Abstract
High-grade (WHO grade II and III) meningiomas represent a small subset of meningiomas with aggressive biology and high rate of recurrence. The mainstay treatment for high-grade meningiomas is surgery whereas the role of adjuvant radiotherapy (RT) remains controversial. We retrospectively evaluated the impact of RT following resection on survival of 65 patients with high-grade meningiomas at our institution between 2006 and 2010. Of 65 patients, 44 (68%) were female. The median age of diagnosis was 51.3 years. Of 46 patients who underwent gross total resection (GTR), 16 (34.8%) patients received RT, whereas 14 (73.7%) of 19 patients who underwent subtotal resection (STR) received RT. At a median follow up 66.6 months, the 5-year OS and 5-year PFS rates for all 65 patients were 65.4% and 53.6%, respectively. Postoperative RT did not improve OS or PFS in unselected high-grade meningiomas. However, adjuvant RT following STR significantly improved PFS compared with STR alone (P = 0.018) with the 5-year PFS rates with and without adjuvant RT of 71% and 40%, respectively. The 5-year OS rates for STR patients with and without RT were 86% and 40%, respectively. In the GTR group, adjuvant RT was not associated with significant survival benefits. In conclusion, adjuvant RT after STR for high-grade meningiomas improved local disease control and survival compared with STR alone.