Trends for survival and functional recovery in radiation-induced meningiomas
Leon Schmidt (Mainz), Santhosh G. Thavarajasingam (Mainz), Elena Schmidt (Mainz), Florian Ringel (Mainz), Darius Kalasauskas (Mainz)
Meningiomas are the most common intracranial neoplasms, accounting for 37.6% of intracranial malignancies. Rarely, tumorigenesis might be induced by radiotherapy, which is often used in the setting of pediatric central nervous system (CNS) malignancies. Although radiation-induced meningiomas are a known complication of CNS radiotherapy, there is a paucity of information to guide treatment decisions. This study aimed to determine the clinical characteristics of radiation-induced meningiomas, recurrence and postoperative functional status.
A single-center retrospective study including patients undergoing resection of intracranial meningiomas between 2007 and 2018 was performed. Patients with intracranial radiation exposure were identified using hospital records and compared with non-radiation induced cases. We performed 1:3 propensity score matching between patients being exposed to radiotherapy and non-exposed patients using WHO grade, Simpson class and age. Comparison between the groups was performed using Mann-Whitney, Chi-Squared test and Cox regression analysis.
During this period 841 meningioma patients with sufficient medical records were identified. Radiation-induced meningiomas were present in 33 cases. Propensity score matching with 99 unexposed cases resulted in homogeneous, comparable groups with respect to the variables used. Mean age at diagnosis was 25.8±12.6 years, mean CCI was 1.4±1.5. WHO grade 1 tumors were present in 63.63%, grade 2 in 33.3% and grade 3 in 3.03% of cases. Simpson class 1 resection was achieved in 42.42%, 2 in 18.93%, 3 in 17.42% and 4 in 21.21%. There was better recovery of functional status at 6 months and at last follow-up (mean KPS -1.59 vs -2.24 p<0.001; 2.98 vs -2.58 p<0.001) but the clinical relevance is questionable. Median 5-year progression free survival was significantly lower in radiation exposed cases (43.5 vs 62.1% p=0.035). In multivariate Cox regression analysis, radiation exposure (HR 2.58 95%CI 1.29-5 p=0.008) and WHO grade (2.04 95%CI 1.09-3.8 p=0.025) were the only significant risk factors for recurrence.
In our age, Simpson- and CNS WHO-grade matched cohort, radiation-induced meningiomas exhibited a shorter progression-free survival compared to naïve tumors, independent of known predictors. This suggests unknown differences in pathogenesis requiring further scrutiny.
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