TY - JOUR
T1 - Fractionated radiotherapy adjuvant to surgery of WHO-2 meningioma with and without gross total resection
T2 - a multicenter, retrospective cohort study of 1,452 patients
AU - Mirian, Christian
AU - Jensen, Lasse Rehné
AU - Hoffmann, Adam Gorm
AU - Juratli, Tareq A
AU - Maier, Andrea Daniela
AU - Lindner, Pernilla
AU - Broechner, Anders
AU - Torp, Sverre H
AU - Shih, Helen A
AU - Morshed, Ramin A
AU - Young, Jacob S
AU - Magill, Stephen T
AU - Stummer, Walter
AU - Spille, Dorothee Cäcilia
AU - Brokinkel, Benjamin
AU - Proescholdt, Martin
AU - Kuroi, Yasuhiro
AU - Gousias, Konstantinos
AU - Simon, Matthias
AU - Prat-Acin, Ricardo
AU - Goutagny, Stéphane
AU - Wach, Johannes
AU - Güresir, Erdem
AU - Yamamoto, Junkoh
AU - Kim, Young Zoon
AU - Lee, Joo Ho
AU - Kim, Daniel W
AU - Koshy, Matthew
AU - Cannon, Donald M
AU - Shrieve, Dennis C
AU - Suh, Chang-Ok
AU - Chang, Jong Hee
AU - Kamenova, Maria
AU - Straumann, Sven
AU - Soleman, Jehuda
AU - Eyüpoglu, Ilker Y
AU - Catalan, Tony
AU - Lui, Austin
AU - Theodosopoulos, Philip V
AU - McDermott, Michael W
AU - Góes, Pedro
AU - Wang, Fang
AU - Souhami, Luis
AU - Guiot, Marie-Christine
AU - Csonka, Tamás
AU - Endo, Toshiki
AU - Gupta, Tejpal
AU - Patel, Akash J
AU - Klisch, Tiemo J
AU - Kim, Jun Won
AU - Maiuri, Francesco
AU - Barresi, Valeria
AU - Tabernero, María Dolores
AU - Skyrman, Simon
AU - Krause, Mechthild
AU - Law, Ian
AU - Kristensen, Bjarne Winther
AU - Munch, Tina Nørgaard
AU - Meling, Torstein
AU - Fugleholm, Kåre
AU - Blanche, Paul
AU - Mathiesen, Tiit
PY - 2026/2/9
Y1 - 2026/2/9
N2 - PURPOSE: The role of adjuvant fractionated radiotherapy (aFRT) after gross total resection (GTR) of WHO-2 meningiomas remains unclear. We aimed to estimate the effect of aFRT on recurrence risk and survival following GTR and subtotal resection (STR).METHODS: We analyzed 1452 patients with WHO-2 from our international, multicenter database (followed between 1989 and 2019). Outcomes were recurrence (10-year follow-up) and death (5-year follow-up). Risk estimates were obtained using competing risks and survival analysis. Average treatment effects were estimated by G-computation, adjusted for potential confounding by age, sex, Simpson grade, Ki-67 proliferation index, location, country group (universal healthcare or not), and year of treatment initiation. The robustness of findings was examined through sensitivity analyses.RESULTS: Overall, 276 of 1452 patients (19.0%) received aFRT. Among GTR patients, unadjusted analysis showed comparable recurrence proportions between irradiated and non-irradiated patients (25.5% vs. 22.8% within 5 years). Adjusted analyses provided no evidence that aFRT reduced the risk of recurrence (largest difference: −2.7%, 95% CI −5.6 to 0.2); although, the CIs include the possibility of small beneficial effects. In STR patients, aFRT was associated with reduced recurrence risk in both unadjusted and adjusted analyses. Unexpectedly, a higher mortality was observed among irradiated GTR patients, largely driven by older patients with low Ki-67 PI receiving aFRT. Sensitivity analyses showed similar results for patients with STR but discrepancy in estimates for those with GTR.CONCLUSION: Adjuvant FRT showed a consistent reduction in recurrence risk after STR while inconsistent recurrence risk estimates were observed for patients with GTR. The findings reflect efficacy of aFRT using real-world data without standardized guidelines.SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11060-025-05349-7.
AB - PURPOSE: The role of adjuvant fractionated radiotherapy (aFRT) after gross total resection (GTR) of WHO-2 meningiomas remains unclear. We aimed to estimate the effect of aFRT on recurrence risk and survival following GTR and subtotal resection (STR).METHODS: We analyzed 1452 patients with WHO-2 from our international, multicenter database (followed between 1989 and 2019). Outcomes were recurrence (10-year follow-up) and death (5-year follow-up). Risk estimates were obtained using competing risks and survival analysis. Average treatment effects were estimated by G-computation, adjusted for potential confounding by age, sex, Simpson grade, Ki-67 proliferation index, location, country group (universal healthcare or not), and year of treatment initiation. The robustness of findings was examined through sensitivity analyses.RESULTS: Overall, 276 of 1452 patients (19.0%) received aFRT. Among GTR patients, unadjusted analysis showed comparable recurrence proportions between irradiated and non-irradiated patients (25.5% vs. 22.8% within 5 years). Adjusted analyses provided no evidence that aFRT reduced the risk of recurrence (largest difference: −2.7%, 95% CI −5.6 to 0.2); although, the CIs include the possibility of small beneficial effects. In STR patients, aFRT was associated with reduced recurrence risk in both unadjusted and adjusted analyses. Unexpectedly, a higher mortality was observed among irradiated GTR patients, largely driven by older patients with low Ki-67 PI receiving aFRT. Sensitivity analyses showed similar results for patients with STR but discrepancy in estimates for those with GTR.CONCLUSION: Adjuvant FRT showed a consistent reduction in recurrence risk after STR while inconsistent recurrence risk estimates were observed for patients with GTR. The findings reflect efficacy of aFRT using real-world data without standardized guidelines.SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11060-025-05349-7.
UR - https://www.scopus.com/pages/publications/105029682269
U2 - 10.1007/s11060-025-05349-7
DO - 10.1007/s11060-025-05349-7
M3 - Journal article
C2 - 41661453
SN - 0167-594X
VL - 176
SP - 201
JO - Journal of Neuro-Oncology
JF - Journal of Neuro-Oncology
IS - 3
M1 - 201
ER -