Radiation therapy for residual or recurrent atypical meningioma: The effects of modality, timing, and tumor pathology on long-term outcomes

Sam Q. Sun, Chunyu Cai, Rory K.J. Murphy, Todd Dewees, Ralph G. Dacey, Robert L. Grubb, Keith M. Rich, Gregory J. Zipfel, Joshua L. Dowling, Eric C. Leuthardt, Joseph R. Simpson, Clifford G. Robinson, Michael R. Chicoine, Richard J. Perrin, Jiayi Huang, Albert H. Kim

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Optimal use of stereotactic radiosurgery (SRS) vs external beam radiation therapy (EBRT) for treatment of residual/recurrent atypical meningioma is unclear. OBJECTIVE: To analyze features associated with progression after radiation therapy. METHODS: Fifty radiation-naive patients who received SRS or EBRT for residual and/or recurrent atypical meningioma were examined for predictors of progression using Cox regression and Kaplan-Meier analyses. RESULTS: Thirty-two patients (64%) received adjuvant radiation after subtotal resection, 12 patients (24%) received salvage radiation after progression following subtotal resection, and 6 patients (12%) received salvage radiation after recurrence following gross total resection. Twenty-one patients (42%) received SRS (median 18 Gy), and 7 (33%) had tumor progression. Twenty-nine patients (58%) received EBRT (median 54 Gy), and 13 (45%) had tumor progression. Whereas tumor volume (P .53), SRS vs EBRT (P .45), and adjuvant vs salvage (P .34) were not associated with progression after radiation therapy, spontaneous necrosis (hazard ratio [HR] 82.3, P <.001), embolization necrosis (HR 15.6, P .03), and brain invasion (HR 3.8, P .008) predicted progression in univariate and multivariate analyses. Tumors treated with SRS/EBRT had 2- and 5-year actuarial locoregional control rates of 91%/88% and 71%/69%, respectively. Tumors with spontaneous necrosis, embolization necrosis, and no necrosis had 2- and 5-year locoregional control rates of 76%, 92%, and 100% and 36%, 73%, and 100%, respectively (P <.001). CONCLUSION: This study suggests that necrosis may be a negative predictor of radiation response regardless of radiation timing or modality.

Original languageEnglish (US)
Pages (from-to)23-32
Number of pages10
JournalNeurosurgery
Volume79
Issue number1
DOIs
StatePublished - Jul 1 2016

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Meningioma
Radiosurgery
Radiotherapy
Pathology
Necrosis
Radiation
Neoplasms
Kaplan-Meier Estimate
Tumor Burden
Multivariate Analysis
Recurrence
Brain

Keywords

  • Atypical meningioma
  • Radiation therapy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Radiation therapy for residual or recurrent atypical meningioma : The effects of modality, timing, and tumor pathology on long-term outcomes. / Sun, Sam Q.; Cai, Chunyu; Murphy, Rory K.J.; Dewees, Todd; Dacey, Ralph G.; Grubb, Robert L.; Rich, Keith M.; Zipfel, Gregory J.; Dowling, Joshua L.; Leuthardt, Eric C.; Simpson, Joseph R.; Robinson, Clifford G.; Chicoine, Michael R.; Perrin, Richard J.; Huang, Jiayi; Kim, Albert H.

In: Neurosurgery, Vol. 79, No. 1, 01.07.2016, p. 23-32.

Research output: Contribution to journalArticle

Sun, SQ, Cai, C, Murphy, RKJ, Dewees, T, Dacey, RG, Grubb, RL, Rich, KM, Zipfel, GJ, Dowling, JL, Leuthardt, EC, Simpson, JR, Robinson, CG, Chicoine, MR, Perrin, RJ, Huang, J & Kim, AH 2016, 'Radiation therapy for residual or recurrent atypical meningioma: The effects of modality, timing, and tumor pathology on long-term outcomes', Neurosurgery, vol. 79, no. 1, pp. 23-32. https://doi.org/10.1227/NEU.0000000000001160
Sun, Sam Q. ; Cai, Chunyu ; Murphy, Rory K.J. ; Dewees, Todd ; Dacey, Ralph G. ; Grubb, Robert L. ; Rich, Keith M. ; Zipfel, Gregory J. ; Dowling, Joshua L. ; Leuthardt, Eric C. ; Simpson, Joseph R. ; Robinson, Clifford G. ; Chicoine, Michael R. ; Perrin, Richard J. ; Huang, Jiayi ; Kim, Albert H. / Radiation therapy for residual or recurrent atypical meningioma : The effects of modality, timing, and tumor pathology on long-term outcomes. In: Neurosurgery. 2016 ; Vol. 79, No. 1. pp. 23-32.
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abstract = "BACKGROUND: Optimal use of stereotactic radiosurgery (SRS) vs external beam radiation therapy (EBRT) for treatment of residual/recurrent atypical meningioma is unclear. OBJECTIVE: To analyze features associated with progression after radiation therapy. METHODS: Fifty radiation-naive patients who received SRS or EBRT for residual and/or recurrent atypical meningioma were examined for predictors of progression using Cox regression and Kaplan-Meier analyses. RESULTS: Thirty-two patients (64{\%}) received adjuvant radiation after subtotal resection, 12 patients (24{\%}) received salvage radiation after progression following subtotal resection, and 6 patients (12{\%}) received salvage radiation after recurrence following gross total resection. Twenty-one patients (42{\%}) received SRS (median 18 Gy), and 7 (33{\%}) had tumor progression. Twenty-nine patients (58{\%}) received EBRT (median 54 Gy), and 13 (45{\%}) had tumor progression. Whereas tumor volume (P .53), SRS vs EBRT (P .45), and adjuvant vs salvage (P .34) were not associated with progression after radiation therapy, spontaneous necrosis (hazard ratio [HR] 82.3, P <.001), embolization necrosis (HR 15.6, P .03), and brain invasion (HR 3.8, P .008) predicted progression in univariate and multivariate analyses. Tumors treated with SRS/EBRT had 2- and 5-year actuarial locoregional control rates of 91{\%}/88{\%} and 71{\%}/69{\%}, respectively. Tumors with spontaneous necrosis, embolization necrosis, and no necrosis had 2- and 5-year locoregional control rates of 76{\%}, 92{\%}, and 100{\%} and 36{\%}, 73{\%}, and 100{\%}, respectively (P <.001). CONCLUSION: This study suggests that necrosis may be a negative predictor of radiation response regardless of radiation timing or modality.",
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T2 - The effects of modality, timing, and tumor pathology on long-term outcomes

AU - Sun, Sam Q.

AU - Cai, Chunyu

AU - Murphy, Rory K.J.

AU - Dewees, Todd

AU - Dacey, Ralph G.

AU - Grubb, Robert L.

AU - Rich, Keith M.

AU - Zipfel, Gregory J.

AU - Dowling, Joshua L.

AU - Leuthardt, Eric C.

AU - Simpson, Joseph R.

AU - Robinson, Clifford G.

AU - Chicoine, Michael R.

AU - Perrin, Richard J.

AU - Huang, Jiayi

AU - Kim, Albert H.

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N2 - BACKGROUND: Optimal use of stereotactic radiosurgery (SRS) vs external beam radiation therapy (EBRT) for treatment of residual/recurrent atypical meningioma is unclear. OBJECTIVE: To analyze features associated with progression after radiation therapy. METHODS: Fifty radiation-naive patients who received SRS or EBRT for residual and/or recurrent atypical meningioma were examined for predictors of progression using Cox regression and Kaplan-Meier analyses. RESULTS: Thirty-two patients (64%) received adjuvant radiation after subtotal resection, 12 patients (24%) received salvage radiation after progression following subtotal resection, and 6 patients (12%) received salvage radiation after recurrence following gross total resection. Twenty-one patients (42%) received SRS (median 18 Gy), and 7 (33%) had tumor progression. Twenty-nine patients (58%) received EBRT (median 54 Gy), and 13 (45%) had tumor progression. Whereas tumor volume (P .53), SRS vs EBRT (P .45), and adjuvant vs salvage (P .34) were not associated with progression after radiation therapy, spontaneous necrosis (hazard ratio [HR] 82.3, P <.001), embolization necrosis (HR 15.6, P .03), and brain invasion (HR 3.8, P .008) predicted progression in univariate and multivariate analyses. Tumors treated with SRS/EBRT had 2- and 5-year actuarial locoregional control rates of 91%/88% and 71%/69%, respectively. Tumors with spontaneous necrosis, embolization necrosis, and no necrosis had 2- and 5-year locoregional control rates of 76%, 92%, and 100% and 36%, 73%, and 100%, respectively (P <.001). CONCLUSION: This study suggests that necrosis may be a negative predictor of radiation response regardless of radiation timing or modality.

AB - BACKGROUND: Optimal use of stereotactic radiosurgery (SRS) vs external beam radiation therapy (EBRT) for treatment of residual/recurrent atypical meningioma is unclear. OBJECTIVE: To analyze features associated with progression after radiation therapy. METHODS: Fifty radiation-naive patients who received SRS or EBRT for residual and/or recurrent atypical meningioma were examined for predictors of progression using Cox regression and Kaplan-Meier analyses. RESULTS: Thirty-two patients (64%) received adjuvant radiation after subtotal resection, 12 patients (24%) received salvage radiation after progression following subtotal resection, and 6 patients (12%) received salvage radiation after recurrence following gross total resection. Twenty-one patients (42%) received SRS (median 18 Gy), and 7 (33%) had tumor progression. Twenty-nine patients (58%) received EBRT (median 54 Gy), and 13 (45%) had tumor progression. Whereas tumor volume (P .53), SRS vs EBRT (P .45), and adjuvant vs salvage (P .34) were not associated with progression after radiation therapy, spontaneous necrosis (hazard ratio [HR] 82.3, P <.001), embolization necrosis (HR 15.6, P .03), and brain invasion (HR 3.8, P .008) predicted progression in univariate and multivariate analyses. Tumors treated with SRS/EBRT had 2- and 5-year actuarial locoregional control rates of 91%/88% and 71%/69%, respectively. Tumors with spontaneous necrosis, embolization necrosis, and no necrosis had 2- and 5-year locoregional control rates of 76%, 92%, and 100% and 36%, 73%, and 100%, respectively (P <.001). CONCLUSION: This study suggests that necrosis may be a negative predictor of radiation response regardless of radiation timing or modality.

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