Abstract
Atypical and anaplastic meningiomas have reduced progression-free/overall survival (PFS/OS) compared to benign meningiomas. Stereotactic radiosurgery (SRS) for atypical meningiomas (AMs) and anaplastic meningiomas (malignant meningiomas, MMs) has not been adequately described. To define clinical/radiographic outcomes for patients undergoing SRS for AM/MMs. An international, multicenter, retrospective cohort study was performed to define clinical/imaging outcomes for patients receiving SRS for AM/MMs. Tumor progression was assessed with response assessment in neuro-oncology (RANO) criteria. Factors associated with PFS/OS were assessed using Kaplan-Meier analysis and a Cox proportional hazards model. A total of 271 patients received SRS for AMs (n=233, 85.9%) or MMs (n=38, 14.0%). Single-fraction SRS was most commonly employed (n=264, 97.4%) with a mean target dose of 14.8 Gy.SRSwasused as adjuvant treatment (n=85, 31.4%), salvage therapy (n=182, 67.2%), or primary therapy (1.5%). The 5-yr PFS/OS rate was 33.6% and 77.0%, respectively. Increasing age (hazard ratio (HR)=1.01, P<.05) and a Ki-67 index>15% (HR=1.66, P<.03) negatively correlated with PFS. MMs (HR=3.21, P<.05), increased age (HR=1.04, P=.04), and reduced KPS (HR=0.95, P=.04) were associated with shortened OS. Adjuvant versus salvage SRS did not impact PFS/OS. A shortened interval between surgery and SRS improved PFS for AMs (HR=0.99, P=.02) on subgroup analysis. Radiation necrosis occurred in 34 (12.5%) patients. Five-year rates of repeat surgery/radiation were 33.8% and 60.4%, respectively. AM/MMs remain challenging tumors to treat. Elevated proliferative indices are associated with tumor recurrence, while MMs have worse survival. SRS can control AM/MMs in the short term, but the 5-yr PFS rates are low, underscoring the need for improved treatment options for these patients.
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