Treatment of WHO Grade 2 Meningiomas With Stereotactic Radiosurgery: Identification of an Optimal Group for SRS Using RPA.

Roman O Kowalchuk
Matthew J. Shepard
Kimball Sheehan
Darrah Sheehan
Andrew Faramand
Ajay Niranjan
Hideyuki Kano
Jason Gurewitz
Kenneth Bernstein
Roman Liscak
Khumar Guseynova
Inga S. Grills, Beaumont Health
Jacob S. Parzen
Christopher P. Cifarelli
Azeem A. Rehman
Ahmet Atik
Joshua Bakhsheshian
Gabriel Zada
Eric Chang
Steven Giannotta
Herwin Speckter
Hsiu-Mei Wu
Douglas Kondziolka
David Mathieu
Cheng-Chia Lee
Ronald E. Warnick
L Dade Lunsford
Daniel M. Trifiletti
Jason P. Sheehan


PURPOSE: This study assesses a large multi-institutional database to present the outcomes of World Health Organization grade 2 meningiomas treated with stereotactic radiosurgery (SRS). We also compare the 3-year progression-free survival (PFS) to that reported in the Radiation Therapy Oncology Group 0539 phase 2 cooperative group meningioma trial.

METHODS AND MATERIALS: From an international, multicenter group, data were collected for grade 2 meningioma patients treated with SRS for demonstrable tumor from 1994 to 2019. Statistical methods used included the Kaplan-Meier method, Cox proportional hazards analysis, and recursive partitioning analysis.

RESULTS: Two hundred thirty-three patients treated at 12 institutions were included. Patients presented at a median age of 60 years (range, 13-90), and many had at least 2 prior resections (30%) or radiation therapy (22%). Forty-eight percent of patients had prior gross total resection. At SRS, the median treatment volume was 6.1 cm

CONCLUSIONS: SRS should be considered in carefully selected patients with atypical meningiomas. We suggest the use of our good-prognostic group to optimize patient selection, and we strongly encourage the initiation of a clinical trial to prospectively validate these outcomes.