P18.07.A CLINICAL OUTCOMES OF PATIENTS TREATED WITH FRACTIONATED PHOTON RADIOTHERAPY FOR INTERMEDIATE AND HIGH-RISK MENINGIOMAS AT THE CHRISTIE HOSPITAL
Abstract BACKGROUND Radiotherapy is often used as a postoperative treatment for WHO Grade 2 (G2) and Grade 3 (G3) meningioma. However, there is limited data on the long-term outcomes following radiotherapy for these patients. The present study aims to evaluate the outcomes of intermediate and high-r...
Saved in:
Published in | Neuro-oncology (Charlottesville, Va.) Vol. 25; no. Supplement_2; p. ii123 |
---|---|
Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
US
Oxford University Press
08.09.2023
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Abstract | Abstract
BACKGROUND
Radiotherapy is often used as a postoperative treatment for WHO Grade 2 (G2) and Grade 3 (G3) meningioma. However, there is limited data on the long-term outcomes following radiotherapy for these patients. The present study aims to evaluate the outcomes of intermediate and high-risk meningioma patients treated with radiotherapy.
MATERIAL AND METHODS
A retrospective analysis was conducted on all G2 and G3 meningioma patients treated at our centre with fractionated radiotherapy from 2012 to 2021. Clinical status at follow up was updated to 20 March 2023. Those who received stereotactic radiosurgery or were re-irradiated were excluded. Univariate Cox Regression modelling was conducted to assess association of progression, progression-free survival (PFS) and overall survival (OS) with clinical variables.
RESULTS
Forty-three patients were included in the analysis, 25 (58.2%) female. 39 patients had G2 and 4 G3 meningioma. Median age was 60 (range 11-80) years. Median follow-up was 72 months. At the time of radiotherapy, most (n= 34) had an ECOG performance status (PS) of 0-1. The dose fractionation was 50.4Gy (n=2), 54Gy (n=20) or 59.4Gy(n=1) in 1.8Gy fractions, or 60Gy(n=20) in 2Gy fractions. The PFS was 76.7% (95%CI:64.1,89.4) at 3 years and 64.3% (95%CI:49.8,78.9) at 5 years. OS was 79.1% (95% CI:66.9,91.2) at 3 years and 74.0% (95% CI:60.8,87.3) at 5 years. For the lower dose subgroup (50.4/54Gy), 3 and 5-year PFS rates were 86.4% (95% CI: 72.0,100) and 72.7% (95% CI:54.1,91.3), while 3 and 5-year OS rates were both 86.4% (95% CI:72.0,100). For the higher dose subgroup (59.4/60Gy), 3 and 5-year PFS rates were 66.7% (95% CI:46.5,86.8) and 55.0% (95% CI: 32.8,77.2), while 3 and 5 year OS were 71.4% (95% CI: 52.1,90.8) and 59.9% (95% CI: 38.1,81.8). All survival times were calculated from radiotherapy end date. Effect of dose (low vs high), age (either continuous or categorical as <60 vs ≥60), gender, WHO grade and PS were examined in univariate Cox regression for relationship to each of progression free status at last assessment, PFS and OS. No factor was statistically significant for progression free status or PFS. For OS, we found a significant association of worse OS with higher doses (59.4/60Gy), Hazard ratio (HR) 3.749 (95%CI: 1.18,11.9), p=0.025, and a borderline significance for age ≥60, HR 3.056 (95%CI:0.995,9.39), p=0.051. At the end of follow-up, 18 patients were alive without progression (16 G2, 2 G3), 8 were alive with progression (all G2), 10 had died with progression (9 G2, 1 G3) and 7 had died without progression (6 G2, 1 G3).
CONCLUSION
The worse OS in the higher dose group likely relates to clinical risk factors beyond WHO grade. There is a need for clinical trials to improve outcomes for intermediate and high risk meningioma. This may require better risk stratification by use of molecular markers, dose escalation or dose painting of high risk sub volumes and when possible targeted agents. |
---|---|
AbstractList | Abstract
BACKGROUND
Radiotherapy is often used as a postoperative treatment for WHO Grade 2 (G2) and Grade 3 (G3) meningioma. However, there is limited data on the long-term outcomes following radiotherapy for these patients. The present study aims to evaluate the outcomes of intermediate and high-risk meningioma patients treated with radiotherapy.
MATERIAL AND METHODS
A retrospective analysis was conducted on all G2 and G3 meningioma patients treated at our centre with fractionated radiotherapy from 2012 to 2021. Clinical status at follow up was updated to 20 March 2023. Those who received stereotactic radiosurgery or were re-irradiated were excluded. Univariate Cox Regression modelling was conducted to assess association of progression, progression-free survival (PFS) and overall survival (OS) with clinical variables.
RESULTS
Forty-three patients were included in the analysis, 25 (58.2%) female. 39 patients had G2 and 4 G3 meningioma. Median age was 60 (range 11-80) years. Median follow-up was 72 months. At the time of radiotherapy, most (n= 34) had an ECOG performance status (PS) of 0-1. The dose fractionation was 50.4Gy (n=2), 54Gy (n=20) or 59.4Gy(n=1) in 1.8Gy fractions, or 60Gy(n=20) in 2Gy fractions. The PFS was 76.7% (95%CI:64.1,89.4) at 3 years and 64.3% (95%CI:49.8,78.9) at 5 years. OS was 79.1% (95% CI:66.9,91.2) at 3 years and 74.0% (95% CI:60.8,87.3) at 5 years. For the lower dose subgroup (50.4/54Gy), 3 and 5-year PFS rates were 86.4% (95% CI: 72.0,100) and 72.7% (95% CI:54.1,91.3), while 3 and 5-year OS rates were both 86.4% (95% CI:72.0,100). For the higher dose subgroup (59.4/60Gy), 3 and 5-year PFS rates were 66.7% (95% CI:46.5,86.8) and 55.0% (95% CI: 32.8,77.2), while 3 and 5 year OS were 71.4% (95% CI: 52.1,90.8) and 59.9% (95% CI: 38.1,81.8). All survival times were calculated from radiotherapy end date. Effect of dose (low vs high), age (either continuous or categorical as <60 vs ≥60), gender, WHO grade and PS were examined in univariate Cox regression for relationship to each of progression free status at last assessment, PFS and OS. No factor was statistically significant for progression free status or PFS. For OS, we found a significant association of worse OS with higher doses (59.4/60Gy), Hazard ratio (HR) 3.749 (95%CI: 1.18,11.9), p=0.025, and a borderline significance for age ≥60, HR 3.056 (95%CI:0.995,9.39), p=0.051. At the end of follow-up, 18 patients were alive without progression (16 G2, 2 G3), 8 were alive with progression (all G2), 10 had died with progression (9 G2, 1 G3) and 7 had died without progression (6 G2, 1 G3).
CONCLUSION
The worse OS in the higher dose group likely relates to clinical risk factors beyond WHO grade. There is a need for clinical trials to improve outcomes for intermediate and high risk meningioma. This may require better risk stratification by use of molecular markers, dose escalation or dose painting of high risk sub volumes and when possible targeted agents. |
Author | Goyal, L Gaito, S Colaco, R Mcbain, C Whitfield, G France, A Pan, S |
Author_xml | – sequence: 1 givenname: L surname: Goyal fullname: Goyal, L – sequence: 2 givenname: S surname: Gaito fullname: Gaito, S – sequence: 3 givenname: A surname: France fullname: France, A – sequence: 4 givenname: R surname: Colaco fullname: Colaco, R – sequence: 5 givenname: C surname: Mcbain fullname: Mcbain, C – sequence: 6 givenname: S surname: Pan fullname: Pan, S – sequence: 7 givenname: G surname: Whitfield fullname: Whitfield, G |
BookMark | eNpVUdtKxDAQDaLg9Qd8mh_omss2TZ8kdLPb4G5T2oj4FLLdqCvaSquCf-LnWl0RfJphzmVmOMdov-3agNA5wROCU3bRhreubS7azm8ISyZTEu-hIxJTFsWC8_2fnkYiJskhOh6GR4wpiTk5Qp8lEROcTCRkS13oTC7BXNvMrFQNZg6ltFoVtgZbKWnVDG60zWFeycxqU_xMytxYU0AlZ9rYXFWyvIW5qUAXVlUrNdMjC2Qxg1wv8qjS9RWsVKGLhTYrWYO0MKogy0dk3AW5qUtt5fIUHdz5pyGc_dYTdD1XNsujpVl8nxk146M8WvuUi2nACU83VMRrJlJOGhGwaLDngnru0xCvqU-xSGOOGUv8hgc2slkINLATdLnzfXlbP4dNE9rX3j-5l3777PsP1_mt-4-02wd33707gqcinVI-OtCdQ9N3w9CHuz8xwe47HbdLx_2m48Z02BfBe3zZ |
ContentType | Journal Article |
Copyright | The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2023 |
Copyright_xml | – notice: The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2023 |
DBID | AAYXX CITATION 5PM |
DOI | 10.1093/neuonc/noad137.415 |
DatabaseName | CrossRef PubMed Central (Full Participant titles) |
DatabaseTitle | CrossRef |
DatabaseTitleList | CrossRef |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 1523-5866 |
EndPage | ii123 |
ExternalDocumentID | 10_1093_neuonc_noad137_415 |
GroupedDBID | --- .2P .I3 .XZ .ZR 0R~ 123 18M 2WC 36B 4.4 48X 53G 5VS 5WD 70D AABZA AACZT AAJKP AAMDB AAMVS AAOGV AAPNW AAPQZ AAPXW AARHZ AASNB AAUAY AAVAP AAYXX ABEUO ABIXL ABJNI ABKDP ABNHQ ABNKS ABPTD ABQLI ABQNK ABWST ABXVV ABZBJ ACGFO ACGFS ACUFI ACUTO ACYHN ADBBV ADEYI ADGZP ADHKW ADHZD ADIPN ADJQC ADOCK ADQBN ADRIX ADRTK ADVEK ADYVW ADZXQ AEGPL AEGXH AEJOX AEKSI AEMDU AENEX AENZO AEPUE AETBJ AEWNT AFFZL AFIYH AFOFC AFXAL AFXEN AGINJ AGKEF AGQXC AGSYK AGUTN AHXPO AIAGR AIJHB AJEEA AKWXX ALMA_UNASSIGNED_HOLDINGS ALUQC AOIJS APIBT APWMN ATGXG AXUDD BAWUL BAYMD BCRHZ BEYMZ BHONS BTRTY BVRKM C45 CDBKE CITATION CS3 CZ4 DAKXR DIK DILTD DU5 D~K E3Z EBS EE~ EMB EMOBN ENERS F5P F9B FECEO FLUFQ FOEOM FOTVD FQBLK GAUVT GJXCC GX1 H5~ HAR HW0 HYE HZ~ IOX J21 KOP KQ8 KSI KSN MHKGH N9A NGC NOMLY NOYVH O9- OAUYM OAWHX OCZFY ODMLO OJQWA OJZSN OK1 OPAEJ OVD OWPYF P2P P6G PAFKI PEELM Q1. Q5Y RD5 RHF ROX RPM RUSNO RW1 RXO SV3 TEORI TJX TR2 W8F WOQ X7H YAYTL YKOAZ YXANX ~91 5PM |
ID | FETCH-LOGICAL-c1376-ba9684e0769d285b38961c8e08c0a682a6a9e5b2a9089560337ad6e39d23ee2e3 |
IEDL.DBID | RPM |
ISSN | 1522-8517 |
IngestDate | Tue Sep 17 21:28:06 EDT 2024 Thu Sep 12 17:42:02 EDT 2024 |
IsPeerReviewed | true |
IsScholarly | true |
Issue | Supplement_2 |
Language | English |
License | This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) |
LinkModel | DirectLink |
MergedId | FETCHMERGED-LOGICAL-c1376-ba9684e0769d285b38961c8e08c0a682a6a9e5b2a9089560337ad6e39d23ee2e3 |
ParticipantIDs | pubmedcentral_primary_oai_pubmedcentral_nih_gov_10489426 crossref_primary_10_1093_neuonc_noad137_415 |
PublicationCentury | 2000 |
PublicationDate | 2023-09-08 20230908 |
PublicationDateYYYYMMDD | 2023-09-08 |
PublicationDate_xml | – month: 09 year: 2023 text: 2023-09-08 day: 08 |
PublicationDecade | 2020 |
PublicationPlace | US |
PublicationPlace_xml | – name: US |
PublicationTitle | Neuro-oncology (Charlottesville, Va.) |
PublicationYear | 2023 |
Publisher | Oxford University Press |
Publisher_xml | – name: Oxford University Press |
SSID | ssj0021561 |
Score | 2.435815 |
Snippet | Abstract
BACKGROUND
Radiotherapy is often used as a postoperative treatment for WHO Grade 2 (G2) and Grade 3 (G3) meningioma. However, there is limited data on... |
SourceID | pubmedcentral crossref |
SourceType | Open Access Repository Aggregation Database |
StartPage | ii123 |
SubjectTerms | POSTER PRESENTATIONS |
Title | P18.07.A CLINICAL OUTCOMES OF PATIENTS TREATED WITH FRACTIONATED PHOTON RADIOTHERAPY FOR INTERMEDIATE AND HIGH-RISK MENINGIOMAS AT THE CHRISTIE HOSPITAL |
URI | https://pubmed.ncbi.nlm.nih.gov/PMC10489426 |
Volume | 25 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1Lb5wwELaSHKpeqrRp1fQRzSG3iGUXgzFHi7DBSXgIvGp6QmC8aqSGjaLkv_TndnhV2WuPYI_AzIiZTzPzDSHnng44wuTW0o02lkvN1gqMxksMjblhtFl6fYNzkrJ4417feXcHhM29MEPRvm7uF93vh0V3_2uorXx80PZcJ2bnSYgQggfoWuxDcogWOmP0CWYhIhlZUhFm9ZPnp1YZhO52Z152nba7Xd2uqL9w-2G4r9zRflnkKz-zPibvpgARxPgi78mB6T6QN8mUAj8hf_IV74lABYS3Mu3ZDCDbqDBLohKyNeRCyShVJagiEvhXgh9SxbAuxmKR4U4eZypLoRCXMlNxVIj8JyAWhIEdt6d7xF0g0kuI5VVsFbK8gSRKZXols0SUIBSgFIQxruCzIM7KXCpx-5Fs1pEKY2sar2BpPDyzmjpg3DVLnwWtw70GQxe20twsuV7WjDs1qwPjNU7dpwYxMKLUr1tmKO6mxjiGfiJH3a4znwm4JuC6Na1Pgy0CtqZpPd9pETuymm2p3p6Si_krV48ji0Y1Zr9pNeqkmnRSoU5OCd9TxD-Rngp7fwUtZKDEni3iy_-LfiVv-1HyQ_0Y_0aOnp9ezHcMOJ6bMwy15c3ZYGV_Aetszss |
link.rule.ids | 230,315,730,783,787,888,27938,27939,53808,53810 |
linkProvider | National Library of Medicine |
linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3LbpwwFLXSVGq76Ttq-vSiu4rHYDBmiQgT0wwPgUdJVwgbjxq1YaJqZtMv6ef28qoy3bVLsA2Gg_A9usfnIvTRUwEDmtwaSiptuERvjEArOITQmGlKpO31G5zTjPK1-_nKuzpCdN4LM4j2lbw2u-83Znf9ddBW3t4oa9aJWUUaAYVgASwt1j10Hy5ps5mlT0QLOMnokwpEq689P22WAfJudXq_7ZTVbZt2QXzT7cvh3lmQDoWRd1aa5RN0Oc9xFJh8M_c7aaqff9k3_vtDPEWPp-ATh2P7M3Sku-foQTql11-gX8WC9SajIY5WSdY7JeB8LaI8jSucL3ERiiTORIVFGYfwx8OXieB4WY5ClOFMwXORZ7gMz5Jc8LgMiy8YeCYenHd7K0nohcPsDPPknBtlUl3gNM6S7DzJ07DCocAwCkccWuBemOdVkYhw9RKtl7GIuDGVbjAUvFZqyCagzNW2T4PWYZ6EsIguFNM2U3ZDmdPQJtCedJo-7QhBFyF-01JNoDfR2tHkBB13206_QtjVAVOtbn0SbIAMStl6vtMCL6UN3RC1OUWfZvzq29Ghox4z66Qe0a4ntGtA-xSxA4j_DOlttg9bALjBbnsG6vX_D_2AHnKRrmrA7uINetSXrB90auwtOt792Ot3ENjs5PvhK_4Nu1zv_w |
linkToPdf | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3LbpwwFLXaVIq66btK0pcX3VXADAZjlhYDgSY8BIyaqgsExqhRG2aUzmz6Jf3cXvOoMl1mCbbF4yDuPbrH5yL00RYuA5rcaqIRUrOI7DRXCjiE1JhJSpqFrTY4xwkN19bnK_tqUlX-mmSVvWiu9f7njd5ffx-0ldsbYcw6MSOLPaAQzIXQYmzbzniIHtnKpmpm6hPZAl4yeqUC2VL956cNM0DgjV7uN70w-k3dLomjW6ol7p2gdCiOvBNtgqfo23yfo8jkh77fNbr4_Z-F4_0e5Bl6MiWhmI9znqMHsn-BjuOpzP4S_cmWTJmNcuxdRolyTMDpuvTS2C9wGuCMl5GflAUuc5_Dnw9_icoQB_koSBnOZGFapgnO-SpKy9DPefYVA9_EgwOvspSEWZgnKxxG56GWR8UFjv0kSs6jNOYF5iWGVdgLYQSuhcO0yKKSX75C68AvvVCbWjhoAl4t1ZrapcySC4e6rcnsBtIjuhRMLphY1JSZNa1daTdmrcqPkHwR4tQtlQRmEylNSV6jo37TyxOELeky0crWIW4HpLBpWtsxW-CntKYdEd0p-jRjWG1Hp45qrLCTakS8mhCvAPFTxA5g_rdE2W0fjgB4g-32DNbZ_Zd-QMfZKqgAuos36LHqXD_I1dhbdLS73ct3kN_smvfDh_wXjanydg |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=P18.07.A+CLINICAL+OUTCOMES+OF+PATIENTS+TREATED+WITH+FRACTIONATED+PHOTON+RADIOTHERAPY+FOR+INTERMEDIATE+AND+HIGH-RISK+MENINGIOMAS+AT+THE+CHRISTIE+HOSPITAL&rft.jtitle=Neuro-oncology+%28Charlottesville%2C+Va.%29&rft.au=Goyal%2C+L&rft.au=Gaito%2C+S&rft.au=France%2C+A&rft.au=Colaco%2C+R&rft.date=2023-09-08&rft.issn=1522-8517&rft.eissn=1523-5866&rft.volume=25&rft.issue=Supplement_2&rft.spage=ii123&rft.epage=ii123&rft_id=info:doi/10.1093%2Fneuonc%2Fnoad137.415&rft.externalDBID=n%2Fa&rft.externalDocID=10_1093_neuonc_noad137_415 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1522-8517&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1522-8517&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1522-8517&client=summon |