Impact of timing of radiotherapy on outcomes in atypical meningioma: a clinical audit

Publication date: Available online 4 February 2018
Source:Practical Radiation Oncology
Author(s): Sidharth Pant, Raees Tonse, Sadhana Kannan, Aliasgar Moiyadi, Prakash Shetty, Sridhar Epari, Ayushi Sahay, Goda Jayant Sastri, Rakesh Jalali, Tejpal Gupta
BackgroundRole of early adjuvant radiotherapy (RT) in patients with atypical meningioma remains controversial.PurposeTo report the impact of timing of RT on outcomes in atypical meningioma.MethodsPatients of atypical meningioma were identified through electronic search of institutional database. Following surgery, RT was delivered either in upfront adjuvant setting (early adjuvant RT) or after recurrence/progression (salvage RT).ResultsThere were 51 patients in early adjuvant RT group and 30 patients in salvage RT group. Six of 51 (12%) patients in early adjuvant RT group recurred/progressed compared to 34 of 35 (97%) patients kept on observation after initial surgery. Thirty of these 34 patients received salvage RT, mostly after re-excision. Twelve of 30 (40%) patients recurred/progressed after salvage RT, compared to 6 of 51 (12%) patients after early adjuvant RT (p=0.003). Post-RT 5-year progression-free survival was significantly better for early adjuvant RT compared to salvage RT (69% vs 28%, log-rank p<0.001).ConclusionsWithin the limitations of any retrospective analysis, upfront early adjuvant RT can significantly reduce the risk of local recurrence/progression in atypical meningiomas compared to initial observation. A sizeable proportion of patients who are observed initially recur/progress over time necessitating salvage therapy. However, re-excision followed by salvage RT may not be as effective as early adjuvant RT.



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