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Treatment of WHO Grade 2 Meningiomas With Stereotactic Radiosurgery: Identification of an Optimal Group for SRS Using RPA

RO. Kowalchuk, MJ. Shepard, K. Sheehan, D. Sheehan, A. Faramand, A. Niranjan, H. Kano, J. Gurewitz, K. Bernstein, R. Liscak, K. Guseynova, IS. Grills, JS. Parzen, CP. Cifarelli, AA. Rehman, A. Atik, J. Bakhsheshian, G. Zada, E. Chang, S....

. 2021 ; 110 (3) : 804-814. [pub] 20210203

Language English Country United States

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc21025455

PURPOSE: 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. METHODS AND MATERIALS: 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. RESULTS: 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 cm3 (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 cm3, 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%). CONCLUSIONS: 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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$a Kowalchuk, Roman O $u Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. Electronic address: Kowalchuk.Roman@mayo.edu
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$a Treatment of WHO Grade 2 Meningiomas With Stereotactic Radiosurgery: Identification of an Optimal Group for SRS Using RPA / $c RO. Kowalchuk, MJ. Shepard, K. Sheehan, D. Sheehan, A. Faramand, A. Niranjan, H. Kano, J. Gurewitz, K. Bernstein, R. Liscak, K. Guseynova, IS. Grills, JS. Parzen, CP. Cifarelli, AA. Rehman, A. Atik, J. Bakhsheshian, G. Zada, E. Chang, S. Giannotta, H. Speckter, HM. Wu, D. Kondziolka, D. Mathieu, CC. Lee, RE. Warnick, LD. Lunsford, DM. Trifiletti, JP. Sheehan
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$a PURPOSE: 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. METHODS AND MATERIALS: 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. RESULTS: 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 cm3 (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 cm3, 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%). CONCLUSIONS: 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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$a Shepard, Matthew J $u Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
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$a Sheehan, Kimball $u Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
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$a Sheehan, Darrah $u Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
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$a Faramand, Andrew $u Center of Image Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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$a Niranjan, Ajay $u Center of Image Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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$a Kano, Hideyuki $u Center of Image Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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$a Gurewitz, Jason $u Department of Neurosurgery, NYU Langone Health System, New York, New York
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$a Bernstein, Kenneth $u Department of Medical Physics, NYU Langone Health System, New York, New York
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$a Liscak, Roman $u Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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$a Guseynova, Khumar $u Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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$a Grills, Inga S $u Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
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$a Parzen, Jacob S $u Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
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$a Cifarelli, Christopher P $u Department of Neurologic Surgery, West Virginia University, Morgantown, West Virginia
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$a Rehman, Azeem A $u Department of Neurologic Surgery, West Virginia University, Morgantown, West Virginia
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$a Atik, Ahmet $u Department of Neurologic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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$a Bakhsheshian, Joshua $u Department of Neurologic Surgery, University of Southern California, Los Angeles, California
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$a Zada, Gabriel $u Department of Neurologic Surgery, University of Southern California, Los Angeles, California
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$a Chang, Eric $u Department of Radiation Oncology, University of Southern California, Los Angeles, California
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$a Giannotta, Steven $u Department of Neurologic Surgery, University of Southern California, Los Angeles, California
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$a Speckter, Herwin $u Centro Gamma Knife Dominicano, CEDIMAT, Plaza de la Salud, Santo Domingo, Dominican Republic
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$a Wu, Hsiu-Mei $u Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan
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$a Kondziolka, Douglas $u Department of Neurosurgery, NYU Langone Health System, New York, New York
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$a Mathieu, David $u Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada
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$a Lee, Cheng-Chia $u National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Neurosurgery, Taipei Veteran General Hospital, Taipei, Taiwan
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$a Warnick, Ronald E $u Department of Neurologic Surgery, Mayfield Clinic, Cincinnati, Ohio
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$a Lunsford, L Dade $u Center of Image Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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$a Trifiletti, Daniel M $u Mayo Clinic, Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
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$a Sheehan, Jason P $u Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
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