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Journal of Neurosurgical Sciences 2021 Nov 11

DOI: 10.23736/S0390-5616.21.05522-3

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Adjuvant radiotherapy in grossly total resected grade II atypical meningiomas. A protective effect on recurrence? A systematic review and meta-analysis

Matteo ZOLI 1, 2, Giuseppe M. DELLA PEPA 3 , Alessandro CARRETTA 2, Daniele BONGETTA 4, Teresa SOMMA 5, Cesare ZOIA 6, Giovanni RAFFA 7

1 Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; 2 Department of Bio-Medical and Neuro-Motor Sciences (DIBINEM), University of Bologna, Bologna, Italy; 3 Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome, Rome, Italy; 4 Neurosurgery Unit, Fatebenefratelli e Oftalmico Hospital, Milan, Italy; 5 Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy; 6 Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; 7 Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy


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INTRODUCTION: Management of grade II Atypical Meningiomas (AM) remains controversial. Conflicting evidences exist on the possible protective effect of adjuvant radiotherapy (ART) on recurrence in grossly resected AMs. The aim of this meta-analysis is to evaluate the role of ART in grossly resected (Simpson grades 1-3) AMs on the recurrence and survival.
EVIDENCE ACQUISITION: Data were retrieved from comparative studies of AMs undergone surgical resection alone vs. surgery+ART. Only grossly total resected AMs (Simpson grade 1,2,3) were included. The individual and pooled odds ratio (OR) for the crude recurrence, progression free survival (PFS) at 1, 3 and 5-years, as well as for the overall survival (OS) at 5-years were calculated by using the Mantel-Haenszel model in surgery alone vs. surgery+ART.
EVIDENCE SYNTHESIS: 11 studies were considered eligible. 8 were included for the outcome “crude recurrence”; 6 for PFS at 1-3 years, 7 for PFS at 5-years; 6 for the OS at 5-years. Results suggest that surgery+ART might have a protective role on recurrence in gross-totally resected AMs (OR:1.66). Specifically, surgery+ART slightly improved PFS at 1-year (OR:0.92) and more consistently at 3- and 5-years (OR:0.31 and 0.35 respectively) hence favoring a combined approach.
CONCLUSIONS: Current literature on the impact of ART after gross total resection of AM are still heterogeneous and not systematically reported. The present meta-analysis suggests a possible protective role of postoperative RT against long-term recurrence as compared to surgical resection alone.


KEY WORDS: Atypical meningioma; Adjuvant radiotherapy; Radiotherapy; Simpson grade; Grade II meningioma

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