C Leland Rogers1, Minhee Won2, Michael A Vogelbaum3, Arie Perry4, Lynn S Ashby5, Jignesh M Modi6, Anthony M Alleman7, James Galvin8, Shannon E Fogh4, Emad Youssef9, Nimisha Deb10, Young Kwok11, Clifford G Robinson12, Hui-Kuo Shu13, Barbara J Fisher14, Valerie Panet-Raymond15, William G McMillan16, John F de Groot17, Peixin Zhang2, Minesh P Mehta18. 1. Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona. Electronic address: Neuropub@barrowneuro.org. 2. NRG Oncology Statistics and Data Management Center/American College of Radiology, Philadelphia, Pennsylvania. 3. Moffitt Cancer Center, Tampa, Florida. 4. University of California-San Francisco, San Francisco, California. 5. Saint Joseph's Hospital and Medical Center, Phoenix, Arizona. 6. Yale New Haven Hospital, New Haven, Connecticut. 7. The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. 8. IROC Philadelphia, Philadelphia, Pennsylvania. 9. Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona. 10. Department of Radiation Oncology, St. Luke's University Health Network, Bethlehem, Pennsylvania. 11. University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland. 12. Washington University, St. Louis, Missouri. 13. Emory University, Atlanta, Georgia. 14. London Regional Cancer Program, London, Ontario, Canada. 15. McGill University, Montréal, Québec, Canada. 16. Juravinski Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada. 17. University of Texas MD Anderson Cancer Center, Houston, Texas. 18. Miami Cancer Institute, Baptist Health, Miami, Florida.
Abstract
BACKGROUND: Phase 2 cooperative group meningioma trial assessing the safety and efficacy of risk-adaptive management strategies. This is the initial analysis of the high-risk cohort. METHODS AND MATERIALS: High-risk patients were those with a new or recurrent World Health Organization (WHO) grade III meningioma of any resection extent, recurrent WHO grade II of any resection extent, or new WHO grade II after subtotal resection. Patients received intensity-modulated radiotherapy (IMRT) using a simultaneous integrated boost technique (60 Gy high dose and 54 Gy low dose in 30 fractions). Three-year progression-free survival (PFS) was the primary endpoint. Adverse events (AEs) were scored per NCI Common Terminology Criteria for Adverse Events version 3. RESULTS: Of 57 enrolled patients, 53 received protocol treatment. Median follow-up was 4.0 years (4.8 years for living patients). Two patients withdrew without progression before year 3; for the remaining 51 patients, 3-year PFS was 58.8%. Among all 53 protocol-treated patients, 3-year PFS was 59.2%. Three-year local control was 68.9%, and overall survival was 78.6%. Of 51 patients, 1 patient (1.9%) experienced a late grade-5 necrosis-related AE. All other acute (23 of 53 patients) and late (21 of 51 patients) AEs were grades 1 to 3. CONCLUSIONS: Patients with high-risk meningioma treated with IMRT (60 Gy/30) experienced 3-year PFS of 58.8%. Combined acute and late AEs were limited to grades 1 to 3, except for a single necrosis-related grade 5 event. These results support postoperative IMRT for high-risk meningioma and invite ongoing investigations to improve outcomes further.
BACKGROUND: Phase 2 cooperative group meningioma trial assessing the safety and efficacy of risk-adaptive management strategies. This is the initial analysis of the high-risk cohort. METHODS AND MATERIALS: High-risk patients were those with a new or recurrent World Health Organization (WHO) grade III meningioma of any resection extent, recurrent WHO grade II of any resection extent, or new WHO grade II after subtotal resection. Patients received intensity-modulated radiotherapy (IMRT) using a simultaneous integrated boost technique (60 Gy high dose and 54 Gy low dose in 30 fractions). Three-year progression-free survival (PFS) was the primary endpoint. Adverse events (AEs) were scored per NCI Common Terminology Criteria for Adverse Events version 3. RESULTS: Of 57 enrolled patients, 53 received protocol treatment. Median follow-up was 4.0 years (4.8 years for living patients). Two patients withdrew without progression before year 3; for the remaining 51 patients, 3-year PFS was 58.8%. Among all 53 protocol-treated patients, 3-year PFS was 59.2%. Three-year local control was 68.9%, and overall survival was 78.6%. Of 51 patients, 1 patient (1.9%) experienced a late grade-5 necrosis-related AE. All other acute (23 of 53 patients) and late (21 of 51 patients) AEs were grades 1 to 3. CONCLUSIONS:Patients with high-risk meningioma treated with IMRT (60 Gy/30) experienced 3-year PFS of 58.8%. Combined acute and late AEs were limited to grades 1 to 3, except for a single necrosis-related grade 5 event. These results support postoperative IMRT for high-risk meningioma and invite ongoing investigations to improve outcomes further.
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