title: The role of adjuvant radiotherapy after gross total resection of atypical meningiomas.
abstract: BACKGROUND
  Atypical meningiomas (AMs) frequently recur after gross total resection (GTR).
  
  
  OBJECTIVE
  We conducted a meta-analysis to evaluate the benefit of adjuvant therapy after GTR of AMs.
  
  
  METHODS
  A PubMed/MEDLINE search identified studies detailing AMs treated by GTR alone or GTR and adjuvant radiotherapy (RT) published between 1984 and 2012. Original data from 14 retrospective studies were combined and analyzed. Odds ratio (OR) and χ(2) testing were used when appropriate. Selected datasets were used to generate each variable, where available.
  
  
  RESULTS
  A total of 757 patients (male/female ratio 9:10) with AMs were included; 72.52% (n = 549) of AMs were treated by GTR alone, and 27.47% (n = 208) underwent adjuvant RT after GTR to a median dose of 54 Gy. The crude recurrence rate was twice as high without adjuvant RT (33.7% vs. 15%, P = 0.005). The 1-year local control rate was 90% for GTR and 97% for GTR + RT (OR = 3.36, P = 0.11). The median 5-year local control rate was 62% for GTR and 73% for GTR + RT, respectively (OR = 1.71, P = 0.06). The 5-year overall survival for each group was 90% (OR = 0.97, P = 0.95). A total of 85% of recurrences were salvaged, 33% by RT and 67% by surgery. Radiation-related toxicity was <10%, at a median follow-up of 42 months.
  
  
  CONCLUSIONS
  Postoperative RT for AMs may decrease risk for relapse of disease and improve local control, although most tumors are salvageable with surgery or radiation. Although the data suggest little or no impact of postoperative RT on survival, further investigation regarding the long-term efficacy and toxicity of radiation is warranted.
authors.affiliation: College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA.
authors.forename: Shaakir
authors.initials: S
authors.lastname: Hasan
authors.affiliation: College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Young
authors.affiliation: College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA.
authors.forename: Trevine
authors.initials: T
authors.lastname: Albert
authors.affiliation: Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Ashish H
authors.initials: AH
authors.lastname: Shah
authors.affiliation: Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Okoye
authors.affiliation: Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Amade
authors.initials: A
authors.lastname: Bregy
authors.affiliation: Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA.
authors.forename: Simon S
authors.initials: SS
authors.lastname: Lo
authors.affiliation: Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Fazilat
authors.initials: F
authors.lastname: Ishkanian
authors.affiliation: Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA. Electronic address: rkomotar@med.miami.edu.
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Komotar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008579:Meningioma / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adjuvant radiotherapy; Atypical meningioma; Gross tumor resection; Meningioma; Postoperative; Radiation; Surgery