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Adjuvant radiotherapy versus observation following gross total resection for atypical meningioma: a systematic review and meta-analysis

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Authors
Chun, Se-Woong; Kim, Kyung Min; Kim, Min-Sung; Kang, Ho; Dho, Yun-Sik; Seo, Youngbeom; Kim, Jin Wook; Kim, Yong Hwy; Park, Chul-Kee
Issue Date
2021-02-17
Publisher
BMC
Citation
Radiation Oncology. 2021 Feb 17;16(1):34
Keywords
Atypical meningiomaGross total resectionAdjuvantRadiotherapyPostoperative
Abstract
Background
The impact of adjuvant radiotherapy (RT) on atypical meningioma (AM) underwent a gross total resection (GTR) remains unclear, showing conflicting results from various studies. The objective of this study was to perform an updated meta-analysis for observational studies to determine the effect of adjuvant RT after GTR on local recurrence and survival outcomes compared to observation after GTR.

Methods
PubMed, Embase, and Web of Science were searched to identify comparative studies that reported outcomes of adjuvant RT versus observation for AM patients after GTR. Local recurrence rate, progression-free survival (PFS), overall survival (OS), and toxicities related to RT were considered as outcomes of interest. Differences between two cohorts were estimated by calculating odds ratios (OR) for LR rate and hazard ratios (HR) for survival outcomes with 95% confidence intervals (CIs) for meta-analysis, using R version 4.0.3 software. Included studies were appraised with the Risk of Bias Assessment tool for Non-Randomized Studies. Outcome ratios were combined with the Mantel–Haenszel method and the inverse variance-weighted method, appropriately.

Results
Data from 30 studies involving 2904 patients (adjuvant RT: n = 737; observation: n = 2167) were eventually included. Significant reduction of local recurrence rate was seen in the adjuvant RT cohort compare to that in the observation cohort (OR 0.50; 95% CI 0.36–0.68; p < 0.0001). Pooled HRs of PFS at 1-year, 3-year, 5-year, and > 5-year revealed that adjuvant RT was superior to observation. There was no significant difference in OS between the two cohorts during any period. Most toxicities were tolerable with grade 1 or 2. There was no documented grade 5 toxicity.

Conclusions
For AM patients who underwent GTR, evidence suggested that adjuvant RT could potentially decrease local recurrence and improve PFS better than observation.
ISSN
1748-717X
Language
English
URI
https://hdl.handle.net/10371/174318
DOI
doi.org/10.1186/s13014-021-01759-9
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College of Medicine/School of Medicine (의과대학/대학원)Neurosurgery (신경외과학전공)Journal Papers (저널논문_신경외과학전공)
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