surgery still remains controversial (adjuvant versus salvage fRT). We assessed the outcomes of the largest, multi-institutional cohort of surgically resected meningiomas treated with subsequent adjuvant and salvage fRT to identify factors associated with local freedom from recurrence (LFFR) over 3-10 years post-fRT and to determine the optimal timing of fRT.

Methods: Patients with intracranial meningiomas who underwent surgery and fRT between 1997 and 2018 were included. Primary endpoints were radiographic recurrence/progression and time to progression from the completion of fRT.

Results: 404 meningiomas were included for analysis. Of these, 167 (41.3%) recurred post-fRT. Clinical covariates independently associated with worse PFS post-fRT included receipt of previous RT to the meningioma, having a WHO grade 3 meningioma or recurrent meningioma, the meningioma having a higher MIB1-index or brain invasion on pathology, and older patient age at diagnosis. Subgroup analysis identified higher MIB1-index as a histological factor associated with poorer LFFR in WHO grade 2 meningiomas. 179 patients underwent adjuvant RT shortly after surgery whereas 225 patients had delayed, salvage fRT after recurrence/progression. Following propensity score matching, patients that underwent adjuvant fRT had improved LFFR post-fRT compared to those that received salvage fRT.

Conclusion: There is a paucity of clinical factors that can predict a meningioma's response to fRT following surgery. Adjuvant fRT may be associated with improved PFS post-fRT compared to salvage fRT. Molecular biomarkers of RT-responsiveness are needed to better inform fRT treatment decisions.

Keywords: Adjuvant; Fractionated; Meningioma; Radiotherapy; Surgery.