Patient-Facility Distance and Adjuvant Radiotherapy for WHO Grade 2-3 Meningioma.

Abstract

Objectives: Adjuvant radiotherapy (RT) is commonly used after surgery for WHO grade 2 and 3 meningioma, but the role of patient-facility distance in RT receipt and dose/fractionation choice is not well defined. We examined whether travel distance was associated with receipt and type of adjuvant RT.

Methods: We used the National Cancer Database to identify adults diagnosed between 2010 and 2020 with surgically treated WHO grade 2 or 3 meningioma and a CROWFLY distance ≤250 miles. Patients were categorized into 3 groups according to WHO grade and extent of resection: grade 2 with gross total resection, grade 2 with subtotal resection/biopsy, and grade 3 with any resection. Outcomes were receipt of adjuvant RT, SRS/HF-SRS versus fractionated EBRT among classifiable RT recipients, and overall survival.

Results: Among 14,218 patients, 4063 (28.6%) received adjuvant RT. In multivariate models, the odds of RT receipt decreased with increasing distance, becoming statistically significant at 25 to <50 miles and remaining lower in more distant bins. Among 2767 classifiable RT recipients, greater distance was associated with higher odds of SRS/HF-SRS rather than fractionated EBRT. Distance was not associated with overall survival. Selected fine-bin estimates included OR=1.47 at 25 to <50 miles, OR=2.40 at 75 to <100 miles, and OR=3.08 at 150 to 250 miles.

Conclusions: Greater patient-facility distance was associated with lower receipt of adjuvant RT and greater use of shorter stereotactic regimens among treated patients. These findings support geography as a predictor of both whether and how patients with higher-grade meningioma receive postoperative radiotherapy.