Radiotherapy Improves Survival in Atypical Meningioma, Lancet Study Finds
- Adjuvant radiotherapy cuts the risk of recurrence in half for patients with newly diagnosed WHO grade 2 atypical meningioma following complete surgical removal, according to findings published September...
- At a median follow-up of 64 months, researchers documented meningioma recurrence in 11 of 78 patients, or 14%, in the radiotherapy group.
- Statistical analysis showed that radiotherapy was associated with a lower hazard of recurrence or death, yielding a hazard ratio of 0.51.
Adjuvant radiotherapy cuts the risk of recurrence in half for patients with newly diagnosed WHO grade 2 atypical meningioma following complete surgical removal, according to findings published September 25 in The Lancet. The phase 3, open-label, multicentre trial followed 157 randomized patients across 58 hospitals in 11 countries to compare adjuvant radiotherapy directly against observation.
Radiotherapy and Observation Outcomes Compared at 64 Months
At a median follow-up of 64 months, researchers documented meningioma recurrence in 11 of 78 patients, or 14%, in the radiotherapy group. By contrast, recurrence occurred in 24 of 79 patients, or 30%, in the observation group. Five-year disease-free survival reached 79.9% for patients who received radiotherapy compared with 64.3% for those kept under observation. The absolute difference in 5-year disease-free survival stood at 15.6 percentage points.
Statistical analysis showed that radiotherapy was associated with a lower hazard of recurrence or death, yielding a hazard ratio of 0.51. In post hoc analyses that incorporated molecular data, radiotherapy maintained its association with improved disease-free survival after adjustments for DNA methylation class and integrated molecular risk scores. Michael D. Jenkinson, PhD, of the University of Liverpool’s Institute of Systems, Molecular and Integrative Biology led the international research collaboration.
ROAM Trial Evaluates Radiotherapy for Atypical Meningioma
The international trial, known as ROAM/EORTC-1308, evaluated patients aged 16 years or older who had undergone surgeon-assessed complete resection of a newly diagnosed atypical meningioma. Out of 990 total patients assessed for eligibility between April 28, 2016, and May 21, 2021, 157 were randomized. The median age of participants was 57.40 years, comprising 84 female participants and 73 male participants.
Radiotherapy administration involved external-beam intensity-modulated treatment delivering 60 Gy in 30 fractions over 6 weeks. Treatment plans underwent prospective central quality-assurance review before treatment commenced. Serious adverse events related to radiotherapy emerged in 5 of 66 participants, consisting of two early and three late events, with zero treatment-related deaths. Health-related quality of life and neurocognitive function remained similar across both trial arms.
Missing Data and Open Label Design Limit Trial
Trial limitations included local assessment of pathology and MRI recurrence without central review, alongside the inherent inability to mask treatment assignment in an open-label design. The trial recorded 41 total recurrence or death events, falling short of the prespecified target of 46 events. Additionally, 12 participants assigned to the radiotherapy group did not receive the treatment, a factor that may have understated the overall treatment effect. Long-term evaluations of health-related quality of life and neurocognitive function also faced substantial missing data.