Lillie O'steen1, Robert J Amdur2, Christopher G Morris1, William M Mendenhall1. 1. University of Florida College of Medicine, Department of Radiation Oncology, Gainesville, FL, United States. 2. University of Florida College of Medicine, Department of Radiation Oncology, Gainesville, FL, United States. Electronic address: amdurr@shands.ufl.edu.
Abstract
BACKGROUND: There is debate about the curability of benign meningioma and the value of long-term follow-up. A major Scandinavian study reports a high recurrence rate after surgery alone, with the majority of recurrences presenting after 10 years and death from tumor in the majority of patients with recurrence. The purpose of our study is to report the rate and time-course of recurrence ≥10 years after fractionated radiotherapy for benign meningioma with visible tumor at the time of RT and to compare these results to surgery-alone series. METHODS: A single-institution study of all (149) adults treated with fractionated radiotherapy (50-52 Gy at 1.7-1.8 Gy in the vast majority) for visible intracranial benign meningioma between 1984 and 2006. The median follow-up in patients alive at last follow-up was 12.0 years. RESULTS: Seven (5%) of 149 patients developed recurrent meningioma with an actuarial recurrence rate of 3% at 10 years, 5% at 15 years, and 8% at 20 years. The majority (58%) of recurrences presented at least 10 years after radiotherapy. Only 4% of 149 patients died of recurrent meningioma but death was the result of recurrent meningioma in almost all (86%) patients with recurrence. CONCLUSION: Our results contradict the conclusion based on patients treated with surgery-alone that recurrence of benign meningioma is common with long-term follow-up. After fractionated radiotherapy, the 20-year control rate is approximately 90%. Our results confirm that a substantial percentage of recurrences present >10 years after treatment. These findings have important implications for the choice of initial treatment and follow-up duration.
BACKGROUND: There is debate about the curability of benign meningioma and the value of long-term follow-up. A major Scandinavian study reports a high recurrence rate after surgery alone, with the majority of recurrences presenting after 10 years and death from tumor in the majority of patients with recurrence. The purpose of our study is to report the rate and time-course of recurrence ≥10 years after fractionated radiotherapy for benign meningioma with visible tumor at the time of RT and to compare these results to surgery-alone series. METHODS: A single-institution study of all (149) adults treated with fractionated radiotherapy (50-52 Gy at 1.7-1.8 Gy in the vast majority) for visible intracranial benign meningioma between 1984 and 2006. The median follow-up in patients alive at last follow-up was 12.0 years. RESULTS: Seven (5%) of 149 patients developed recurrent meningioma with an actuarial recurrence rate of 3% at 10 years, 5% at 15 years, and 8% at 20 years. The majority (58%) of recurrences presented at least 10 years after radiotherapy. Only 4% of 149 patients died of recurrent meningioma but death was the result of recurrent meningioma in almost all (86%) patients with recurrence. CONCLUSION: Our results contradict the conclusion based on patients treated with surgery-alone that recurrence of benign meningioma is common with long-term follow-up. After fractionated radiotherapy, the 20-year control rate is approximately 90%. Our results confirm that a substantial percentage of recurrences present >10 years after treatment. These findings have important implications for the choice of initial treatment and follow-up duration.