Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990.

The authors retrospectively analyzed 140 patients treated at the University of California, San Francisco, from 1967 to 1990 to evaluate the results of radiation therapy (median 5400 cGy) given as an adjuvant to subtotal resection of intracranial meningioma. Of the 140 meningiomas, 117 were benign and 23 were malignant. The median follow-up period was 40 months. The overall survival rate at 5 years was 85% for the benign and 58% for the malignant tumor groups (p = 0.02); the 5-year progression-free survival rates were 89% and 48%, respectively (p = 0.001). For patients with benign meningioma, the 10-year overall and progression-free survival rates were 77%. An improved progression-free survival rate in that group was not related to tumor size but was associated with a younger age (p = 0.01) and treatment after 1980 with innovative technologies (p = 0.002); none of those variables affected the progression-free survival rate in the patients with malignant meningioma. Increased progression-free survival in the benign tumor group was also significantly associated with increasing the minimum radiation dose (p = 0.04). The 5-year progression-free survival rate for patients with benign meningioma treated after 1980 (when computerized tomography or magnetic resonance imaging was used for planning therapy) was 98%, as compared with 77% for patients treated before 1980 (p = 0.002). There were no second central nervous system tumors. Morbidity (3.6%) included sudden blindness or cerebral necrosis and death. When total resection of benign meningioma is not feasible, subtotal resection combined with precise treatment planning techniques and adjuvant radiation therapy can achieve results comparable to those of total resection.