Abstract
BACKGROUND
WHO grade III meningiomas are rare but aggressive tumors with high recurrence rate and poor prognosis. The standard care in these patients is maximal surgical resection followed by adjuvant radiotherapy (RT). However, increasing age is associated with decreasing benefit but increasing risk of cognitive side-effects from cranial irradiation. The purpose of this study was to evaluate the benefit of the RT after surgery in elderly patients diagnosed with WHO grade III meningiomas.
METHODS
The US National Cancer Database was used to identify patients with histologically confirmed WHO grade III meningiomas who received either surgery alone or surgery followed by RT from 2004-2013. Demographic and clinicopathologic factors associated with the use of treatment were analyzed using the chi-square test and multivariable logistic regression. Overall survival (OS) was evaluated by Kaplan-Meier analysis, multivariable Cox proportional hazard regression, and propensity score-matched analysis.
RESULTS
In total, 830 patients were included, among whom 369 (44.5%) received surgery alone and 461(55.5%) received surgery followed by RT. RT was associated with significantly improved OS when compared with surgery alone on multivariable analysis after adjusting for age at diagnosis, comorbidity, tumor size and extent of resection (adjusted HR,0.709; 95%CI,0.584-0.861;p=0.001). A significant OS benefit for adjuvant RT persisted in a propensity score-matched analysis (HR,0.527;95% CI,0.341-0.816;p=0.004) after matching the two cohorts on age, comorbidity status, year of diagnosis, tumor size and extent of resection. In the subgroup analysis among elderly patients (defined as age over 70), adjuvant RT was identified as an independent predictor of longer OS on both multivariable analysis(adjusted HR,0.708;95% CI,0.530-0.946;p=0.02) and propensity score-matched analysis (log-rank p=0.001).
CONCLUSION
Our results underline the OS benefit associated with adjuvant RT in elderly patients with WHO grade III meningiomas.