To analyze the impact of adjuvant radiotherapy on progression-free survival (PFS) and cause-specific survival (CSS) in patients with WHO grade II meningiomas, focusing on the extent of resection and proliferative index.
Approach:
Study Design: Retrospective analysis of 318 patients with WHO grade II meningiomas treated from 1990 to 2023, assessing survival outcomes using Kaplan–Meier curves and Cox proportional hazards models.
Patient Groups: Patients were categorized based on the extent of resection (gross total vs. subtotal) and Ki-67 index (<10% vs. ≥10%).
Statistical Analysis: Competing risk models were used to estimate cause-specific hazard functions.
Key Findings:
Adjuvant radiotherapy was associated with significantly reduced PFS after both GTR and STR (p<0.0001).
CSS was also less following radiotherapy after GTR (p=0.0237).
Stereotactic fractionated conformal radiotherapy and radiosurgery were independent predictors of recurrence and death.
In the GTR group, radiation was associated with worse survival outcomes compared to surgery alone.
Interpretation:
Adjuvant radiotherapy is significantly associated with decreased PFS and CSS, highlighting the need for personalized approaches and further prospective studies.
Limitations:
The study is retrospective and may be subject to biases inherent in such designs.
Long-term follow-up data may not incorporate recent advances in molecular biology and genetics.
Conclusion:
These findings contradict some current treatment paradigms and highlight the need for further research.
