Abstract
Purpose: It is controversial whether atypical meningioma patients undergoing gross-total resection (GTR) can benefit from postoperative radiotherapy (PORT). This study aimed to investigate the effectiveness of PORT on atypical meningioma patients.Methods: Patients diagnosed with atypical meningioma from 2008 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan–Meier survival curves were generated, and the log-rank test was used to compare the differences among groups. Univariable and multivariable COX regressions were conducted for survival analyses.Results: A total of 1,014 patients were enrolled. The 5-years survival rate of the overall patients was 79.0%. PORT was performed in 315 (31.1%) patients. The utilization rates of PORT in patients undergoing GTR and undergoing subtotal resection (STR) were 26.7% and 42.2%, respectively. For patients undergoing STR, log-rank test showed that overall survival (OS) time was significantly longer in patients receiving PORT than those not (p = 0.026). For patients undergoing GTR, OS time did not show significant association with PORT (p = 0.339). In addition, patients undergoing STR with PORT had no significantly different OS time compared with those undergoing GTR with PORT (p = 0.398). Multivariable Cox regression analysis showed that receipt of PORT (p = 0.187) was not an independent predictor of OS after adjustment.Conclusion: PORT may not prolong the OS in atypical meningioma patients undergoing GTR. However, patients undergoing STR may benefit from PORT and achieve similar OS to those undergoing GTR.
Highlights
Meningiomas are the most common primary intracranial tumors with an incidence rate of about 8 per 100,000 population, accounting for ∼37% of all central nervous system tumors [1]
By using the SEER database, the current study found that PatientsPostoperative radiotherapy (PORT) could not prolong the overall survival (OS) time in atypical meningioma patients undergoing gross-total resection (GTR), which indicates that these patients may not benefit from PORT after GTR
PORT has been routinely recommended for atypical meningioma patients undergoing subtotal resection (STR) [3, 5], it is surprising that the utilization rate of PORT was only 42.6% in these patients and even lower in the elder patients. These results indicate that atypical meningioma patients undergoing STR receive insufficient postoperative treatment and that adherence to clinical guidelines need to be improved for these patients, especially for elder patients
Summary
Meningiomas are the most common primary intracranial tumors with an incidence rate of about 8 per 100,000 population, accounting for ∼37% of all central nervous system tumors [1]. Postoperative radiotherapy (PORT) is routinely recommended for meningioma patients undergoing subtotal resection (STR), while for those undergoing gross-total resection (GTR), postoperative therapeutic strategies vary depending on grades [3, 5]. After GTR, observation is recommended for patients with WHO grade I meningioma, and PORT is suggested for patients with anaplastic meningioma [3, 5]. Optimal management for atypical meningioma patients after GTR is still controversial, and it is contentiously debated whether these patients can benefit from PORT. A phase II clinical trial (RTOG 0539) suggested that PORT can improve 3-year progression-free survival for intermediate-risk meningioma patients [16]
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