Fractionated radiotherapy adjuvant to surgery of WHO-2 meningioma with and without gross total resection: a multicenter, retrospective cohort study of 1,452 patients

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). 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. 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. 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.

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Publication Details

Journal
Journal of Neuro-Oncology
Published
2026-02-01
DOI
https://doi.org/10.1007/s11060-025-05349-7
Citations
2
Primary Topic
Meningioma and schwannoma management
Type
article
Field-Weighted Citation Impact
63.04

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article

Fractionated radiotherapy adjuvant to surgery of WHO-2 meningioma with and without gross total resection: a multicenter, retrospective cohort study of 1,452 patients

Ricardo Prat-Acín, Tamás Csonka, Matthew Koshy, D. Kim et al.
2 citations
Journal of Neuro-Oncology
Meningioma and schwannoma management
63.04
article

Fractionated radiotherapy adjuvant to surgery of WHO-2 meningioma with and without gross total resection: a multicenter, retrospective cohort study of 1,452 patients

Ricardo Prat-Acín, Tamás Csonka, Matthew Koshy, D. Kim, Junkoh Yamamoto, Tony Catalan, Tiit Illimar Mathiesen, Pernilla Lindner, Yasuhiro Kuroi, Dorothee Cäcilia Spille, Pedro Góes, Bjarne Winther Kristensen, Luís Souhami, Konstantinos Gousias, Fang Wang, Ramin A. Morshed, H. Shih, Dennis C. Shrieve, Donald M. Cannon, Paul Blanche, Benjamin Brokinkel, Tabernero, Philip V. Theodosopoulos, Andrea Daniela Maier, Simon Skyrman, M Krause, Maria Kamenova, Lasse Rehné Jensen, Sven Straumann, SVERRE HELGE TORP, Tareq Adnan Juratli, Christian Mirian, Jacob Young, Ilker Y. Eyüpoglu, Austin Lui, Torstein Ragnar Meling, Stéphane Goutagny, Akash Patel, Ian H. Law, Anders Broechner, Jun Won Kim, Kåre Buch Fugleholm, Y Z Kim, F Maiuri, Chang-Ok Suh, Hoffmann Al, Toshiki Endo, Walter Stummer, Johannes Wach, Erdem Güresir, Jehuda Soleman, Tina Nørgaard Munch, Martin Proescholdt, Stephen T Magill, Tiemo J Klisch, Marie-Christine Guiot, Jong Hee Chang, Tejpal Gupta, Michael W McDermott, Valeria Barresi, Matthias Simon, Joo Ho Lee
article en
2 citations

Abstract

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). 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. 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. 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.

Journal of Neuro-OncologyVol. 176(3)
Statens Serum Institut (DK), Northwestern University (US), University of Verona (IT), University of Copenhagen (DK), University of Debrecen (HU), Harvard University (US), Seoul National University (KR), German Cancer Research Center (DE), University of California, San Francisco (US), Baylor College of Medicine (US), University of Occupational and Environmental Health Japan (JP), Yonsei University (KR), European University Cyprus (CY), Université Paris Cité (FR), Norwegian University of Science and Technology (NO), Heidelberg University (DE), University of Münster (DE), Samsung (South Korea) (KR), Hôpital Beaujon (FR), Tata Memorial Hospital (IN), Spencer Foundation (US), McGill University Health Centre (CA), Helmholtz-Zentrum Dresden-Rossendorf (DE), University Hospital of Basel (CH), Copenhagen University Hospital (DK), Rigshospitalet (DK), Seoul National University Hospital (KR), Karolinska Institutet (SE), University Hospital Regensburg (DE), University of Cyprus (CY), University of Illinois Chicago (US), Massachusetts General Hospital (US), Assistance Publique – Hôpitaux de Paris (FR), St Olav's University Hospital (NO), National Center for Tumor Diseases (DE), Neurological Research Institute (US), Leitat Technological Center (ES), University of Illinois Hospital & Health Sciences System (US), University Hospital Leipzig (DE), Athens Medical Center (GR), Clemenshospital Münster (DE), Instituto de Investigación Biomédica de Salamanca (ES), Tokyo Women's Medical University Adachi Medical Center (JP), Tokyo Women's Medical University (JP), Gangnam Severance Hospital (KR), Texas Children's Hospital (US), First Affiliated Hospital of Zhengzhou University (CN), Advanced Centre for Treatment, Research and Education in Cancer (IN), Neurological Surgery (US), University Hospital Carl Gustav Carus (DE), Fondazione IRCCS Istituto Neurologico Carlo Besta (IT), University of Naples Federico II (IT), Sungkyunkwan University (KR), Tohoku Medical and Pharmaceutical University (JP), Universidade Federal de São Paulo (BR)
Cancer Prevention and Research Institute of Texas, Texas Children's Hospital, Fondazione Ricerca Molinette, H. Lundbeck A/S
Good health and well-being
Openalex Percentile: Top 0%
Meningioma and schwannoma management
63.04
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