Impact of Salvage Surgery and Reirradiation for Radiation Failed Recurrent Skull Base Meningiomas

Introduction and Objective: Long-term follow-up of meningiomas has demonstrated recurrence rates of up to 60% after 15 years. There is limited data available to guide the management of recurrent and previously radiated skull base meningiomas and challenges related to salvage surgery, reirradiation and lack of clear systemic therapy strategies remain. In this study, we analyzed data from our experience with recurrent and previously radiated meningiomas to assess the impact of salvage surgery and reirradiation on PFS.

Methods: A retrospective cohort study of 48 patients with recurrent and previously radiated meningiomas who were treated between 1995 and 2021 was conducted. Data were extracted from medical records and include clinical, radiologic, and pathologic reports. Patients were clustered according to WHO grades. We analyzed the complications related to reirradiation and salvage surgery and the impact of different treatment modalities on PFS using Cox proportional hazard ratios.

Results: Forty-eight patients (33 WHO grade 1; 11 WHO grade 2; and 4 WHO grade 3) were treated for 143 recurrences after their first radiation treatment. For WHO grade 1 meningiomas, STR was associated with increased risk of recurrence when compared with GTR (HR: 3.38; 95% CI, 1.268–9.036; p = 0.0189) with no change in tumor control rates associated with adjuvant re-RT (HR: 0.65, 95% CI: 0.28–1.479, p = 0.255). For WHO grade 2 meningiomas, GTR did not significantly confer improved tumor control relative to STR (HR: 2.378; 95% CI, 0.96–5.86; p = 0.055), but adjuvant re-RT after STR was associated with improved outcomes (HR: 0.316; 95% CI, 0.13–0.768; p = 0.029). For WHO grade 3 meningiomas, EOR did not correlate with outcomes, but reirradiation was associated with decreased odds of progression (HR: 0.276; 95% CI, 0.078–0.97; p = 0.028).

Conclusion: This study examined the impact of retreatment on PFS in a large cohort of recurrent meningiomas that had been previously radiated. At the time of recurrence WHO grade 1 meningiomas exhibited improved PFS with GTR, subtotally resected WHO grade 2 meningiomas appear to have improved PFS when reirradiated, and salvage radiation in WHO grade 3 meningiomas showed improved PFS.

Publication History

Article published online:
01 February 2023