• Matthew J Shepard, Zhiyuan Xu, Kathryn Kearns, Chelsea Li, Ajay Chatrath, Kimball Sheehan, Darrah Sheehan, Andrew Faramand, Ajay Niranjan, Hideyuki Kano, Jason Gurewitz, Kenneth Bernstein, Roman Liscak, Khumar Guseynova, Inga S Grills, 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, John G Golfinos, David Mathieu, Cheng-Chia Lee, Ronald E Warnick, L Dade Lunsford, and Jason P Sheehan.
• Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia.
• Neurosurgery. 2021 Apr 15; 88 (5): 980-988.

BackgroundAtypical and anaplastic meningiomas have reduced progression-free/overall survival (PFS/OS) compared to benign meningiomas. Stereotactic radiosurgery (SRS) for atypical meningiomas (AMs) and anaplastic meningiomas (malignant meningiomas, MMs) has not been adequately described.ObjectiveTo define clinical/radiographic outcomes for patients undergoing SRS for AM/MMs.MethodsAn international, multicenter, retrospective cohort study was performed to define clinical/imaging outcomes for patients receiving SRS for AM/MMs. Tumor progression was assessed with response assessment in neuro-oncology (RANO) criteria. Factors associated with PFS/OS were assessed using Kaplan-Meier analysis and a Cox proportional hazards model.ResultsA total of 271 patients received SRS for AMs (n = 233, 85.9%) or MMs (n = 38, 14.0%). Single-fraction SRS was most commonly employed (n = 264, 97.4%) with a mean target dose of 14.8 Gy. SRS was used as adjuvant treatment (n = 85, 31.4%), salvage therapy (n = 182, 67.2%), or primary therapy (1.5%). The 5-yr PFS/OS rate was 33.6% and 77.0%, respectively. Increasing age (hazard ratio (HR) = 1.01, P < .05) and a Ki-67 index > 15% (HR = 1.66, P < .03) negatively correlated with PFS. MMs (HR = 3.21, P < .05), increased age (HR = 1.04, P = .04), and reduced KPS (HR = 0.95, P = .04) were associated with shortened OS. Adjuvant versus salvage SRS did not impact PFS/OS. A shortened interval between surgery and SRS improved PFS for AMs (HR = 0.99, P = .02) on subgroup analysis. Radiation necrosis occurred in 34 (12.5%) patients. Five-year rates of repeat surgery/radiation were 33.8% and 60.4%, respectively.ConclusionAM/MMs remain challenging tumors to treat. Elevated proliferative indices are associated with tumor recurrence, while MMs have worse survival. SRS can control AM/MMs in the short term, but the 5-yr PFS rates are low, underscoring the need for improved treatment options for these patients.© Congress of Neurological Surgeons 2021.

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