title: Adjuvant radiation therapy, local recurrence, and the need for salvage therapy in atypical meningioma.
abstract: BACKGROUND
  The impact of adjuvant radiation in patients with atypical meningioma remains poorly defined. We sought to determine the impact of adjuvant radiation therapy in this population.
  
  
  METHODS
  We identified 91 patients with World Health Organization grade II (atypical) meningioma managed at Dana-Farber/Brigham and Women's Cancer Center between 1997 and 2011. A propensity score model incorporating age at diagnosis, gender, Karnofsky performance status, tumor location, tumor size, reason for diagnosis, and era of treatment was constructed using logistic regression for the outcome of receipt versus nonreceipt of radiation therapy. Propensity scores were then used as continuous covariates in a Cox proportional hazards model to determine the adjusted impact of adjuvant radiation therapy on both local recurrence and the combined endpoint of use of salvage therapy and death due to progressive meningioma.
  
  
  RESULTS
  The median follow-up in patients without recurrent disease was 4.9 years. After adjustment for pertinent confounding variables, radiation therapy was associated with decreased local recurrence in those undergoing gross total resection (hazard ratio, 0.25; 95% CI, 0.07-0.96; P = .04). No differences in overall survival were seen in patients who did and did not receive radiation therapy.
  
  
  CONCLUSIONS
  Patients who have had a gross total resection of an atypical meningioma should be considered for adjuvant radiation therapy given the improvement in local control. Multicenter, prospective trials are required to definitively evaluate the potential impact of radiation therapy on survival in patients with atypical meningioma.
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Ayal A
authors.initials: AA
authors.lastname: Aizer
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Nils D
authors.initials: ND
authors.lastname: Arvold
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Paul
authors.initials: P
authors.lastname: Catalano
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Claus
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Golby
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Mark D
authors.initials: MD
authors.lastname: Johnson
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Ossama
authors.initials: O
authors.lastname: Al-Mefty
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Patrick Y
authors.initials: PY
authors.lastname: Wen
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: David A
authors.initials: DA
authors.lastname: Reardon
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Eudocia Q
authors.initials: EQ
authors.lastname: Lee
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Nayak
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Mikael L
authors.initials: ML
authors.lastname: Rinne
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Rameen
authors.initials: R
authors.lastname: Beroukhim
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Weiss
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Shakti H
authors.initials: SH
authors.lastname: Ramkissoon
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Malak
authors.initials: M
authors.lastname: Abedalthagafi
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Sandro
authors.initials: S
authors.lastname: Santagata
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Ian F
authors.initials: IF
authors.lastname: Dunn
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (N.D.A., B.M.A.); Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts (P.C.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (E.B.C., A.J.G., M.D.J., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R., E.Q.L., L.N., M.L.R., R.B.); Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.E.W.); Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (S.H.R., S.S., M.A.).
authors.forename: Brian M
authors.initials: BM
authors.lastname: Alexander
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008579:Meningioma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000401:mortality*; D016879:Salvage Therapy; D015996:Survival Rate
keywords: atypical meningioma; radiation; recurrence; salvage