Top Line: Does dose-escalation improve outcomes for grade 2 and 3 meningioma?
The Study: There’s growing evidence that dose escalation may improve local control for higher grade meningioma. This single institution study took a look back at outcomes for 118 patients with WHO grade 2 (94.1%) or grade 3 meningioma treated with adjuvant (66.9%) or salvage RT (33.1%). Most (81.4%) had gross disease at the time of radiation. Between 2000 and 2021, their practice changed from using standard doses for all patients to using dose-escalated boost for gross residual disease. For the study, a total dose <66 Gy was categorized as standard dose (54.2%) and 66 Gy or higher was considered escalated dose (45.8%). In the latter group, 90% received 70 Gy in 35 fractions using a SIB technique where the larger PTV received 63-64 Gy in 35 fractions. Despite there being a higher proportion of patients with gross disease and grade 3 disease, PFS was significantly higher in the dose-escalated cohort (64.6% v 40.8% at 5 years). This was driven by a significant reduction in local failure with dose-escalation (31.8% v 53.9% at 5 years). Importantly, there was no difference in the rate of radiation necrosis with dose-escalation (3.7% v 7.8%).
TBL: In this single-institution cohort, a dose of 66 Gy or higher for WHO grade 2 or 3 meningioma was associated with a lower rate of local failure and better progression free survival. | Zeng, Int J Radiat Oncol Biol Phys 2023
The Study: There’s growing evidence that dose escalation may improve local control for higher grade meningioma. This single institution study took a look back at outcomes for 118 patients with WHO grade 2 (94.1%) or grade 3 meningioma treated with adjuvant (66.9%) or salvage RT (33.1%). Most (81.4%) had gross disease at the time of radiation. Between 2000 and 2021, their practice changed from using standard doses for all patients to using dose-escalated boost for gross residual disease. For the study, a total dose <66 Gy was categorized as standard dose (54.2%) and 66 Gy or higher was considered escalated dose (45.8%). In the latter group, 90% received 70 Gy in 35 fractions using a SIB technique where the larger PTV received 63-64 Gy in 35 fractions. Despite there being a higher proportion of patients with gross disease and grade 3 disease, PFS was significantly higher in the dose-escalated cohort (64.6% v 40.8% at 5 years). This was driven by a significant reduction in local failure with dose-escalation (31.8% v 53.9% at 5 years). Importantly, there was no difference in the rate of radiation necrosis with dose-escalation (3.7% v 7.8%).
TBL: In this single-institution cohort, a dose of 66 Gy or higher for WHO grade 2 or 3 meningioma was associated with a lower rate of local failure and better progression free survival. | Zeng, Int J Radiat Oncol Biol Phys 2023