Surgery alone versus surgery plus adjuvant radiotherapy for WHO grade 2 meningioma: meta-analysis of reconstructed time-to-event data

• Published in: Neurosurgical review Vol. 47; no. 1; p. 702
• Main Authors: Verly, Gabriel, Bresciani, Lucas, Delfino, Thiffany, Nascimento, Marcos, Magill, Stephen T., Galvão, Gustavo da Fontoura
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 28-09-2024
• Subjects: Combined Modality Therapy; Humans; Medicine; Medicine & Public Health; Meningeal Neoplasms - radiotherapy; Meningeal Neoplasms - surgery; Meningioma - radiotherapy; Meningioma - surgery; Neoplasm Grading; Neurosurgery; Neurosurgical Procedures - methods; Radiotherapy, Adjuvant - methods; Review; Treatment Outcome; Atypical meningioma; Radiotherapy; Meningioma; Radiation; Cancer
• ISSN: 1437-2320; 1437-2320
• DOI: 10.1007/s10143-024-02946-4

Introduction
WHO Grade 2 meningiomas present diagnostic and management challenges. Surgery, particularly gross total resection (GTR), is crucial, often followed by adjuvant radiotherapy (RT); however, there are clinical equipoise and ongoing randomized trials of RT after GTR.
Methods
This systematic review evaluates the efficacy of gross total resection (GTR) and GTR plus adjuvant radiotherapy (RT) for WHO grade 2 meningiomas, adhering to PRISMA guidelines. It excludes irrelevant studies, conducts a thorough search until January 2024, and specifically analyzes overall survival (OS) and progression-free survival (PFS) outcomes for WHO grade 2 meningiomas. Statistical analysis adopts a two-stage approach with the R package “IPDfromKM,” and quality assessment is conducted using the ROBINS-I tool.
Results
In our analysis of 23 studies involving 3822 WHO grade 2 meningioma patients, GTR + RT resulted in a significantly longer PFS (HR: 0.849, 95% CI: 0.730 to 0.988,
p
 = 0.035) compared to GTR alone. Although OS trended better with GTR + RT (HR: 0.79, 95% CI: 0.57 to 1.11,
p
 = 0.173), the difference was not statistically significant, suggesting the need for further investigation.
Conclusion
Our study reveals a benefit to adjuvant RT for improving PFS for WHO grade 2 meningiomas. Integrating molecular characteristics into treatment strategies will refine the management of these tumors in the future.