TY - JOUR
T1 - Analysis of recurrence probability following radiotherapy in patients with CNS WHO grade 2 meningioma using integrated molecular-morphologic classification
AU - Deng, Maximilian Y
AU - Hinz, Felix
AU - Maas, Sybren L N
AU - Anil, Günes
AU - Sievers, Philipp
AU - Conde-Lopez, Cristina
AU - Lischalk, Jonathan
AU - Rauh, Sophie
AU - Eichkorn, Tanja
AU - Regnery, Sebastian
AU - Bauer, Lukas
AU - Held, Thomas
AU - Meixner, Eva
AU - Lang, Kristin
AU - Hörner-Rieber, Juliane
AU - Herfarth, Klaus
AU - Jones, David
AU - Pfister, Stefan M
AU - Jungk, Christine
AU - Unterberg, Andreas
AU - Wick, Wolfgang
AU - von Deimling, Andreas
AU - Debus, Jürgen
AU - Sahm, Felix
AU - König, Laila
N1 - Funding Information:
M.D. is supported by the Medical Faculty of Heidelberg. This study was supported by Supported by the Else Kröner Fresenius Foundation (EKFS, Grant No: 2015_A_60 and 2017_EKES.24), the German Cancer Aid (Grant No. 70112956).
Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - BACKGROUND: The current World Health Organization (WHO) classification of brain tumors distinguishes 3 malignancy grades in meningiomas, with increasing risk of recurrence from CNS WHO grades 1 to 3. Radiotherapy is recommended by current EANO guidelines for patients not safely amenable to surgery or after incomplete resection in higher grades. Despite adequately predicting recurrence probability for the majority of CNS WHO grade 2 meningioma patients, a considerable subset of patients demonstrates an unexpectedly early tumor recurrence following radiotherapy.METHODS:A retrospective cohort of 44 patients with CNS WHO grade 2 meningiomas were stratified into 3 risk groups (low, intermediate, and high) using an integrated morphological, CNV- and methylation family-based classification. Local progression-free survival (lPFS) following radiotherapy (RT) was analyzed and total dose of radiation was correlated with survival outcome. Radiotherapy treatment plans were correlated with follow-up images to characterize the pattern of relapse. Treatment toxicities were further assessed.RESULTS: Risk stratification of CNS WHO grade 2 meningioma into integrated risk groups demonstrated a significant difference in 3-year lPFS following radiotherapy between the molecular low- and high-risk groups. Recurrence pattern analysis revealed that 87.5 % of initial relapses occurred within the RT planning target volume or resection cavity.CONCLUSIONS: Integrated risk scoring can identify CNS WHO grade 2 meningioma patients at risk or relapse and dissemination following radiotherapy. Therapeutic management of CNS WHO grade 2 meningiomas and future clinical trials should be adjusted according to the molecular risk-groups, and not rely on conventional CNS WHO grading alone.
AB - BACKGROUND: The current World Health Organization (WHO) classification of brain tumors distinguishes 3 malignancy grades in meningiomas, with increasing risk of recurrence from CNS WHO grades 1 to 3. Radiotherapy is recommended by current EANO guidelines for patients not safely amenable to surgery or after incomplete resection in higher grades. Despite adequately predicting recurrence probability for the majority of CNS WHO grade 2 meningioma patients, a considerable subset of patients demonstrates an unexpectedly early tumor recurrence following radiotherapy.METHODS:A retrospective cohort of 44 patients with CNS WHO grade 2 meningiomas were stratified into 3 risk groups (low, intermediate, and high) using an integrated morphological, CNV- and methylation family-based classification. Local progression-free survival (lPFS) following radiotherapy (RT) was analyzed and total dose of radiation was correlated with survival outcome. Radiotherapy treatment plans were correlated with follow-up images to characterize the pattern of relapse. Treatment toxicities were further assessed.RESULTS: Risk stratification of CNS WHO grade 2 meningioma into integrated risk groups demonstrated a significant difference in 3-year lPFS following radiotherapy between the molecular low- and high-risk groups. Recurrence pattern analysis revealed that 87.5 % of initial relapses occurred within the RT planning target volume or resection cavity.CONCLUSIONS: Integrated risk scoring can identify CNS WHO grade 2 meningioma patients at risk or relapse and dissemination following radiotherapy. Therapeutic management of CNS WHO grade 2 meningiomas and future clinical trials should be adjusted according to the molecular risk-groups, and not rely on conventional CNS WHO grading alone.
UR - http://www.scopus.com/inward/record.url?scp=85162969792&partnerID=8YFLogxK
U2 - 10.1093/noajnl/vdad059
DO - 10.1093/noajnl/vdad059
M3 - Article
C2 - 37293256
SN - 2632-2498
VL - 5
JO - Neuro-Oncology Advances
JF - Neuro-Oncology Advances
IS - 1
M1 - vdad059
ER -