Low-risk meningioma: Initial outcomes from NRG Oncology/RTOG 0539

Author:

Rogers C Leland1ORCID,Pugh Stephanie L2,Vogelbaum Michael A3,Perry Arie4,Ashby Lynn S5,Modi Jignesh M6,Alleman Anthony M7,Barani Igor J8,Braunstein Steve9,Bovi Joseph A10,de Groot John F11,Whitton Anthony C12,Lindhorst Scott M13,Deb Nimisha14,Shrieve Dennis C15,Shu Hui-Kuo16,Bloom Beatrice17,Machtay Mitchell18,Mishra Mark V19,Robinson Clifford G20,Won Minhee2,Mehta Minesh P21

Affiliation:

1. GammaWest Cancer Services , Salt Lake City, Utah , USA

2. NRG Oncology Statistics and Data Management Center , Philadelphia, Pennsylvania , USA

3. Moffitt Cancer Center, Neuosurgery , Tampa, Florida , USA

4. University of California, San Francisco, Neuropathology , San Francisco, California , USA

5. Barrow Neurological Institute , Neurology, Phoenix, Arizona , USA

6. MidState Medical Center, Radiology , Meriden, Connecticut , USA

7. University of Oklahoma, Radiology , Oklahoma City, Oklahoma , USA

8. Barrow Neurological Institute, Radiation Oncology , Phoenix, Arizona , USA

9. University of California, San Francisco, Radiation Oncology , San Francisco, California , USA

10. Medical College of Wisconsin, Radiation Oncology , Milwaukee, Wisconsin , USA

11. University of California, San Francisco, Neuro Oncology , San Francisco, California , USA

12. Juravinski Cancer Centre, Radiation Oncology , Hamilton, Ontario , Canada

13. Medical University of South Carolina, Neuro Oncology , Charleston, South Carolina , USA

14. St. Luke’s Hospital-Anderson Campus Cancer Center , Easton, Pennsylvania , USA

15. Huntsman Cancer Institute, Radiation Oncology, University of Utah , Salt Lake City, Utah , USA

16. Winship Cancer Institute at Emory University, Radiation Oncology , Atlanta, Georgia , USA

17. Northwell Health, Radiation Oncology , New Hyde Park, New York , USA

18. Penn State Cancer Institute, Radiation Oncology , Hershey, Pennsylvania , USA

19. University of Maryland, Radiation Oncology, Baltimore , Baltimore, Maryland , USA

20. Washington University, Radiation Oncology , St. Louis, St. Louis, Missouri , USA

21. Miami Cancer Institute, Baptist Health South Florida , Miami, Florida , USA

Abstract

Abstract Background Three- and five-year progression-free survival (PFS) for low-risk meningioma managed with surgery and observation reportedly exceeds 90%. Herewith we summarize outcomes for low-risk meningioma patients enrolled on NRG/RTOG 0539. Methods This phase II trial allocated patients to one of three groups per World Health Organization grade, recurrence status, and resection extent. Low-risk patients had either gross total (GTR) or subtotal resection (STR) for a newly diagnosed grade 1 meningioma and were observed after surgery. The primary endpoint was 3-year PFS. Adverse events (AEs) were scored using Common Terminology Criteria for Adverse Events (CTCAE) version 3. Results Among 60 evaluable patients, the median follow-up was 9.1 years. The 3-, 5-, and 10-year rates were 91.4% (95% CI, 84.2 to 98.6), 89.4% (95% CI, 81.3 to 97.5), 85.0% (95% CI, 75.3 to 94.7) for PFS and 98.3% (95% CI, 94.9 to 100), 98.3%, (95% CI, 94.9 to 100), 93.8% (95% CI, 87.0 to 100) for overall survival (OS), respectively. With centrally confirmed GTR, 3/5/10y PFS and OS rates were 94.3/94.3/87.6% and 97.1/97.1/90.4%. With STR, 3/5/10y PFS rates were 83.1/72.7/72.7% and 10y OS 100%. Five patients reported one grade 3, four grade 2, and five grade 1 AEs. There were no grade 4 or 5 AEs. Conclusions These results prospectively validate high PFS and OS for low-risk meningioma managed surgically but raise questions regarding optimal management following STR, a subcohort that could potentially benefit from adjuvant therapy.

Funder

National Cancer Institute

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Neurology (clinical),Oncology

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