Clinical Scorecard: The Role of Adjuvant Radiotherapy in Managing WHO Grade II Meningiomas: An Ongoing Debate

At a Glance

Key Highlights

• Adjuvant radiotherapy associated with reduced PFS and CSS.
• Significant findings for both gross total resection (GTR) and subtotal resection (STR) groups.
• Stereotactic fractionated conformal radiotherapy and radiosurgery are independent predictors of recurrence and death.
• In GTR group, radiation correlated with worse survival outcomes compared to surgery alone.
• Need for personalized approaches and further prospective studies highlighted.

Guideline-Based Recommendations

Diagnosis

• Histological diagnosis of WHO grade II meningioma based on updated classification criteria.

Management

• Maximal surgical resection is the cornerstone of therapy.
• Consideration of adjuvant radiotherapy after STR.

Monitoring & Follow-up

• Postoperative MRI typically performed within 48 hours, followed by imaging at 3, 6, and 12 months, then annually.

Risks

• Increased hazards of recurrence and mortality associated with adjuvant radiotherapy.

Patient & Prescribing Data

318 patients with WHO grade II meningiomas treated from 1990 to 2023.

104 patients received adjuvant radiation therapy.

Clinical Best Practices

• Evaluate the extent of resection and Ki-67 index when considering adjuvant radiotherapy.
• Utilize competing risk models for assessing survival outcomes.

Related Resources & Content

• European Association of Neuro−Oncology (EANO) Guidelines
• National Comprehensive Cancer Network (NCCN) Guidelines