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Publications

Journal Article Ahead of print

PubMed: 41352691 DOI: 10.1016/j.ijrobp.2025.11.045

Pattern of Failure Analysis and Clinical Outcomes in Patients with Grade 2 Meningiomas Following Radiation Therapy.

Int J Radiat Oncol Biol Phys

Authors: Felix Ehret, Andrzej Niemierko, John A Wolfgang, Grace Lee, Kevin Oh, Marc Bussière, Helen A Shih

Affiliations

  • Department of Radiation Oncology, Massachusetts General Hospital, Mass General Brigham, Harvard Medical School, Boston, MA, USA; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, a partnership between DKFZ and Charité - Universitätsmedizin Berlin, Germany.
  • Department of Radiation Oncology, Massachusetts General Hospital, Mass General Brigham, Harvard Medical School, Boston, MA, USA.
  • Department of Radiation Oncology, Massachusetts General Hospital, Mass General Brigham, Harvard Medical School, Boston, MA, USA.
  • Department of Radiation Oncology, Massachusetts General Hospital, Mass General Brigham, Harvard Medical School, Boston, MA, USA.

Abstract

BACKGROUND

Grade 2 meningiomas often recur after surgery and radiation therapy. However, large, in-depth failure analyses are lacking, limiting the potential to refine radiation therapy. We report a pattern of failure analysis, encompassing treatment and outcome data from over two decades.

MATERIALS AND METHODS

Patients who underwent proton- or photon-based fractionated adjuvant or salvage radiation therapy for a grade 2 meningioma between 2000 and 2023 were included. Subsequently, an in-depth analysis of the failure pattern was conducted.

RESULTS

A total of 105 patients were included, with 36 patients having 46 progressive or recurrent grade 2 meningiomas during the available follow-up. Most patients received 59.4 Gy (interquartile range [IQR]: 57.6 - 59.4) in 33 fractions (62.9%) and underwent proton radiation therapy (61.0%), with a median voxel-based equivalent uniform dose (EUD) of 60.1 Gy (IQR: 57.3 - 61.3). Most recurrent and progressive tumors were either located in the treatment volume (35/46, 76.1%) or within 2 cm of it (9/46, 19.6%). The median distance to out-of-field failures was 11.9 mm. The EUD (hazard ratio [HR]: 0.77, 95% confidence interval [CI]: 0.59 - 0.98), target volume (HR: 1.6, 95% CI: 1.2 - 2.1), RTOG 0539 risk classification (high vs. intermediate, HR: 7.9, 95% CI: 1.5 - 42.7), male sex (HR: 2.0, 95% CI: 0.9 - 4.4), treatment indication (salvage vs. adjuvant, HR: 2.4, 95% CI: 1.1 - 5.5), and age at radiation therapy (HR: 1.5, 95% CI: 1.0 - 2.1) were associated with progression.

CONCLUSION

This in-depth pattern of failure analysis for grade 2 meningiomas after radiation therapy demonstrated that treatment failures predominantly occur in close spatial relation to the irradiated target volume. Large treatment volumes, macroscopic disease, and a low EUD considerably impact disease control, underscoring the need for further local treatment and targeting refinements.

MeSH

Radiotherapy, Radiobiology, Meningioma, Therapeutics