High-risk Meningioma: Initial Outcomes From NRG Oncology/RTOG 0539

• Authors: Leland C Rogers, St. Joseph’s Hospital and Medical Center; Minhee Won, American College of Radiology; Michael A Vogelbaum, Moffitt Cancer Center, Tampa, Florida; Hui-Kuo Shu, Emory University; Arie Perry, University of California San Francisco; Lynn S Ashby, St. Joseph’s Hospital and Medical Center; Jignesh M Modi, Yale New Haven Hospital; Anthony M Alleman, University of Oklahoma; James Galvin, Imaging & Radiat Oncol Core Philadelphia; Shannon E Fogh, University of California San Francisco; Emad Youssef, St. Joseph’s Hospital and Medical Center; Nimisha Deb, St. Luke’s University Health Network; Young Kwok, University of Maryland; Clifford G Robinson, Washington University; Barbara J Fisher, London Regional Cancer Program; Valerie Panet-Raymond, McGill University; William G McMillan, McMaster University; John F de Groot, Univ Texas MD Anderson Canc Ctr; Peixin Zhang, American College of Radiology; Minesh P Mehta, Baptist Health, Miami
• Journal Title: INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
• Volume: Volume 106, Number 4
• Publisher: ELSEVIER SCIENCE INC | 2020-03-15, Pages 790-799
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.ijrobp.2019.11.028
• Subjects: Health Sciences, Oncology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Radiology, Nuclear Medicine & Medical Imaging; HEALTH-ORGANIZATION CLASSIFICATION; ADJUVANT RADIOTHERAPY; INTRACRANIAL MENINGIOMAS; FOLLOW-UP; RECURRENCE; MANAGEMENT; SURVIVAL; SURGERY

Abstract

Background: Phase 2 cooperative group meningioma trial assessing the safety and efficacy of risk-adaptive management strategies. This is the initial analysis of the high-risk cohort. Methods and Materials: High-risk patients were those with a new or recurrent World Health Organization (WHO) grade III meningioma of any resection extent, recurrent WHO grade II of any resection extent, or new WHO grade II after subtotal resection. Patients received intensity-modulated radiotherapy (IMRT) using a simultaneous integrated boost technique (60 Gy high dose and 54 Gy low dose in 30 fractions). Three-year progression-free survival (PFS) was the primary endpoint. Adverse events (AEs) were scored per NCI Common Terminology Criteria for Adverse Events version 3. Results: Of 57 enrolled patients, 53 received protocol treatment. Median follow-up was 4.0 years (4.8 years for living patients). Two patients withdrew without progression before year 3; for the remaining 51 patients, 3-year PFS was 58.8%. Among all 53 protocol-treated patients, 3-year PFS was 59.2%. Three-year local control was 68.9%, and overall survival was 78.6%. Of 51 patients, 1 patient (1.9%) experienced a late grade-5 necrosis-related AE. All other acute (23 of 53 patients) and late (21 of 51 patients) AEs were grades 1 to 3. Conclusions: Patients with high-risk meningioma treated with IMRT (60 Gy/30) experienced 3-year PFS of 58.8%. Combined acute and late AEs were limited to grades 1 to 3, except for a single necrosis-related grade 5 event. These results support postoperative IMRT for high-risk meningioma and invite ongoing investigations to improve outcomes further.