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Outcomes of salvage radiation for recurrent world health organization grade II meningiomas: a retrospective cohort study

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Abstract

Purpose

The optimal modality of radiation—intensity-modulated radiation therapy (IMRT) or stereotactic radiosurgery (SRS)—in patients with recurrent WHO grade II meningiomas is not well-established. The purpose of this study was to compare progression-free survival (PFS) in patients undergoing salvage IMRT vs SRS. We compared PFS in those with and without history of prior radiation.

Methods

Forty-two patients with 71 tumor recurrences treated with IMRT or SRS were retrospectively reviewed. Thirty-two salvage treatments were performed on recurrent tumors never treated with prior radiation (‘radiation-naïve’ cohort), whereas 39 salvage treatments were performed on recurrent tumors previously treated with radiation (‘re-treatment cohort’).

Results

In the ‘radiation-naïve’ cohort, 3-year PFS for IMRT and SRS was 68.8% and 60.7%, respectively (p = 0.61). The median tumor volume for patients treated with IMRT was significantly larger than for patients treated with SRS (5.7 vs 2.2 cm3; p = 0.04). The 3-year PFS for salvage IMRT or SRS in the ‘re-treatment’ cohort was 45.4% vs 65.8% in the ‘radiation-naïve’ cohort (p = 0.008). When analyzing the outcome of multiple re-treatments, median PFS was 47 months for 1st or 2nd salvage radiation (IMRT or SRS) compared to 16 months for the 3rd or greater salvage radiation treatment (p = 0.003).

Conclusion

For salvage radiation of recurrent grade II tumors that are ‘radiation-naïve’, comparable 3-year PFS rates were found between IMRT and SRS, despite the IMRT group having significantly larger tumors. Salvage radiation overall was less successful in the ‘re-treatment’ cohort compared with the ‘radiation-naïve’ cohort. Additionally, the effectiveness of radiation significantly declines with successive salvage radiation treatments.

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Data availability

De-identified raw data available upon request.

Code availability

Available upon request.

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Authors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

    Arbaz A. Momin, Jianning Shao, John H. Suh, Erin S. Murphy, Samuel T. Chao, Lilyana Angelov, Alireza M. Mohammadi, Gene H. Barnett, Pablo F. Recinos & Varun R. Kshettry

  2. Department of Neurosurgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Skull Base, Pituitary & Cerebrovascular Surgery, CLCM of CWRU, 9500 Euclid Avenue, Cleveland, OH, CA5-8644195, USA

    Arbaz A. Momin, Jianning Shao, Pranay Soni, João Paulo Almeida, Lilyana Angelov, Alireza M. Mohammadi, Gene H. Barnett, Pablo F. Recinos & Varun R. Kshettry

  3. Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA

    John H. Suh, Erin S. Murphy & Samuel T. Chao

  4. Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA

    João Paulo Almeida, John H. Suh, Erin S. Murphy, Samuel T. Chao, Lilyana Angelov, Alireza M. Mohammadi, Gene H. Barnett, Pablo F. Recinos & Varun R. Kshettry

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  1. Arbaz A. Momin
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Correspondence to Varun R. Kshettry.

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Conflict of interest

Gene H. Barnett (consultant, Monteris Medical, Inc.), John Suh (consultant for NovoCure and Philips), Varun R. Kshettry (consultant, Integra).

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Momin, A.A., Shao, J., Soni, P. et al. Outcomes of salvage radiation for recurrent world health organization grade II meningiomas: a retrospective cohort study. J Neurooncol 152, 373–382 (2021). https://doi.org/10.1007/s11060-021-03711-z

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