Abstract
Background and PurposeConsensus regarding the need for adjuvant radiotherapy (RT) in patients with atypical meningiomas (AMs) is lacking. We compared the effects of adjuvant RT after surgery, gross total resection (GTR), and subtotal resection (STR) on progression-free survival (PFS) and overall survival (OS) in patients with AMs, respectively.MethodsWe performed a systematic review and meta-analysis of the literature published in PubMed, Embase, and the Cochrane Library from inception to February 1, 2021, to identify articles comparing the PFS and OS of patients receiving postoperative RT after surgery, GTR and STR.ResultsWe identified 2307 unique studies; 24 articles including 3078 patients met the inclusion criteria. The sensitivity analysis results showed that for patients undergoing undifferentiated surgical resection, adjuvant RT reduced tumor recurrence (HR=0.70, p<0.0001) with no significant effect on survival (HR=0.89, p=0.49). Postoperative RT significantly increased PFS (HR=0.69, p=0.01) and OS (HR=0.55, p=0.007) in patients undergoing GTR. The same improvement was observed in patients undergoing STR plus RT (PFS: HR=0.41, p<0.00001; OS: HR=0.47, p=0.01). A subgroup analysis of RT in patients undergoing GTR showed no change in PFS in patients undergoing Simpson grade I and II resection (HR=1.82, p=0.22) but significant improvement in patients undergoing Simpson grade III resection (HR=0.64, p=0.02).ConclusionRegardless of whether GTR or STR was performed, postoperative RT improved PFS and OS to varying degrees. Especially for patients undergoing Simpson grade III or IV resection, postoperative RT confers the benefits for recurrence and survival.
Highlights
Meningiomas are the most common primary tumors of the brain, representing more than one-third of all intracranial tumors [1]
It is necessary to perform a meta-analysis to evaluate the efficacy of surgical resection with RT on survival outcomes, including overall survival (OS) and progression-free survival (PFS), in patients suffering from atypical meningioma (AM)
Meta-Analysis of PFS and OS Between Surgery+RT and Surgery In the analysis of PFS and OS in atypical meningioma patients treated with surgery and RT or surgery alone, 19 and 7 studies were included, respectively, and the results are shown in
Summary
Meningiomas are the most common primary tumors of the brain, representing more than one-third of all intracranial tumors [1]. Atypical Meningioma Radiotherapy meningiomas (AMs) accounts for about 15-20% of all meningiomas, and associated with a higher risk of recurrence and a worse prognosis than benign meningiomas [3, 4]. Maximal safe surgical resection is currently the preferred treatment for atypical meningiomas, but there is no clear consensus on the use of adjuvant radiotherapy (RT) in these patients [5]. It is necessary to perform a meta-analysis to evaluate the efficacy of surgical resection with RT on survival outcomes, including overall survival (OS) and progression-free survival (PFS), in patients suffering from AMs. Consensus regarding the need for adjuvant radiotherapy (RT) in patients with atypical meningiomas (AMs) is lacking. We compared the effects of adjuvant RT after surgery, gross total resection (GTR), and subtotal resection (STR) on progression-free survival (PFS) and overall survival (OS) in patients with AMs, respectively
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