Long-Term Analysis of NRG Oncology RTOG 0539: A Phase II Trial of Observation for Low-Risk Meningioma and Radiotherapy for Intermediate- and High-Risk Meningioma
NRG Oncology RTOG 0539 was a prospective phase II trial of risk-adapted radiotherapy for patients with WHO grade 1-3 meningioma. Low-risk (group 1, n = 60) was defined as a grade 1 tumor after gross total resection or subtotal resection (GTR/STR) and prospectively monitored. Intermediate-risk (group 2, n = 52) was defined as recurrent grade 1 or newly diagnosed grade 2 tumor after GTR and treated with radiotherapy (54 Gy). High-risk (group 3, n = 53) included a newly diagnosed grade 2 tumor after STR, newly diagnosed grade 3 tumor, or recurrent grade 2 or 3 tumor and treated with radiotherapy (60 Gy). Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The median follow-up times for the low-, intermediate-, and high-risk cohorts were 12.1, 12.0, and 11.1 years, respectively. The 10-year PFS and OS rates for the low-, intermediate-, and high-risk cohorts were 85.2% and 94.1%, 72.2% and 84.7%, and 42.5% and 51.1%, respectively. Five patients (9.6%) and eight patients (15.1%) had a grade 3+ toxicity attributed to radiotherapy in the intermediate- and high-risk cohorts, respectively. The long-term outcomes using this risk-adapted approach support observation for low-risk patients, inform radiotherapy patient selection and practice standards for intermediate- and high-risk patients, and provide comparative benchmarks for future trials.
Authors
- Prashant Vempati (ORCID: https://orcid.org/0000-0003-0398-8088)
- Anthony Whitton (ORCID: https://orcid.org/0000-0002-9469-3543)
- Hui‐Kuo G. Shu (ORCID: https://orcid.org/0000-0002-4060-0874)
- Mark Vikas Mishra (ORCID: https://orcid.org/0000-0002-2588-1575)
- Nimisha Deb
- J Li
- Minhee Won (ORCID: https://orcid.org/0000-0003-2214-282X)
- Christina I. Tsien (ORCID: https://orcid.org/0000-0002-5458-5732)
- Anthony M. Alleman
- Joseph Bovi (ORCID: https://orcid.org/0000-0002-3686-1940)
- Jignesh Modi
- C. Leland Rogers
- Rupesh Kotecha
- Steve Braunstein
- Scott M. Lindhorst (ORCID: https://orcid.org/0000-0002-1585-4450)
- John H. Suh (ORCID: https://orcid.org/0000-0001-9523-2637)
- Clifford G. Robinson (ORCID: https://orcid.org/0000-0002-1399-9904)
- Michael A. Vogelbaum (ORCID: https://orcid.org/0000-0002-9833-2374)
- Beatrice Bloom
- Minesh P. Mehta (ORCID: https://orcid.org/0000-0002-4812-5713)
- Mei-Yin Polley (ORCID: https://orcid.org/0000-0003-0106-0323)
- Arie Perry (ORCID: https://orcid.org/0000-0002-8300-7261)
- Dennis C. Shrieve (ORCID: https://orcid.org/0000-0002-9212-7249)
- Igor Johan Barani (ORCID: https://orcid.org/0000-0002-8256-1906)
- Grant K. Hunter (ORCID: https://orcid.org/0000-0001-7160-9778)
- Lynn Ashby
Institutions
- American College of Radiology (US)
- Intermountain Healthcare (US)
- University of Maryland, Baltimore (US)
- Northwell Health (US)
- Cleveland Clinic (US)
- Barrow Neurological Institute (US)
- St. Joseph's Hospital and Medical Center (US)
- The University of Texas MD Anderson Cancer Center (US)
- Emory University (US)
- Medical University of South Carolina (US)
- University of California, San Francisco (US)
- Medical College of Wisconsin (US)
- Washington University in St. Louis (US)
- University of Utah (US)
- McGill University Health Centre (CA)
- Moffitt Cancer Center (US)
- University of Chicago (US)
- Utah Cancer Specialists (US)
- Saint Joseph's Hospital (US)
- WellSpan Health (US)
- Miami Heart Research Institute (US)
- Midstate Medical Center (US)
- NRG Oncology (US)
- University of Oklahoma Health Sciences Center (US)
- Case Western Reserve University (US)
- Hamilton Health Sciences (CA)
Publication Details
- Journal
- Journal of Clinical Oncology
- Published
- 2026-05-27
- DOI
- https://doi.org/10.1200/jco-25-01441
- Primary Topic
- Meningioma and schwannoma management
- Type
- article
- Field-Weighted Citation Impact
- 0.00