J Neurol Surg B Skull Base 2020; 81(S 01): S1-S272
DOI: 10.1055/s-0040-1702393
Oral Presentations
Georg Thieme Verlag KG Stuttgart · New York

Brachytherapy with Surgical Resection as Salvage Treatment for Recurrent High-Grade Meningiomas: A Matched Cohort Study

Michael A. Mooney
1   Barrow Neurological Institute, Phoenix, Arizona, United States
,
Wenya L. Bi
2   Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Jonathan Cantalino
2   Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Kyle Wu
2   Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Thomas Harris
2   Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Lucas Possatti
2   Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Parikshit Juvekar
2   Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Liangge Hsu
2   Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Ian F. Dunn
2   Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Ossama Al-Mefty
2   Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Phillip M. Devlin
2   Brigham and Women's Hospital, Boston, Massachusetts, United States
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Publikationsdatum:
05. Februar 2020 (online)

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    Background: Outcomes of recurrent high-grade meningiomas are poor with high rates of re-recurrence, increased risk of subsequent intervention, and increased disease-related mortality.

    Objective: The aim of this study is to evaluate brachytherapy after surgical resection as a salvage treatment strategy in patients with recurrent high-grade meningioma who exhausted prior external beam treatment options.

    Methods: Single-center retrospective review of our institutional experience of brachytherapy implantation from 2012 to 2018. The primary outcome of the study was progression-free survival (PFS). Secondary outcomes included overall survival (OS) and complications. A matched cohort of patients not treated with brachytherapy over the same time period was evaluated as a control group. All patients had received prior radiation treatment and underwent planned gross total resection (GTR) surgery.

    Results: A total of 27 cases were evaluated. Compared with prior treatment, brachytherapy implantation demonstrated a statistically significant improvement in tumor control [HR 0.316, 0.101–0.991, p = 0.034]. PFS-6 and PFS-12 were 92.3 and 84.6%, respectively. Compared with the matched control cohort, brachytherapy treatment demonstrated improved PFS [HR 0.310 (0.103–0.933, p = 0.030]. Overall survival was not statistically significantly different between groups [HR 0.381 (0.073–1.982, p = 0.227]. Overall postoperative complications were comparable between groups, although there was a higher incidence of radiation necrosis in the brachytherapy cohort.

    Conclusion: Brachytherapy with planned GTR improved PFS in recurrent high-grade meningioma patients who exhausted prior external beam radiation treatment options. Future improvement of brachytherapy dose delivery methods and techniques may continue to prolong control rates and improve outcomes for this challenging group of patients.


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    Die Autoren geben an, dass kein Interessenkonflikt besteht.