Toxicities Associated with Adjuvant Radiation Therapy in Atypical Meningioma

IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology Pub Date : 2025-01-25 DOI:10.1016/j.adro.2025.101726

Grace Lee MD , Audrey Aitelli BS , Andrzej Niemierko PhD , Nayan Lamba MD , Daniel W. Kim MD, MBA , William T. Curry MD , Kevin S. Oh MD , Frederick G. Barker II MD , Helen A. Shih MD, MS, MPH

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Abstract

Purpose

While adjuvant radiation therapy (RT) may prolong progression-free survival in resected atypical meningiomas, whether such progression-free survival benefit outweighs potential treatment toxicities remains controversial. Here, we compare the acute and late toxicity outcomes of atypical meningiomas managed with upfront adjuvant RT versus surveillance.

Methods and Materials

In our prior single-institution retrospective study of 230 patients with resected atypical meningiomas between 2000 and 2015, adjuvant RT was associated with a significantly lower risk of progression/recurrence compared with surveillance (hazard ratio, 0.21; P < .01), with 36% of surveillance patients eventually requiring salvage RT. In this study, the acute (≤6 months) and late (>6 months) RT toxicities from the same patient cohort for those who received adjuvant (n = 51) versus salvage RT (n = 64) were compared. Additionally, treatment toxicity at the last follow-up was compared between the adjuvant RT (n = 51) and the surveillance (n = 179) groups. Toxicities were graded per the Common Terminology Criteria for Adverse Events v5.0.

Results

RT in the adjuvant compared with the salvage setting was generally associated with greater RT toxicities both in the acute (90% vs 69%, P < .01) and late (57% vs 33%, P = .01) setting. While there was no significant difference in grade 3 to 4 acute toxicities, late grade 3 to 4 toxicities were present in 14% of the adjuvant group versus 3% of the salvage RT group (P = .04). Radionecrosis was present in 18% of adjuvant RT versus 8% of salvage RT group (P = .11). Between the adjuvant RT and surveillance groups, any treatment-related toxicity at the last follow-up was greater in the adjuvant RT group (31% vs 15%, P < .01), with a trend toward greater grade 3 to 4 toxicities (8% vs 3%, P = .10). There was no difference in the rate of cerebrovascular accident (4% vs 4%, P = .99).

Conclusions

Adjuvant RT may be associated with greater acute and late treatment toxicities, which can significantly impact the quality of life of patients with atypical meningioma. Potential RT toxicity should be carefully weighed against tumor control benefits in deciding the optimal use and timing of RT.

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来源期刊

Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.60

自引率

4.30%

发文量

208

审稿时长

98 days

期刊介绍： The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.