title: Early adjuvant radiotherapy in the treatment of atypical meningioma.
abstract: Atypical meningiomas have a greater propensity to recur than benign meningiomas and the benefits of early adjuvant radiotherapy are unclear. Existing studies report conflicting results. This retrospective cohort study evaluated the role of early adjuvant radiotherapy following surgical resection of atypical meningioma. A triple center case-note review of adults with newly-diagnosed atypical meningiomas between 2001 and 2010 was performed. Pathology diagnosis was made according to the World Health Organization classification in use at the time of surgery. Patients with multiple meningiomas, neurofibromatosis type 2 and radiation-induced meningiomas were excluded. Extent of resection was defined as gross total resection (GTR; Simpson Grade I-III) or subtotal resection (STR; Simpson Grade IV-V). Survival analysis was performed using the Kaplan-Meier method. One hundred thirty-three patients were identified with a median age of 62years (range 22-86years) and median follow-up of 57.4months (range 0.1-152.2months). Tumors were mostly located in the convexity (50.4%) or falcine/parasagittal regions (27.1%). GTR (achieved in 85%) was associated with longer progression free survival (PFS) (5year PFS 81.2% versus 40.08%, log-rank=11.117, p=0.001) but not overall survival (OS) (5year OS 76.6% versus 39.7%, log-rank=3.652, p=0.056). Following GTR, early adjuvant radiotherapy was administered to 28.3% of patients and did not influence OS (5year OS 77.0% versus 75.7%, log-rank=0.075, p=0.784) or PFS (5year PFS 82.0% versus 79.3%, log-rank=0.059, p=0.808). Although extent of resection emerged as an important prognostic variable, early adjuvant radiotherapy did not influence outcome following GTR of atypical meningiomas. Prospective randomized controlled trials are planned.
authors.affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Lower Lane, Liverpool L9 7LJ, UK; Institute of Translational Medicine and School of Medicine, University of Liverpool, Liverpool, UK. Electronic address: michael.jenkinson@liv.ac.uk.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Jenkinson
authors.affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Lower Lane, Liverpool L9 7LJ, UK; Institute of Translational Medicine and School of Medicine, University of Liverpool, Liverpool, UK.
authors.forename: Mueez
authors.initials: M
authors.lastname: Waqar
authors.affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Lower Lane, Liverpool L9 7LJ, UK.
authors.forename: Jibril Osman
authors.initials: JO
authors.lastname: Farah
authors.affiliation: Department of Neuropathology, Beaumont Hospital, Dublin, Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Farrell
authors.affiliation: Department of Neurosurgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy.
authors.forename: Giuseppe M V
authors.initials: GM
authors.lastname: Barbagallo
authors.affiliation: Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: Robin
authors.initials: R
authors.lastname: McManus
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland.
authors.forename: Seamus
authors.initials: S
authors.lastname: Looby
authors.affiliation: Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Hussey
authors.affiliation: Department of Radiation Oncology, Beaumont Hospital, Dublin, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Fitzpatrick
authors.affiliation: Department of Neurosurgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Certo
authors.affiliation: Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Javadpour
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D008579:Meningioma / Q000532:radiotherapy* / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009381:Neoplasms, Radiation-Induced; D017063:Outcome Assessment, Health Care; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D055815:Young Adult
keywords: Atypical meningioma; Radiotherapy; Surgery; Survival